High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection

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.

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.

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.

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.