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DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
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Significance of Specimen Extraction Site in Minimizing Hernia Risk After Distal Pancreatectomy.
Pranay S Ajay1, Hardik U Shah2, Sameer Sandhu2
1Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Annals of Surgical Oncology
|August 27, 2024
Summary
Minimally invasive distal pancreatectomy with upper midline specimen extraction significantly increases incisional hernia risk. Pfannenstiel incisions are recommended for specimen extraction in robotic or laparoscopic distal pancreatectomy to reduce incisional hernia incidence.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Abdominal Surgery
Background:
- Incisional hernia (IH) causes significant patient morbidity and healthcare costs.
- Determining IH incidence after distal pancreatectomy (DP) is crucial for patient outcomes.
- Stratifying IH by specimen extraction site can identify risk factors.
Purpose of the Study:
- To determine the incidence of incisional hernia (IH) in patients undergoing distal pancreatectomy (DP).
- To compare IH rates based on specimen extraction sites: upper midline (UM) versus Pfannenstiel.
- To identify optimal surgical approaches for minimizing IH after DP.
Main Methods:
- Retrospective review of imaging for DP patients (2016-2021).
- Radiologists assessed fascial defects on postoperative imaging, blinded to surgical approach.
- Specimen extraction sites were categorized as UM or Pfannenstiel.
Main Results:
- Of 219 patients, 60% underwent minimally invasive surgery (MIS).
- MIS with UM incisions had a 17.8 times higher odds of IH compared to Pfannenstiel incisions (p=0.01).
- Overall IH odds increased by 4% per month of follow-up (OR 1.04, p<0.001).
Conclusions:
- Pfannenstiel incisions are associated with lower incisional hernia rates.
- Recommend Pfannenstiel incision for specimen extraction in laparoscopic or robotic DP when feasible.
- This approach may reduce patient morbidity and healthcare burden.
