Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
Centre for Colon and Rectal Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Ann Surg. 2018 Jul;268(1):41-47. doi: 10.1097/SLA.0000000000002615.
To compare the incidence of incisional hernia (IH) between midline and transverse specimen extraction site in patients undergoing laparoscopic colectomy.
Midline specimen extraction incision is most commonly used in laparoscopic colectomy, but has high IH risk. IH may be lower for transverse incision.
A single-center superiority trial was conducted. Eligible patients undergoing laparoscopic colectomy were randomly assigned to midline or transverse specimen extraction. Primary outcome was IH incidence at 1 year. Power calculation required 76 patients per group to detect a reduction in IH from 20% to 5%. Secondary outcomes included perioperative outcomes, pain scores, health-related quality of life (SF-36), and cosmesis (Body Image Questionnaire).
A total of 165 patients were randomly assigned to transverse (n = 79) or midline (n = 86) specimen extraction site, of which 141 completed 1-year follow-up (68 transverse, 73 midline). Patient, tumor, surgical data, and perioperative morbidity were similar. Pain scores were similar on each postoperative day. On intention-to-treat analysis, there was no difference in the incidence of IH at 1 year (transverse 2% vs midline 8%, P = 0.065) or after mean 30.3 month (standard deviation 9.4) follow-up (6% vs 14%, P = 0.121). On per-protocol analysis there were more IH after midline incision with longer follow-up (15% vs 2%, P = 0.013). On intention-to-treat analysis, SF-36 domains body pain and social functioning were improved after transverse incision. Cosmesis was higher after midline incision on per-protocol analysis, but without affecting body image.
Per-protocol analysis of this trial demonstrates that a transverse specimen extraction site has a lower incidence of IH compared to midline with longer follow-up but has worse cosmesis.
比较腹腔镜结直肠切除术中经中线和横向标本提取部位切口疝（IH）的发生率。
腹腔镜结直肠切除术中最常使用中线标本提取切口，但 IH 风险较高。横向切口可能较低。
进行了一项单中心优势试验。符合条件的接受腹腔镜结直肠切除术的患者被随机分配到中线或横向标本提取组。主要结局是 1 年时 IH 的发生率。需要每组 76 例患者才能检测到 IH 从 20%降至 5%。次要结局包括围手术期结局、疼痛评分、健康相关生活质量（SF-36）和美容（身体形象问卷）。
共有 165 例患者被随机分配至横向（n=79）或中线（n=86）标本提取部位，其中 141 例完成了 1 年随访（横向 68 例，中线 73 例）。患者、肿瘤、手术数据和围手术期发病率相似。术后每天的疼痛评分相似。意向治疗分析中，1 年时 IH 的发生率无差异（横向 2%与中线 8%，P=0.065）或平均 30.3 个月（标准差 9.4）随访后（6%与 14%，P=0.121）。在方案分析中，随着随访时间的延长，中线切口 IH 更多（15%比 2%，P=0.013）。意向治疗分析中，横向切口后 SF-36 身体疼痛和社会功能域得到改善。方案分析中，中线切口的美容效果更高，但不影响身体形象。
本试验的方案分析表明，与中线相比，较长时间的随访后，横向标本提取部位 IH 的发生率较低，但美容效果较差。
