Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference?

Abstract

The aim of the present study was to explore incidence and severity of parastomal hernia (PSH) formation during the first 2years after open/laparoscopic abdominoperineal resection (APR). This was a retrospective cohort study conducted in a single institution. All patients who underwent laparoscopic/open APR for low rectal cancer within a 10-year study period were assessed for study eligibility. In total, 148 patients were included in the study (97 patients after laparoscopic APR; 51 patients after open APR). There were no statistically significant differences between study subgroups regarding demographic and clinical features. The incidence of PSH detected by physical examination was significantly higher in patients after laparoscopic APR 1year after the surgery (50.5% vs. 19.6%, p < 0.001) and 2years after the surgery (57.7% vs. 29.4%, p = 0.001). The incidence of radiologically detected PSH was significantly higher in laparoscopically operated patients after 1year (58.7% vs. 35.3%, p = 0.007) and after 2years (61.8% vs. 37.2%, p = 0.004). The mean diameter of PSH was similar in both study subgroups. The incidence of incisional hernia was significantly higher in patients who underwent open APR after 1year (25.5% vs. 7.2%, p = 0.002) and after 2years (31.3% vs. 7.2%, p < 0.001). The risk of PSH development after laparoscopic APR appears to be significantly higher in comparison with patients undergoing open APR. Higher incidence of PSH should be considered a potential disadvantage of minimally invasive approach to patients with low rectal cancer.