title: Specimen extraction from the defunctioning ileostomy site or Pfannenstiel incision during total laparoscopic low anterior resection for rectal cancer.
abstract: BACKGROUND
  Laparoscopic low anterior resection is commonly performed, but there is controversy about the optimal specimen extraction site. The purpose of the study was to evaluate the outcomes of two different specimen extraction sites.
  
  
  METHODS
  In this prospective study of total laparoscopic low anterior resection for rectal cancer, we compared the outcomes of specimen extraction from a right lower quadrant trocar site that is also used for a defunctioning ileostomy (21 patients) or a Pfannenstiel incision (25 patients).
  
  
  RESULTS
  The median visual analog pain score on postoperative Days 1 and 3 and meperidine requirement were significantly higher in the Pfannenstiel than in the ileostomy site group. Time to resumption of oral diet and hospital stay were significantly shorter in the ileostomy site than in the Pfannenstiel group. All four parastomal hernias were observed in the ileostomy site group.
  
  
  CONCLUSIONS
  Use of the stoma site for specimen extraction in total laparoscopic low anterior resection for rectal cancer may minimize abdominal wall incisions, decrease postoperative recovery time, decrease pain level and analgesic requirement, and improve cosmesis. Although this procedure may increase the incidence of parastomal hernia, hernia repair may be performed during ileostomy takedown surgery, and the temporary stoma site (which also is the right lower quadrant trocar entry site) may be suggested as a proper specimen extraction site.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Baskent University , Ankara, Turkey .
authors.forename: Feza Y
authors.initials: FY
authors.lastname: Karakayali
authors.forename: Tugan
authors.initials: T
authors.lastname: Tezcaner
authors.forename: Gökhan
authors.initials: G
authors.lastname: Moray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004435:Eating; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D011446:Prospective Studies; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D013048:Specimen Handling / Q000379:methods*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine