Natsume Soichiro, Yamaguchi Tatsuro, Nakano Daisuke, Takao Misato, Kato Hiroki, Ise Ichiro, Nakamori Sakiko, Dejima Akira, Kawai Kazushige
Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):298-304. doi: 10.23922/jarc.2024-019. eCollection 2024.
The present study examined the incidence of incisional hernia by comparing patients from whom a specimen was extracted either through a Pfannenstiel incision (PI) with an intracorporeal anastomosis or via a midline incision (MI) with an extracorporeal anastomosis.
The records of 370 consecutive patients who underwent a laparoscopic or robotically-assisted colectomy were retrospectively analyzed. Regardless of the clinical symptoms, incisional hernia was objectively diagnosed based on abdominal computed tomography findings. The surgical outcomes and incisional hernia incidence were retrospectively compared between the groups. Propensity score matching (PSM) was used to balance background differences between the groups.
Eighty-seven and 283 patients were in the PI group and MI group, respectively. After PSM, 71 patients were selected from each group. The median observation time was 572 and 1110 days in the PI and MI group, respectively. The PI group had no incidence of incisional hernia whereas the MI group had a 14% incidence, demonstrating that the former had significantly fewer incisional hernias (p=0.0014). The median interval from surgery to incisional hernia development was 295 days. The PI with an intracorporeal anastomosis was not associated with an increased complication rate.
The PI was preferable for intraoperative specimen extraction owing to the low, associated incidence of incisional hernia.
本研究通过比较经Pfannenstiel切口（PI）行体内吻合术取出标本的患者和经中线切口（MI）行体外吻合术取出标本的患者，来研究切口疝的发生率。
回顾性分析370例连续接受腹腔镜或机器人辅助结肠切除术患者的病历。无论临床症状如何，根据腹部计算机断层扫描结果客观诊断切口疝。回顾性比较两组患者的手术结果和切口疝发生率。采用倾向评分匹配（PSM）来平衡两组之间的背景差异。
PI组和MI组分别有87例和283例患者。PSM后，每组各选择71例患者。PI组和MI组的中位观察时间分别为572天和1110天。PI组无切口疝发生，而MI组的发生率为14%，表明前者的切口疝明显较少（p=0.0014）。从手术到切口疝发生的中位间隔时间为295天。采用体内吻合术的PI与并发症发生率增加无关。
由于切口疝的发生率较低，PI在术中取出标本方面更具优势。
