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Laparoscopic or Robotically Assisted Colectomy with a Pfannenstiel Incision Reduces the Incisional Hernia Incidence
Soichiro Natsume1, Tatsuro Yamaguchi1, Daisuke Nakano1
1Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
The PI was preferable for intraoperative specimen extraction owing to the low, associated incidence of incisional hernia.
Insights
The Pfannenstiel incision (PI) for specimen extraction significantly reduces incisional hernia rates compared to the midline incision (MI). This study found no incisional hernias in the PI group, making it preferable for safer surgical outcomes.
Area of Science:
- Surgical oncology
- Abdominal surgery
- Hernia research
Background:
- Incisional hernias are a common complication following abdominal surgery.
- The method of specimen extraction can influence hernia development.
- Pfannenstiel incision (PI) and midline incision (MI) are common surgical approaches.
Purpose of the Study:
- To compare the incidence of incisional hernias between patients undergoing specimen extraction via PI with intracorporeal anastomosis versus MI with extracorporeal anastomosis.
- To evaluate surgical outcomes associated with each incision type.
Main Methods:
- Retrospective analysis of 370 patients undergoing colectomy (laparoscopic or robotically-assisted).
- Objective diagnosis of incisional hernia using abdominal computed tomography.
- Propensity score matching (PSM) to control for confounding variables.
Main Results:
- After PSM, 71 patients were in each group (PI vs. MI).
- The PI group showed zero incidence of incisional hernias, while the MI group had a 14% incidence (p=0.0014).
- The PI approach was not associated with increased complication rates.
Conclusions:
- Pfannenstiel incision (PI) is associated with a significantly lower incidence of incisional hernias.
- PI is a preferable method for intraoperative specimen extraction due to reduced hernia risk.
- This finding supports PI for improving patient outcomes after colectomy.
