Effect of Specimen Extraction Site on Postoperative Incisional Hernia after Minimally Invasive Right Colectomy

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Incisional hernia (IH) is a common complication following colorectal surgery.
• Minimally invasive techniques still necessitate specimen extraction sites, contributing to IH risk.
• Understanding extraction site impact is crucial for preventing postoperative IH.

Purpose of the Study:

• To evaluate the effect of specimen extraction site on IH rates after minimally invasive right-sided colectomy.
• To compare IH incidence between midline and Pfannenstiel extraction sites.
• To identify risk factors associated with IH development post-colectomy.

Main Methods:

• Retrospective multi-institutional cohort study (2012-2020).
• Included adults undergoing minimally invasive right colectomy with postoperative imaging.
• Primary exposure: midline vs. Pfannenstiel specimen extraction; Main outcome: IH development at ≥1 year postoperatively.

Main Results:

• Midline extraction (57%) was associated with a significantly higher IH rate (25%) compared to Pfannenstiel extraction (0%).
• Midline extraction patients were older and had more prior abdominal surgeries.
• Midline extraction (OR 24.6) and extracorporeal anastomosis (OR 25.8) were independently associated with IH development.

Conclusions:

• Pfannenstiel specimen extraction is linked to a lower risk of incisional hernia development.
• Surgical site selection for specimen extraction can influence postoperative IH rates.
• Choosing Pfannenstiel extraction may be a strategy to mitigate IH risk in right-sided colectomies.