title: Incisional hernias after laparoscopic and robotic right colectomy.
abstract: Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies.
  
  
  
  This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH.
  
  
  
  276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03).
  
  
  
  This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: M
authors.initials: M
authors.lastname: Widmar
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: M
authors.initials: M
authors.lastname: Keskin
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: P
authors.initials: P
authors.lastname: Beltran
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Nash
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Guillem
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: Temple
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Paty
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Weiser
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA. garciaaj@mskcc.org.
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Aguilar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology* / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
keywords: Incisional hernia; Laparoscopic colectomy; Robotic colectomy