Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
Surgical Endoscopy
Erschienen in: Surgical Endoscopy 12/2017

25.04.2017

Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis

verfasst von: Lawrence Lee, Maria Abou-Khalil, Sender Liberman, Marylise Boutros, Gerald M. Fried, Liane S. Feldman

Erschienen in: Surgical Endoscopy | Ausgabe 12/2017

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The incidence of incisional hernia(IH) may be affected by the choice of specimen extraction incision. The objective of this study was to perform a systematic review and meta-analysis comparing the incidence of IH after midline and off-midline incisions in patients undergoing laparoscopic colorectal surgery.

Methods

A systematic search was performed according to PRISMA guidelines to identify all comparative studies from January 1991–August 2016 on the incidence of IH after midline and off-midline(transverse or Pfannenstiel) incisions in patients undergoing laparoscopic colorectal surgery. Case series and studies reporting the IH after stoma site extraction, SILS, or NOTES were excluded. The MINORS instrument was used for quality assessment for observational studies. Weighted estimates were calculated using a random-effects model.

Results

A total of 17 articles were identified and included for meta-analysis, 16 of which were observational studies and 1 was an RCT. The mean MINORS score for observational studies was 12.9 (SD 3.2, range 7–17). Sample sizes in the midline (mean 185, range 20–995) and off-midline(mean 184, range 20–903) groups were similar. Follow-up ranged from 17.3 to 42 months. The pooled incidence of IH was 10.6% (338/3177) in midline, 3.7% (48/1314) in transverse, and 0.9% (9/956) in Pfannenstiel incisions. IH was significantly higher in the midline compared to off-midline groups (weighted OR 4.1, 95% CI 2.0–8.3, I 2 = 79.7%, p for heterogeneity <0.001). Midline incisions were also at higher risk of IH versus transverse (weighted OR 3.0, 95% CI 1.4–6.7, I 2 = 72.7%, p for heterogeneity <0.001) and Pfannenstiel (weighted OR 8.6, 95% CI 3.0–24.6, I 2 = 43.5%, p for heterogeneity = 0.101) incisions. There was no publication bias according the funnel plot or statistically (Egger’s p = 0.336).

Conclusions

Midline incisions for specimen extraction in laparoscopic colorectal surgery are at significantly higher risk of IH compared to off-midline (transverse or Pfannenstiel) incisions, but these data are of poor quality and heterogeneous.
Literatur
1.
van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150CrossRefPubMed
2.
Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642CrossRefPubMed
3.
Funk LM, Perry KA, Narula VK, Mikami DJ, Melvin WS (2013) Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 27:4104–4112CrossRefPubMed
4.
Reynolds D, Davenport DL, Korosec RL, Roth JS (2013) Financial implications of ventral hernia repair: a hospital cost analysis. J Gastrointest Surg 17:159–166 discussion p 166–157 CrossRefPubMed
5.
Kossler-Ebs JB, Grummich K, Jensen K, Huttner FJ, Muller-Stich B, Seiler CM, Knebel P, Buchler MW, Diener MK (2016) Incisional hernia rates after laparoscopic or open abdominal surgery—a systematic review and meta-analysis. World J Surg 40(10):2319–2330CrossRefPubMed
6.
Pecorelli N, Greco M, Amodeo S, Braga M (2016) Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 31(1):85–99CrossRefPubMed
7.
Sajid MS, Bhatti MI, Sains P, Baig MK (2014) Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies. Gastroenterol Rep (Oxf) 2:251–261CrossRef
8.
Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H (2016) Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 59:743–750CrossRefPubMed
9.
Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M, Fried GM, Feldman LS (2012) High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 26:3180–3185CrossRefPubMed
10.
Halm JA, Lip H, Schmitz PI, Jeekel J (2009) Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 13:275–280CrossRefPubMedPubMedCentral
11.
Fassiadis N, Roidl M, Hennig M, South LM, Andrews SM (2005) Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair. Br J Surg 92:1208–1211CrossRefPubMed
12.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed
13.
Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. Bmj 342:d549CrossRefPubMed
14.
15.
Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2006) Comparison of two methods to detect publication bias in meta-analysis. JAMA 295:676–680CrossRefPubMed
16.
Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M, Fried GM, Feldman LS (2012) High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 26:3180–3185CrossRefPubMed
17.
Lim SW, Huh JW, Kim YJ, Kim HR (2013) Vertical transumbilical incision versus left lower transverse incision for specimen retrieval during laparoscopic colorectal surgery. Tech Coloproctol 17:59–65CrossRefPubMed
18.
Tan WS, Chew MH, Ho KS, Yatim JB, Lai JS, Tang CL (2015) Short and long-term outcomes of a randomised controlled trial of vertical periumbilical wound versus transverse left iliac fossa wound for specimen retrieval in laparoscopic anterior resections. Surg Endosc 29:2720–2727CrossRefPubMed
19.
Harr JN, Juo YY, Luka S, Agarwal S, Brody F, Obias V (2016) Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 30:3505–3510CrossRefPubMed
20.
Pares D, Shamali A, Stefan S, Flashman K, O’Leary D, Conti J, Senapati A, Parvaiz A, Khan J (2016) Predictive factors for extraction site hernia after laparoscopic right colectomy. Int J Colorectal Dis 31:1323–1328CrossRefPubMed
21.
Sadava EE, Kerman Cabo J, Galvan MA, Grzona EG, Canelas AG, Bun ME, Rotholtz NA (2015) Incisional hernia after laparoscopic colorectal surgery is there any factor associated? Surg Endosc 29:S79
22.
Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D (2016) Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 30:3823–3829CrossRefPubMed
23.
Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:2596–2600CrossRefPubMed
24.
DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2011) Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 25:1031–1036CrossRefPubMed
25.
Llaguna OH, Avgerinos DV, Lugo JZ, Matatov T, Abbadessa B, Martz JE, Leitman IM (2010) Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am J Surg 200:265–269CrossRefPubMed
26.
Morita Y, Yamaguchi S, Ishii T, Tashiro J, Kondo H, Suzuki A, Hara K, Koyama I (2015) Does transumbilical incision increase incisional hernia at the extraction site of laparoscopic anterior resection? Am J Surg 209:1048–1052CrossRefPubMed
27.
Campagnacci R, Baldoni A, Ghiselli R, Cappelletti-Trombettoni MM, Guerrieri M (2015) Prevention of hernia incision in laparoscopic left colon resection. Minerva Chir 70:155–160PubMed
28.
Navaratnam AV, Ariyaratnam R, Smart NJ, Parker M, Motson RW, Arulampalam TH (2015) Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction. Ann R Coll Surg Engl 97:17–21CrossRefPubMedPubMedCentral
29.
Samia H, Lawrence J, Nobel T, Stein S, Champagne BJ, Delaney CP (2013) Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline? Am J Surg 205:264–267CrossRefPubMed
30.
Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12:1334–1340CrossRefPubMed
31.
Hollander JE, Singer AJ, Valentine S, Henry MC (1995) Wound registry: development and validation. Ann Emerg Med 25:675–685CrossRefPubMed
32.
Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343CrossRefPubMed
33.
Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, Buchler MW (2009) Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg 249:913–920CrossRefPubMed
34.
Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144:1056–1059CrossRefPubMed
35.
Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386:1254–1260CrossRefPubMed
36.
Millbourn D, Cengiz Y, Israelsson LA (2011) Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia 15:261–266CrossRefPubMed
37.
Israelsson LA, Jonsson T (1993) Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 80:1284–1286CrossRefPubMed
38.
Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F, European Hernia S (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24CrossRefPubMed
39.
Rahbari NN, Knebel P, Diener MK, Seidlmayer C, Ridwelski K, Stoltzing H, Seiler CM (2009) Current practice of abdominal wall closure in elective surgery—is there any consensus? BMC Surg 9:8CrossRefPubMedPubMedCentral
40.
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev
41.
Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560CrossRefPubMed
42.
Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101:1439–1447CrossRefPubMed
43.
Israelsson LA, Jonsson T (1996) Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 162:125–129PubMed
44.
Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, Werner J, Buchler MW, Diener MK (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101:51–54CrossRefPubMed
45.
Hoer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirurg 73:474–480CrossRefPubMed
46.
Baucom RB, Beck WC, Holzman MD, Sharp KW, Nealon WH, Poulose BK (2014) Prospective evaluation of surgeon physical examination for detection of incisional hernias. J Am Coll Surg 218:363–366CrossRefPubMed
47.
Naguib N, Rafique H, Dhruva Rao PK, Longworth T, Soukias JM, Masoud A (2015) A review of the incidence of iatrogenic hernia in both laparoscopic and open colorectal surgery: using CT as the gold standard of detection, cohort study. Int J Surg 19:87–90CrossRefPubMed
48.
Bloemen A, van Dooren P, Huizinga BF, Hoofwijk AG (2012) Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia 16:53–57CrossRefPubMed
49.
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583 discussion 583–575 PubMedPubMedCentral
50.
Rogmark P, Petersson U, Bringman S, Ezra E, Osterberg J, Montgomery A (2016) Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: PROLOVE: a randomized controlled trial. Ann Surg 263:244–250CrossRefPubMed
51.
Marchesi F, Pinna F, Percalli L, Cecchini S, Ricco M, Costi R, Pattonieri V, Roncoroni L (2013) Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach. J Laparoendosc Adv Surg Tech A 23:418–424CrossRefPubMed
52.
Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767 discussion 768 CrossRefPubMed
53.
Bartels SA, Vlug MS, Hollmann MW, Dijkgraaf MG, Ubbink DT, Cense HA, van Wagensveld BA, Engel AF, Gerhards MF, Bemelman WA, Collaborative LSG (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101:1153–1159CrossRefPubMed
54.
Aquina CT, Rickles AS, Probst CP, Kelly KN, Deeb AP, Monson JRT, Fleming FJ, Marc (2015) Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum 58:220–227CrossRefPubMed
Metadaten
Titel
Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis
verfasst von
Lawrence Lee
Maria Abou-Khalil
Sender Liberman
Marylise Boutros
Gerald M. Fried
Liane S. Feldman
Publikationsdatum
25.04.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 12/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5573-2

Weitere Artikel der Ausgabe 12/2017

Surgical Endoscopy 12/2017 Zur Ausgabe

OriginalPaper

The effect of an online referral system on referrals to bariatric surgery

OriginalPaper

Primary versus redo paraesophageal hiatal hernia repair: a comparative analysis of operative and quality of life outcomes

OriginalPaper

Optimal radial force and size for palliation in gastroesophageal adenocarcinoma: a comparative analysis of current stent technology

OriginalPaper

Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate

Dynamic Manuscript

Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair

OriginalPaper

The clinical outcomes and risk factors associated with incomplete endoscopic resection of rectal carcinoid tumor

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.
Bildnachweise