Incisional Hernia After Midline Versus Transverse Specimen Extraction Incision: A Randomized Trial in Patients...

Area of Science:

• Gastrointestinal Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Midline incisions are common for specimen extraction in laparoscopic colectomy but are associated with a high risk of incisional hernia (IH).
• Transverse incisions are an alternative that may potentially lower the incidence of IH.

Purpose of the Study:

• To compare the incidence of incisional hernia (IH) between midline and transverse specimen extraction sites in patients undergoing laparoscopic colectomy.
• To evaluate secondary outcomes including perioperative parameters, pain, quality of life, and cosmesis.

Main Methods:

• A single-center, randomized superiority trial involving patients undergoing laparoscopic colectomy.
• Patients were randomly assigned to either a midline or transverse specimen extraction site.
• Primary outcome was IH incidence at 1 year, with secondary outcomes assessed using validated questionnaires.

Main Results:

• No significant difference in IH incidence was observed between transverse and midline sites on intention-to-treat analysis at 1 year (2% vs. 8%) or longer follow-up (6% vs. 14%).
• Per-protocol analysis revealed a significantly lower IH incidence for transverse sites (2%) compared to midline (15%) with longer follow-up (P=0.013).
• Quality of life scores related to body pain and social functioning improved with transverse incisions, while midline incisions showed better cosmesis without impacting body image.

Conclusions:

• Per-protocol analysis suggests transverse specimen extraction sites may lead to a lower incidence of incisional hernias compared to midline sites, especially with extended follow-up.
• Midline incisions may offer superior cosmetic results, though this does not significantly affect body image.
• The choice of incision site involves balancing the risk of incisional hernia with cosmetic considerations.