title: Prevention of hernia incision in laparoscopic left colon resection.
abstract: OBJECTIVE
  Aim of this study was to assess the rate of incisional hernia in laparoscopic left colectomy comparing two different sites of mini-laparotomy: midline and oblique left iliac fossa.
  
  
  METHODS
  The study retrospectively analyzed data from 748 patients who underwent laparoscopic left colectomy, in which we performed a midline 6-7 cm incision of the umbilical pubic tract (438 patients - group A), and an oblique left iliac fossa incision (262 patients - group B). Usually a medial to lateral meso-colon dissection technique with vascular closure was performed as a first step. Electro-thermal bipolar energy was routinely used. The variables compared were operative time, hernia in site of mini-laparotomy, conversion, intraoperative bleeding, 30-day complications, wound infection, length of stay.
  
  
  RESULTS
  From early 2004 to April 2012, 748 patients underwent laparoscopic left colectomy, receiving a midline incision for specimen extraction in 438 cases, group A, and off midline in 262, group B. The mean operative time was 135 (90-245) min for group A and 110.5 (40-195) min for group B, and the mean hospital stay was 8 (5-28) days and 6 (4-30) days for group A and B respectively. Forty-eight patients underwent conversion in open surgery and were removed from the study (33 from group A and 15 from group B). Forty-five incisional hernia occurred in group A (10.2%) vs. 3 in group B (1.1%). We shifted to left iliac fossa incision since June 2010.
  
  
  CONCLUSIONS
  This study summarizes our experience in the effort to reduce incisional hernia in laparoscopic left colectomy. There was a significant difference in rate of hernia comparing midline and oblique left iliac fossa incision. We postulate anatomy of abdominal wall, dynamics and the higher rate of infection of umbilicus to be the key.
authors.affiliation: Unit of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy - abaldoni@libero.it.
authors.forename: R
authors.initials: R
authors.lastname: Campagnacci
authors.forename: A
authors.initials: A
authors.lastname: Baldoni
authors.forename: R
authors.initials: R
authors.lastname: Ghiselli
authors.forename: M M
authors.initials: MM
authors.lastname: Cappelletti-Trombettoni
authors.forename: M
authors.initials: M
authors.lastname: Guerrieri
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D061887:Conversion to Open Surgery; D005260:Female; D006555:Hernia, Ventral / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control