title: Incisional and port-site hernias following robotic colorectal surgery.
abstract: The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery.
  
  
  
  A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis.
  
  
  
  The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found.
  
  
  
  Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Harr
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors.forename: Yen-Yi
authors.initials: YY
authors.lastname: Juo
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Luka
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
authors.affiliation: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA. vobias@mfa.gwu.edu.
authors.forename: Vincent
authors.initials: V
authors.lastname: Obias
mesh_terms: D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures
keywords: Colorectal surgery; Incisional hernias; Robotic surgery; Surgical extraction site; Trocar site hernias