Background: The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after laparoscopic colectomy. Methods: Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009 were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups. Results: Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4 years, p = 0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0 months. The overall incidence of incisional hernia was 21% (21/99), being 29 % (20/68) after midline incision compared with 14 % (1/7) after transverse and 0 % (0/24) after Pfannenstiel incisions (p = 0.002). Of patients with incisional hernia, 47 % (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic score (14.4 vs 17.7, p = 0.02) compared with those without, but there was no difference in body image score. There were no differences in body image or cosmesis between the three incisions. Conclusions: There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction
展开▼
机译：背景：尽管使用腹腔镜进行结肠切除，但切口疝的发生率并未降低。这项研究的目的是评估用于标本提取的切口对腹腔镜结肠切除术后切口疝发生率的影响。方法：从手术室数据库中识别出2003年至2009年在一家大学三级护理中心接受无气孔腹腔镜结肠切除术的患者。通过电话与患者联系以进行参与，并在标本提取部位对切开疝进行了体格检查+超声检查，并完成了身体图像调查表。标本提取切口分为中线组，横向组和Pfannenstiel组。结果：在总共251例患者中，有99例同意参加（68条中线，7例横向，24例泛尼斯蒂尔），而73例患者拒绝同意，而79例患者无法联系。拒绝同意的患者年龄较大（69.8 vs 62.4岁，p = 0.001），但在性别，恶性疾病，术后并发症和拔牙部位方面与参与者相似。平均随访时间为37.0个月。切口疝的总发生率为21％（21/99），中线切口后为29％（20/68），而横向切口后为14％（1/7），普芬尼切尔切口后为0％（0/24）（p = 0.002）。在切口疝患者中，有症状的占47％（10/21）。与无切口疝的患者相比，切开疝的患者的美容评分较低（14.4比17.7，p = 0.02），但身体图像评分无差异。三个切口之间的身体形象或美容效果没有差异。结论：腹腔镜结肠切除术中线标本提取后有症状性切口疝的发生率很高，这对美容效果产生了负面影响。使用横向或潘氏切口进行标本提取可能会降低疝气的风险
展开▼
