From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari).
Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Farzaneh, Carmichael).
J Am Coll Surg. 2024 Aug 1;239(2):107-112. doi: 10.1097/XCS.0000000000001060. Epub 2024 Jul 17.
Incisional hernia (IH) is a known complication after colorectal surgery. Despite advances in minimally invasive surgery, colorectal surgery still requires extraction sites for specimen retrieval, increasing the likelihood of postoperative IH development. The objective of this study is to determine the effect of specimen extraction site on the rate of IH after minimally invasive right-sided colectomy for patients with available imaging.
This is a retrospective multi-institutional cohort study at 2 large academic medical centers in the US. Adults who underwent right-sided minimally invasive colectomy from 2012 to 2020 with abdominal imaging available at least 1 year postoperatively were included in the analysis. The primary exposure was specimen extraction via a midline specimen extraction vs Pfannenstiel specimen extraction. The main outcome was the development of IH at least 1 year postoperatively as visualized on a CT scan.
Of the 341 patients sampled, 194 (57%) had midline specimen extraction and 147 (43%) had a Pfannenstiel specimen extraction. Midline extraction patients were older (66 ± 15 vs 58 ± 16; p < 0.001) and had a higher rate of previous abdominal operation (99, 51% vs 55, 37%, p = 0.01). The rate of IH was higher in midline extraction at 25% (48) compared with Pfannenstiel extraction (0, 0%; p < 0.001). The average length of stay was higher in the midline extraction group at 5.1 ± 2.5 compared with 3.4 ± 3.1 days in the Pfannenstiel extraction group (p < 0.001). Midline extraction was associated with IH development (odds ratio 24.6; 95% CI 1.89 to 319.44; p = 0.004). Extracorporeal anastomosis was associated with a higher IH rate (odds ratio 25.8; 95% CI 2.10 to 325.71; p = 0.002).
Patients who undergo Pfannenstiel specimen extraction have a lower risk of IH development compared with those who undergo midline specimen extraction.
切口疝（IH）是结直肠手术后的已知并发症。尽管微创手术取得了进展，但结直肠手术仍需要提取标本的部位，增加了术后 IH 发展的可能性。本研究旨在确定微创右半结肠切除术后标本提取部位对可获得影像学检查的患者 IH 发生率的影响。
这是美国 2 家大型学术医疗中心的回顾性多机构队列研究。分析纳入了 2012 年至 2020 年期间接受微创右半结肠切除术且术后至少 1 年有腹部影像学检查的成人。主要暴露为通过中线标本提取与 Pfannenstiel 标本提取。主要结局为至少在术后 1 年通过 CT 扫描观察到 IH 的发展。
在抽样的 341 例患者中，194 例（57%）行中线标本提取，147 例（43%）行 Pfannenstiel 标本提取。中线提取组患者年龄更大（66±15 岁比 58±16 岁；p<0.001），且既往腹部手术史比例更高（99，51%比 55，37%；p=0.01）。中线提取组 IH 发生率较高，为 25%（48 例），而 Pfannenstiel 提取组为 0（0%）（p<0.001）。中线提取组的平均住院时间为 5.1±2.5 天，而 Pfannenstiel 提取组为 3.4±3.1 天（p<0.001）。中线提取与 IH 发展相关（比值比 24.6；95%置信区间 1.89 至 319.44；p=0.004）。体外吻合与 IH 发生率较高相关（比值比 25.8；95%置信区间 2.10 至 325.71；p=0.002）。
与行中线标本提取的患者相比，行 Pfannenstiel 标本提取的患者 IH 发展风险较低。
