title: High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection.
abstract: BACKGROUND
  The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after laparoscopic colectomy.
  
  
  METHODS
  Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009 were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups.
  
  
  RESULTS
  Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4 years, p = 0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0 months. The overall incidence of incisional hernia was 21% (21/99), being 29 % (20/68) after midline incision compared with 14 % (1/7) after transverse and 0 % (0/24) after Pfannenstiel incisions (p = 0.002). Of patients with incisional hernia, 47 % (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic score (14.4 vs 17.7, p = 0.02) compared with those without, but there was no difference in body image score. There were no differences in body image or cosmesis between the three incisions.
  
  
  CONCLUSIONS
  There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada. larry.lee@mail.mcgill.ca
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mappin-Kasirer
authors.forename: Alexander
authors.initials: A
authors.lastname: Sender Liberman
authors.forename: Barry
authors.initials: B
authors.lastname: Stein
authors.forename: Patrick
authors.initials: P
authors.lastname: Charlebois
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged