title: Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline?
abstract: BACKGROUND
  Laparoscopic colorectal procedures require specimen extraction. It is unclear whether extraction site affects the incidence of incisional hernia (IH).
  
  
  METHODS
  Patients undergoing laparoscopic colectomy over a 6-year period were identified. Outcomes were compared between patients to evaluate the incidence of hernia.
  
  
  RESULTS
  Among 480 laparoscopic colorectal procedures, extraction sites were midline (n = 305), muscle splitting (n = 128), Pfannenstiel (n = 26), and ostomy (n = 21). Average follow-up was 3.5 years. Age, gender, diagnosis, extraction incision length, and hospital stay were similar. The mean body mass index for all patients was 28 kg/m(2) and for those with IHs was 31 kg/m(2) (P = .008). The overall IH rate was 7%. Midline IHs accounted for 84% of all hernias, occurring in 8.9% of midline extractions (P < .05 vs nonmidline extractions). Hernia rates for muscle-splitting, Pfannenstiel, and ostomy site extractions were 2.3%, 3.8%, and 4.8%, respectively.
  
  
  CONCLUSIONS
  Although midline hernia rates were lower than traditionally reported with open surgery, midline extraction sites have a higher chance of IH than nonmidline sites.
authors: Department of Surgery, Case Western Reserve University Hospitals, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5054, USA.
authors: Hoda
authors: H
authors: Samia
authors: Justin
authors: J
authors: Lawrence
authors: Tamar
authors: T
authors: Nobel
authors: Sharon
authors: S
authors: Stein
authors: Bradley J
authors: BJ
authors: Champagne
authors: Conor P
authors: CP
authors: Delaney
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome