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Guo J, Yang D, Zhang B, Xu X, Yang Z, Zhao Y, Zheng Z, Meng X, Zhang T. The safety of Pfannenstiel incision for specimen extraction in laparoscopic colorectal surgery for colorectal cancer: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2024; 19:1-10. [PMID: 38974765 PMCID: PMC11223536 DOI: 10.5114/wiitm.2023.134194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction The Pfannenstiel incision is often used in gynecological Cesarean section; however, there is limited research on the use of the Pfannenstiel incision for specimen extraction in laparoscopic surgery for the treatment of colorectal cancer. Aim To evaluate the safety of using the Pfannenstiel incision for specimen extraction in laparoscopic surgery for colorectal cancer patients. Material and methods PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP and WanFangData were searched for studies published up to March 10, 2023; a random-effects model (RCT) and a fixed-effect model were used to evaluate the safety. Operative time, length of extraction skin incision, overall complications, superficial wound infection, organ/space surgical site infection and incisional hernia were evaluated. Results A total of 5 studies were included in this research. There were no significant advantages in operation time, length of the incision, overall complications, superficial wound infection and organ/space surgical site in the Pfannenstiel group compared to the no Pfannenstiel group. However, the Pfannenstiel incision has a tendency to increase the length of the incision (SMD = 0.05; 95% CI = -0.22 to 0.33; p = 0.71) and the results of the remaining five (operative time,overall complications,incisional hernia, incisional infection and organ/space surgical site infection) are slightly skewed toward the Pfannenstiel incision. It is worth mentioning that incisional hernia (IH) may have an advantage in the Pfannenstiel group compared to the no Pfannenstiel group. Four studies were not at clear risk of bias and two studies were at risk of bias. Conclusions Our study concludes that the Pfannenstiel incision has a good safety record and it is a good option for extracting specimens during laparoscopic surgery for colon cancer. The Pfannenstiel incision used for laparoscopic surgical specimen extraction has a significantly lower incidence of incisional hernia over no Pfannenstiel.
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Affiliation(s)
- Jingjing Guo
- Liaoning University of Traditional Chinese Medicine, China
| | - Dong Yang
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Bao Zhang
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Xing Xu
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Zhuo Yang
- Department of Gynecology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Yan Zhao
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Zhichao Zheng
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Xiangyu Meng
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
| | - Tao Zhang
- Department of Gastric Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital and Institute), Shenyang, Liaoning, China
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Zhang M, Liu Z, Sun P, Hu X, Zhou H, Jiang Z, Tang J, Liu Q, Wang X. Preliminary surgical outcomes of laparoscopic right hemicolectomy with transrectal specimen extraction: a propensity score matching study of 120 cases (with video). Gastroenterol Rep (Oxf) 2023; 11:goad036. [PMID: 37398927 PMCID: PMC10313420 DOI: 10.1093/gastro/goad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/01/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background Compared with conventional laparoscopic surgery, natural orifice specimen extraction surgery (NOSES) has many advantages. Laparoscopic right colectomy with transvaginal specimen extraction has been reported, but the safety and feasibility of transrectal specimen extraction in male patients with ascending colon cancer remain to be verified. This study aimed to preliminarily evaluate the feasibility and safety of laparoscopic right hemicolectomy with transrectal specimen extraction. Methods The study was conducted at a single tertiary medical center in China. A total of 494 consecutive patients who underwent laparoscopic right colectomy between September 2018 and September 2020 were included. Transrectal specimen extraction was performed in 40 male patients (the NOSES group). Patients in the NOSES group were matched to the conventional laparoscopic group using propensity score matching at a 1:2 ratio. Short-term and long-term outcomes between the two groups were compared and evaluated. Results Forty patients in the NOSES group and 80 patients in the conventional laparoscopic group were matched for analysis. Baseline characteristics were balanced after propensity matching. The operative features, including operating time, intraoperative bleeding, and the number of harvested lymph nodes, were statistically comparable in both groups. In terms of post-operative recovery, patients in the NOSES group showed preferable outcomes, as evidenced by less post-operative pain and faster return to flatus, defecation, and discharge. The post-operative complications rate, according to the Clavien-Dindo classification system, was similar in both groups. No differences in overall survival or disease-free survival were observed between the two groups. Conclusions Laparoscopic right colectomy with transrectal specimen extraction is oncologically safe. Compared with conventional laparoscopic right colectomy, it can reduce post-operative pain, accelerate post-operative recovery, shorten the hospital stay, and achieve better cosmetic effect.
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Affiliation(s)
| | | | - Peng Sun
- Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, P. R. China
| | - Xiyue Hu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Xishan Wang
- Corresponding author. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No. 17 Panjiayuannanli Road, Chaoyang District, Beijing 100021, China. Tel: +86-10-87787110;
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Lee S, Han SW, Lee MR, Kim CY, Ha GW. The effect on incisional hernia of absorbable barbed suture for midline fascial closure in minimally invasive surgery for colorectal and gastric cancers: study protocol for a randomized controlled trial. Trials 2023; 24:311. [PMID: 37149610 PMCID: PMC10164296 DOI: 10.1186/s13063-023-07324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Incisional hernia following abdominal surgery is a frequent complication of midline laparotomy. This complication is strongly associated with the technique and material used for suture. While a monofilament absorbable suture is recommended to prevent incisional hernia, it can lead to suture loosening or surgical-knot breakage. Although barbed sutures can be an alternative suture material in abdominal fascial closure, evidence for its safety and effectiveness is lacking. Therefore, we designed a prospective randomized trial to evaluate the safety and efficacy of absorbable barbed sutures for midline fascia closure in minimally invasive surgery for colorectal and gastric cancers in comparison with conventional absorbable monofilament sutures. METHODS A total of 312 patients who underwent minimally invasive surgery for colorectal and gastric cancers will be randomly allocated to either the absorbable barbed or monofilament suture group for abdominal fascia closure in a 1:1 ratio. The primary outcome is incisional hernia rate within 3 years after surgery, as verified by physical examination and computed tomography. Postoperative complications, including surgical site infection, postoperative pain, and quality of life, will be compared between two groups as secondary outcomes. The investigator will examine the patients until discharge and at 6, 12, 18, 24, and 36 months postoperatively. DISCUSSION This is the first randomized controlled trial to compare absorbable barbed sutures with monofilament sutures for midline fascia closure in minimally invasive surgery. If absorbable barbed sutures demonstrate superior results to those of monofilament sutures, this type of suture material may be recommended as an alternative option for abdominal fascia closure. TRIAL REGISTRATION KCT0007069. Registered on January 30, 2023.
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Affiliation(s)
- Sejin Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Se Wung Han
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chan-Young Kim
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
- Department of Surgery, Jeonbuk National University Hospital, 20 Geonji-Ro, Deokjin-Gu, Jeonju, 54907, Republic of Korea.
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Bhattacharya P, Hussain MI, Zaman S, Mohamedahmed AY, Faiz N, Mashar R, Sarma DR, Peravali R. Comparison of Midline and Off-midline specimen extraction following laparoscopic left-sided colorectal resections: A systematic review and meta-analysis. J Minim Access Surg 2023; 19:183-192. [PMID: 37056082 PMCID: PMC10246630 DOI: 10.4103/jmas.jmas_309_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
Aims This study aims to evaluate comparative outcomes following midline versus off-midline specimen extractions following laparoscopic left-sided colorectal resections. Methods A systematic search of electronic information sources was conducted. Studies comparing 'midline' versus 'off midline' specimen extraction following laparoscopic left-sided colorectal resections performed for malignancies were included. The rate of incisional hernia formation, surgical site infection (SSI), total operative time and blood loss, anastomotic leak (AL) and length of hospital stay (LOS) was the evaluated outcome parameters. Results Five comparative observational studies reporting a total of 1187 patients comparing midline (n = 701) and off-midline (n = 486) approaches for specimen extraction were identified. Specimen extraction performed through an off-midline incision was not associated with a significantly reduced rate of SSI (odds ratio [OR]: 0.71; P = 0.68), the occurrence of AL (OR: 0.76; P = 0.66) and future development of incisional hernias (OR: 0.65; P = 0.64) compared to the conventional midline approach. No statistically significant difference was observed in total operative time (mean difference [MD]: 0.13; P = 0.99), intraoperative blood loss (MD: 2.31; P = 0.91) and LOS (MD: 0.78; P = 0.18) between the two groups. Conclusions Off-midline specimen extraction following minimally invasive left-sided colorectal cancer surgery is associated with similar rates of SSI and incisional hernia formation compared to the vertical midline incision. Furthermore, there were no statistically significant differences observed between the two groups for evaluated outcomes such as total operative time, intra-operative blood loss, AL rate and LOS. As such, we did not find any advantage of one approach over the other. Future high-quality well-designed trials are required to make robust conclusions.
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Affiliation(s)
- Pratik Bhattacharya
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | | | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Ali Yasen Mohamedahmed
- Department of Colorectal Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - Nameer Faiz
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Ruchir Mashar
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Diwakar Ryali Sarma
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
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Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial. Trials 2023; 24:152. [PMID: 36855158 PMCID: PMC9976431 DOI: 10.1186/s13063-023-07162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Minimally invasive surgery has become popular as a surgical approach for colorectal cancer because it has fewer complications related to the abdominal incision and perioperative complications. However, the incidence of incisional hernias in laparoscopic surgery has been reported to be similar to that in open surgery. We developed a new method, the non-muscle-cutting periumbilical transverse incision, for a small incision in laparoscopic colon cancer surgery. This study aims to evaluate the effectiveness of the non-muscle-cutting periumbilical transverse incision in comparison with the midline incision in reducing the incidence of an incisional hernia in patients undergoing laparoscopic colon cancer surgery. METHODS This is an open-label, multi-centre, parallel, superiority, and randomised trial. Altogether, 174 patients will be allocated in a 1:1 ratio to either the midline incision or the non-muscle-cutting periumbilical transverse incision group, after stratifying by the location of the tumour (right- or left-sided). The primary outcome of this study is the incidence of incisional hernias (both symptomatic and radiologic hernias) at 12 months after surgery. The secondary outcomes include operative outcomes, 30-day postoperative complications, pathological results, and patient-reported outcomes (short form-12 health survey questionnaire and body image questionnaire). Both primary (intention-to-treat) and secondary (as-treated principles) analyses will be performed for all outcomes. The statistical significance level was set at p < 0.05 (two-sided testing). DISCUSSION This trial may show that the non-muscle-cutting periumbilical transverse incision will reduce the incidence of incisional hernias compared to the midline incision. TRIAL REGISTRATION Clinical Research Information Service (CRiS) of Republic of Korea, KCT0006082 . Registered on April 12, 2021.
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Paruch JL. Extraction Site in Minimally Invasive Colorectal Surgery. Clin Colon Rectal Surg 2023; 36:47-51. [PMID: 36643827 PMCID: PMC9839428 DOI: 10.1055/s-0042-1758352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The widespread adoption of minimally invasive colorectal surgery has led to improved patient recovery and outcomes. Specimen extraction sites remain a major source of pain and potential postoperative morbidity. Careful selection of the extraction site incision may allow surgeons to decrease postoperative pain, infectious complications, or rates of hernia formation. Options include midline, paramedian, transverse, Pfannenstiel, and natural orifice sites. Patient, disease, and surgeon-related factors should all be considered when choosing a site. This article will review different options for specimen extraction sites.
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Affiliation(s)
- Jennifer L Paruch
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
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Kim CH, Lee J, Lee SY, Heo SH, Jeong YY, Kim HR. Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery. World J Surg 2022; 46:916-924. [PMID: 35076822 DOI: 10.1007/s00268-021-06319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although off-midline incisions (unilateral low transverse or Pfannenstiel incision) have been reported to have a lower incidence of incisional hernia (IH) than periumbilical vertical incision for the purpose of specimen extraction, it is most commonly used in laparoscopic colon cancer surgery because off-midline incisions are associated with the limitation of colon exteriorization. This study aims to investigate the risk of IH after laparoscopic colectomy and compare midline vertical incision versus transverse incision focusing on the incidence of IH. METHODS Patients who underwent elective laparoscopic colectomy due to colon malignancy from June 2015 to May 2017 were included. All patients had either vertical (n = 429) or muscle splitting periumbilical transverse incisions (n = 125). RESULTS Median duration of the follow-up period was 23.6 months, during which IHs occurred in 12.1% patients. The incidence of hernia was significantly lower in the transverse group (3 vs. 64, 2.4% vs. 14.9%, p < 0.001). On multivariate analysis, BMI ≥ 23 [odds ratio (OR) 2.282, 95% confidence interval (CI) 1.245-4.182, p = 0.008], postoperative surgical site infection (OR 3.780, 95% CI 1.969-7.254, p < 0.001) and vertical incision (OR 7.113, 95% CI 2.173-23.287, p < 0.001) were independently related with increased incidence of IH. CONCLUSIONS A muscle splitting periumbilical transverse incision could significantly reduce the rate of IH in minimally invasive colon cancer surgery.
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Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea.
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Ruiz-Tovar J, Boermeester MA, Bordeianou L, Chang GJ, Gorgun E, Justinger C, Lawson EH, Leaper DJ, Mahmoud NN, Mantyh C, McGee MF, Nfonsam V, Rubio-Perez I, Wick EC, Hedrick TL. Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery. J Am Coll Surg 2022; 234:1-11. [PMID: 35213454 PMCID: PMC8719508 DOI: 10.1097/xcs.0000000000000022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies have focused on the development and evaluation of care bundles to reduce the risk of surgical site infection (SSI) throughout the perioperative period. A focused examination of the technical/surgical aspects of SSI reduction during CRS has not been conducted. This study aimed to develop an expert consensus on intraoperative technical/surgical aspects of SSI prevention by the surgical team during colorectal surgery (CRS). STUDY DESIGN In a modified Delphi process, a panel of 15 colorectal surgeons developed a consensus on intraoperative technical/surgical aspects of SSI prevention undertaken by surgical personnel during CRS using information from a targeted literature review and expert opinion. Consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement. RESULTS In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements. The consensus panel supported the use of wound protectors/retractors, sterile incision closure tray, preclosure glove change, and antimicrobial sutures in reducing SSI along with wound irrigation with aqueous iodine and closed-incision negative pressure wound therapy in high-risk, contaminated wounds. CONCLUSIONS Using a modified Delphi method, consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking. This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS.
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Affiliation(s)
- Jaime Ruiz-Tovar
- From the Department of Surgery, Universidad Rey Juan Carlos, Madrid, Spain (Ruiz-Tovar)
| | - Marja A Boermeester
- the Department of Surgery, Free University Hospital, Amsterdam, The Netherlands (Boermeester)
| | - Liliana Bordeianou
- the Department of Surgery, Massachusetts General Hospital, Boston, MA (Bordeianou)
| | - George J Chang
- the Department of Colon and Rectal Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX (Chang)
| | - Emre Gorgun
- the Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH (Gorgun)
| | - Christoph Justinger
- the Department of General and Visceral Surgery, Klinikum Karlsruhe, Karlsruhe, Germany and Albert-Ludwigs-University Freiburg, Freiburg, Germany (Justinger)
| | - Elise H Lawson
- the Division of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, WI (Lawson)
| | - David J Leaper
- Emeritus Professor of Surgery, University of Newcastle, Newcastle upon Tyne, UK (Leaper)
| | - Najjia N Mahmoud
- the Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA (Mahmoud)
| | - Christopher Mantyh
- the Department of Surgery, Duke University Medical Center, Durham, NC (Mantyh)
| | - Michael F McGee
- the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (McGee)
| | - Valentine Nfonsam
- the Department of Surgery, University of Arizona, Tucson, AZ (Nfonsam)
| | - Ines Rubio-Perez
- the General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain (Rubio-Perez)
| | - Elizabeth C. Wick
- the Department of Surgery, University of California, San Francisco, San Francisco, CA (Wick)
| | - Traci L Hedrick
- the Department of Surgery, University of Virginia Health System, Charlottesville, VA (Hedrick)
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Meyer J, Simillis C, Joshi H, Xanthis A, Ashcroft J, Buchs N, Ris F, Davies RJ. Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis. Int J Surg Protoc 2021; 25:216-219. [PMID: 34616959 PMCID: PMC8462477 DOI: 10.29337/ijsp.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery. The objective is to determine if the choice of extraction site modulates the incidence of incisional hernia (IH). Methods/design A systematic review will be performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase and CENTRAL will be searched to look for original studies reporting the incidence of IH after minimally invasive colorectal surgery. Studies will be excluded from the analysis if: 1) they do not report original data, 2) the outcome of interest (incidence of incisional hernia) is not clearly reported and does not allow to extrapolate and/or calculate the required data for network meta-analysis, 3) they include pediatric patients, 4) they include a patients' population with a conversion rate to laparotomy >10%, 5) they do not compare at least two different extraction sites for the operative specimen, 6) they report patients who underwent pure (and not hybrid) natural orifice transluminal endoscopic surgery (NOTES). Network meta-analysis will be performed to determine the incidence of IH per extraction site. Discussion By determining which specimen extraction site leads to reduced rate of IH, this systematic review and network meta-analysis will help colorectal surgeons to choose their extraction site and reduce the morbidity and costs associated with IH. Registration The systematic review and meta-analysis protocol is registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with number CRD42021272226. Highlights Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery, and the choice of the site may probably modulate the incidence of incisional hernia.The present protocol aims to design a systematic review which will identify original studies comparing two extraction sites during minimally invasive colorectal surgery in terms of incidence of incisional hernia.Network meta-analysis will be performed to determine the incidence of IH per extraction site.
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Affiliation(s)
- Jeremy Meyer
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB.,Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Constantinos Simillis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Heman Joshi
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Athanasios Xanthis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - James Ashcroft
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Nicolas Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
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10
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Choi HB, Chung D, Kim JS, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH. Midline incision vs. transverse incision for specimen extraction is not a significant risk factor for developing incisional hernia after minimally invasive colorectal surgery: multivariable analysis of a large cohort from a single tertiary center in Korea. Surg Endosc 2021; 36:1199-1205. [PMID: 33660121 DOI: 10.1007/s00464-021-08388-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Incisional hernia (IH) is a commonly encountered problem even in the era of minimally invasive surgery (MIS). Numerous studies on IH are available in English literature, but there are lack of data from the Eastern part of the world. This study aimed to evaluate the risk factors as well as incidence of IH by analyzing a large cohort collected from a single tertiary center in Korea. METHODS Among a total number of 4276 colorectal cancer patients who underwent a surgical resection from 2006 to 2019 in Korea University Anam Hospital, 2704 patients (2200 laparoscopic and 504 robotic) who met the inclusion criteria were analyzed. IH was confirmed by each patient's diagnosis code registered in the hospital databank based on physical examination and/or computed tomography findings. Clinical data including specimen extraction incision (transverse or vertical midline) were compared between IH group and no IH group. Risk factors of developing IH were assessed by utilizing univariable and multivariable analyses. RESULTS During the median follow-up of 41 months, 73 patients (2.7%) developed IH. Midline incision group (n = 1472) had a higher incidence of IH than that of transverse incision group (n = 1232) (3.5% vs. 1.7%, p = 0.003). The univariable analysis revealed that the risk factors of developing IH were old age, female gender, obesity, co-morbid cardiovascular disease, transverse incision for specimen extraction, and perioperative bleeding requiring transfusion. However, on multivariable analysis, specimen extraction site was not significant in developing IH and transfusion requirement was the strongest risk factor. CONCLUSIONS IH development after MIS is uncommon in Korean patients. Multivariable analysis suggests that specimen extraction site can be flexibly chosen between midline and transverse incisions, with little concern about risk of developing IH. Careful efforts are required to minimize operative bleeding because blood transfusion is a strong risk factor for developing IH.
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Affiliation(s)
- Hong Bae Choi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Dabin Chung
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ji-Seon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Tae-Hoon Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Se-Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seon-Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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Botteri E, Turolo C, Caprioli M, Vettoretto N. Midline incision as specimen extraction site: always to avoid? Single center experience about the use of enlarged umbilical trocar access. Minerva Surg 2020; 76:156-159. [PMID: 32975385 DOI: 10.23736/s2724-5691.20.08384-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND By the years several locations for specimen extraction site (SES) during laparoscopic surgery for colorectal disease have been proposed and many studies have focused their attention on outcomes and complications, but the "best" SES has not yet been found. METHODS In this paper we describe our experience using the enlargement of umbilical trocar access as SES during laparoscopic colorectal surgery: at the end of the intracorporal phase we removed Hasson's trocar from the umbilicus, therefore the skin and fascial incision is enlarged up to 5-6 cm. In our work we considered 36 patients extracted from our database from 2017 with at least one year follow-up. RESULTS We do not report any skin closure dehiscence or surgical site infection (SSI) and in only one patient (2.7%) occurred incisional hernia (IH). The results of our study are good. Important to reach this goal are an accurate wound closure at the end of the surgery, and an optimal perioperative management. CONCLUSIONS The enlargement of umbilical access could enable several postoperative advantages such as a fewer painful area, a reduced number of incisions with a potential risk of SSI, and incisional hernia compared to traditional SES options. However, further studies investigating that are needed. In the future, other incisions will not be necessary except the normal trocar site ones.
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Affiliation(s)
- Emanuele Botteri
- Department of General Surgery, ASST Spedali Civili of Brescia, Montichiari, Brescia, Italy -
| | - Cecilia Turolo
- Department of General Surgery, ASST Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Michela Caprioli
- Department of General Surgery, ASST Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Nereo Vettoretto
- Department of General Surgery, ASST Spedali Civili of Brescia, Montichiari, Brescia, Italy
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Cano-Valderrama O, Sanz-López R, Domínguez-Serrano I, Dziakova J, Catalán V, Rojo M, García-Alonso M, Mugüerza JM, Torres AJ. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure? Surg Endosc 2019; 34:4048-4052. [PMID: 31617098 DOI: 10.1007/s00464-019-07194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. METHODS A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. RESULTS Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. CONCLUSIONS Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.
| | - Rodrigo Sanz-López
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Inmaculada Domínguez-Serrano
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Jana Dziakova
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Vanesa Catalán
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Mikel Rojo
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Mauricio García-Alonso
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Mugüerza
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
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14
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Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc 2017; 31:5083-5093. [DOI: 10.1007/s00464-017-5573-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/16/2017] [Indexed: 01/05/2023]
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15
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Anthuber M, Kriening B, Schrempf M, Geißler B, Märkl B, Rüth S. [Laparoscopic rectal resection technique]. Chirurg 2016; 87:560-6. [PMID: 27277556 DOI: 10.1007/s00104-016-0196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure.
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Affiliation(s)
- M Anthuber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland.
| | - B Kriening
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - M Schrempf
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - B Geißler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - B Märkl
- Institut für Pathologie, Klinikum Augsburg, Augsburg, Deutschland
| | - S Rüth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
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