Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline?

BACKGROUND

Laparoscopic colorectal procedures require specimen extraction. It is unclear whether extraction site affects the incidence of incisional hernia (IH).

METHODS

Patients undergoing laparoscopic colectomy over a 6-year period were identified. Outcomes were compared between patients to evaluate the incidence of hernia.

RESULTS

Among 480 laparoscopic colorectal procedures, extraction sites were midline (n = 305), muscle splitting (n = 128), Pfannenstiel (n = 26), and ostomy (n = 21). Average follow-up was 3.5 years. Age, gender, diagnosis, extraction incision length, and hospital stay were similar. The mean body mass index for all patients was 28 kg/m(2) and for those with IHs was 31 kg/m(2) (P = .008). The overall IH rate was 7%. Midline IHs accounted for 84% of all hernias, occurring in 8.9% of midline extractions (P < .05 vs nonmidline extractions). Hernia rates for muscle-splitting, Pfannenstiel, and ostomy site extractions were 2.3%, 3.8%, and 4.8%, respectively.

CONCLUSIONS

Although midline hernia rates were lower than traditionally reported with open surgery, midline extraction sites have a higher chance of IH than nonmidline sites.