Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Ann Surg Oncol. 2024 Dec;31(13):8688-8698. doi: 10.1245/s10434-024-16096-w. Epub 2024 Aug 27.
Incisional hernia (IH) results in significant morbidity to patients and financial burden to healthcare systems. We aimed to determine the incidence of IH in distal pancreatectomy (DP) patients, stratified by specimen extraction sites.
Imaging in DP patients in our institution from 2016 to 2021 were reviewed by radiologists blinded to the operative approach. Specimen extraction sites were stratified as upper midline/umbilical (UM) versus Pfannenstiel. IH was defined as fascial defect on postoperative imaging. Patients without preoperative and postoperative imaging were excluded.
Of the 219 patients who met our selection criteria, the median age was 64 years, 54% were female, and 64% were White. The majority were minimally invasive (MIS) procedures (n = 131, 60%), of which 52% (n = 64) had a UM incision for specimen extraction, including 45 hand-assist and 19 purely laparoscopic procedures. MIS with Pfannenstiel incisions for specimen extraction was 48% (n = 58), including 44 robotic and 14 purely laparoscopic procedures. Mean follow-up time was 16.3 months (standard deviation [SD] 20.8). Follow-up for MIS procedures with UM incisions was 16.6 months (SD 21.8) versus 15.5 months (SD 18.6) in the Pfannenstiel group (p = 0.30). MIS procedures with UM incisions for specimen extraction had a 17.8 times increase in odds of developing an IH compared with MIS procedures with Pfannenstiel extraction sites (p = 0.01). The overall odds of developing an IH increased by 4% for every month of follow-up (odds ratio 1.04; p < 0.001).
A Pfannenstiel incision should be performed for specimen extraction in cases with purely laparoscopic or robotic distal pancreatectomy, when feasible.
切口疝（IH）会给患者带来显著的发病率和医疗系统的经济负担。我们旨在确定在我院接受胰体尾切除术（DP）的患者中，按标本取出部位分层的 IH 发生率。
由对手术方法不知情的放射科医生对我院 2016 年至 2021 年 DP 患者的影像进行了回顾性分析。标本取出部位分为中上腹部/脐部（UM）与经耻骨联合上缘切口。术后影像学上出现筋膜缺损则定义为 IH。排除了无术前和术后影像学的患者。
在符合我们选择标准的 219 名患者中，中位年龄为 64 岁，54%为女性，64%为白人。大多数为微创（MIS）手术（n=131，60%），其中 52%（n=64）采用 UM 切口取出标本，包括 45 例手辅助和 19 例纯腹腔镜手术。采用 Pfannenstiel 切口取出标本的 MIS 手术占 48%（n=58），包括 44 例机器人手术和 14 例纯腹腔镜手术。平均随访时间为 16.3 个月（标准差 [SD] 20.8）。UM 切口 MIS 手术的随访时间为 16.6 个月（SD 21.8），而 Pfannenstiel 组为 15.5 个月（SD 18.6）（p=0.30）。对于 UM 切口取出标本的 MIS 手术，发生 IH 的几率是 Pfannenstiel 组的 17.8 倍（p=0.01）。每增加一个月的随访，发生 IH 的几率增加 4%（优势比 1.04；p<0.001）。
当可行时，应在完全腹腔镜或机器人胰体尾切除术时，经 Pfannenstiel 切口取出标本。
