Division of Colon and Rectal Surgery, University of Illinois at Chicago College of Medicine, 840 S. Wood St., Suite 518(E) CSB, Chicago, IL 60612, USA.
Surg Endosc. 2011 Apr;25(4):1031-6. doi: 10.1007/s00464-010-1309-2. Epub 2010 Aug 25.
Minimally invasive surgery is associated with smaller surgical incisions than those of traditional midline laparotomy. However, most colorectal resections and all hand-assisted procedures require an incision either for specimen retrieval or insertion of the hand-assist device. The ideal site of this incision has not been evaluated with respect to the incidence of incisional hernia. This study compares the rates of incisional hernia associated with a standard midline laparotomy, a midline incision of reduced length, and a Pfannenstiel incision.
From March 2004 to July 2007, 512 consecutive patients were identified from a prospectively maintained database according to predefined inclusion and exclusion criteria. Patients were divided into three groups depending on the type of incision (open, midline, and Pfannenstiel). Demographic variables, rate of incisional hernia, and risk factors for hernia were compared among the groups.
There were 142, 231, and 139 patients in the open, midline, and Pfannenstiel groups, respectively. All three groups were comparable with respect to age, gender, steroid use, diabetes, number of patients with malignancy, and duration of follow-up. The Pfannenstiel group had a higher mean BMI (p = 0.015) and the open group had a higher rate of wound infection (28.2%) compared to the other groups. Incidence of incisional hernia was similar for the open and midline groups (19.7 and 16%, p = 0.36). At a mean follow-up of 17.5 months, not a single patient with a Pfannenstiel incision developed an incisional hernia (p < 0.001). BMI (p = 0.019), follow-up (p < 0.001), and Pfannenstiel incision (p < 0.001) were found to be predictors (protectors) of incisional hernia on multivariate analysis.
A Pfannenstiel incision is associated with the lowest rate of incisional hernia and should be the incision of choice for hand assistance and specimen extraction in minimally invasive colorectal resections wherever applicable.
微创手术的切口比传统中线剖腹术的切口小。然而，大多数结直肠切除术和所有手助手术都需要一个切口来取出标本或插入手助装置。对于切口疝的发病率，尚未对该切口的理想部位进行评估。本研究比较了标准中线剖腹术、缩短的中线切口和 Pfannenstiel 切口与切口疝相关的发生率。
根据预先确定的纳入和排除标准，从 2004 年 3 月至 2007 年 7 月，从一个前瞻性维护的数据库中确定了 512 名连续患者。根据切口类型（开放式、中线式和 Pfannenstiel 式）将患者分为三组。比较了三组之间的人口统计学变量、切口疝发生率和疝的危险因素。
开放式、中线式和 Pfannenstiel 式组分别有 142、231 和 139 例患者。三组之间的年龄、性别、类固醇使用、糖尿病、恶性肿瘤患者数量和随访时间均无差异。Pfannenstiel 组的平均 BMI 较高（p = 0.015），而开放式组的伤口感染率较高（28.2%）。与其他两组相比。开放式和中线式组的切口疝发生率相似（19.7%和 16%，p = 0.36）。在平均 17.5 个月的随访中，没有一个 Pfannenstiel 切口的患者发生切口疝（p < 0.001）。BMI（p = 0.019）、随访（p < 0.001）和 Pfannenstiel 切口（p < 0.001）在多变量分析中被发现是切口疝的预测因素（保护因素）。
Pfannenstiel 切口与最低的切口疝发生率相关，在微创结直肠切除术中，只要适用，应作为手助和标本取出的切口选择。
