title: Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?
abstract: BACKGROUND
  Incisional hernias are a common postoperative complication with abdominal surgery. The major risk factors for their development include wound infection, obesity, and age. This study aimed to evaluate the impact of extraction-site location and technique on incisional hernia rates in laparoscopic colorectal surgery.
  
  
  METHODS
  A prospective study of 208 consecutive patients who underwent laparoscopic colorectal surgery between March 2002 and July 2006 was performed. The study included only patients who had an extraction site on the abdominal wall. Patients were excluded if they were lost to follow-up evaluation or underwent conversion to open procedure. For the 166 patients included in the study, the mean follow-up period was 20.2 +/- 14.4 months. Extraction-site incisions were classified into two groups: midline or off-midline. Midline wounds involved sharp division of the linea alba and were closed with a single layer of no.1 Vicryl. Off-midline incisions involved sharp division of the anterior and posterior sheaths with blunt spreading of the muscular layers and were closed in two layers with no. 1 Vicryl. Risk factors including wound infection, body mass index (BMI), age, and diabetes were analyzed.
  
  
  RESULTS
  The incisional hernia rate for the entire series was 7.8%. The incisional hernia rate was 17.6% for the midline group (n = 74) and 0% for the off-midline group (n = 92) (p = 0.0002, statistically significant). There was no statistically significant difference in age, BMI, diabetes, follow-up time, or wound infection rate between the two groups.
  
  
  CONCLUSIONS
  In this series, the midline extraction site resulted in a significantly higher incisional hernia rate statistically than the off-midline extraction sites. The authors therefore have adopted an off-midline blunt muscle-splitting extraction site when performing laparoscopic colorectal surgery.
authors.affiliation: The Centre for Minimal Access Surgery, North Bay General Hospital, 750 Scollard Avenue, North Bay, ON, Canada, P1B 5A4. singhr13@hotmail.com
authors.forename: Ravinder
authors.initials: R
authors.lastname: Singh
authors.forename: Alex
authors.initials: A
authors.lastname: Omiccioli
authors.forename: Susan
authors.initials: S
authors.lastname: Hegge
authors.forename: Craig
authors.initials: C
authors.lastname: McKinley
mesh_terms: D034861:Abdominal Wall; D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques