title: Use of a Pfannenstiel incision in minimally invasive colorectal cancer surgery is associated with a lower risk of wound complications.
abstract: BACKGROUND
  The Pfannenstiel incision, widely used in gynecological surgery, has been reported to be associated with lower rates of wound complications than midline incisions in open surgery. However, its effect on wound complications in minimally invasive surgery (MIS) is not well understood. We hypothesize that use of a Pfannenstiel incision in MIS colorectal cancer resections would be associated with fewer short-term wound complication rates.
  
  
  METHODS
  A retrospective cohort study was performed on 171 patients who had undergone MIS colorectal cancer surgery requiring a specimen extraction/hand-access site, divided into a Pfannenstiel and a midline group depending on the type of incision used. Wound complications compared included disruption, infection, dehiscence, evisceration, and fistula formation. The Mann-Whitney U and Fisher's exact tests were used to analyze differences in risk factors between the groups. Logistic regression was performed to determine factors associated with prevention of wound complications.
  
  
  RESULTS
  Patients in the Pfannenstiel group had significantly lower rates of wound disruption (0 vs. 13%, p = 0.02), superficial surgical site infection (7 vs. 22%, p = 0.03), and overall wound complications (13 vs. 30%, p = 0.04). Using multivariate logistic regression, Pfannenstiel incisions and colon rather than rectal resections were significant predictors of prevention of wound complications.
  
  
  CONCLUSIONS
  The use of a Pfannenstiel incision in MIS colorectal cancer resections is associated with a decreased risk of short-term wound complications.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, TX 77030, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Orcutt
authors.forename: C J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: C L
authors.initials: CL
authors.lastname: Marshall
authors.forename: C N
authors.initials: CN
authors.lastname: Robinson
authors.forename: D A
authors.initials: DA
authors.lastname: Anaya
authors.forename: A
authors.initials: A
authors.lastname: Artinyan
authors.forename: S S
authors.initials: SS
authors.lastname: Awad
authors.forename: D H
authors.initials: DH
authors.lastname: Berger
authors.forename: D
authors.initials: D
authors.lastname: Albo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult