Lawrence Lee, MD, Salman Al-Sabah, MD, Pepa Kaneva, MSc, Sender Liberman, MD, Patrick Charlebois, MD, Barry Stein, MD, Gerald Fried, MD, Liane Feldman, MD. McGill University
INTRODUCTION: Despite the use of smaller incisions in laparoscopic colon resection compared to open surgery, incisional hernia (IH) remains a source of considerable morbidity. A midline specimen extraction site may increase the risk of hernia. This study compares the incidence of incisional hernia after midline or transverse specimen extraction site in laparoscopic colon resection.
METHODS: Laparoscopic colon resections performed at a single university center prior to 2010 were retrospectively reviewed. Cases involving a Pfannenstiel incision, stoma creation or reversal, or a hand-assist port were excluded from analysis. Incisional hernias were identified from review of clinic notes and postoperative imaging. Patients were classified according to the specimen extraction site. Patient and operative characteristics, as well as postoperative complications, were compared using chi-squared and Student’s t-test. Logistic regression was performed to identify risk factors associated with diagnosis of incisional hernia. Data are expressed as mean or proportion.
RESULTS: 155 patients were included (134 midline, 21 transverse). The two groups were comparable in terms of age, gender, diabetes, malignancy, and length of follow-up (11.4 months). BMI was higher in the transverse group (29 vs. 26 kg/m2, p=0.04). Surgical site infections occurred in 13% (18/134) in the midline group versus 19% (4/21) in the transverse group (p=0.49). Overall, 10% (15/155) of patients were diagnosed with an IH. 10% (13/134) of patients in the midline group developed an IH compared to 5% (1/21) in the transverse group (p=0.41). Patients with IH (IH+) had a higher BMI (30 vs. 26 kg/m2, p=0.03) and had more wound infections (40 vs. 11%, p=0.003) compared to those without (IH-). There were no differences in age, gender, or diabetes. Follow-up was significantly longer in IH+ patients compared to the IH- (22.6 vs. 10.3 months, p=0.005). Logistic regression identified higher BMI, longer follow-up and surgical site infections as significant predictors of incisional hernia; extraction site was not significant.
CONCLUSIONS: After laparoscopic colon resection, surgical site infection and body habitus may be more important risk factors than extraction site for the development of an incisional hernia.
Program Number: S073