The Incidence of Incisional Hernia after Colorectal Surgery Depends on the Extraction Site: A Cohort Analysis

Abstract

Abstract Background Although minimally invasive surgery has reduced the incidence of incisional hernia in colorectal surgery, specimen extraction site still constitutes a risk for incisional hernia. Aims We aimed to analyse the incidence of incisional hernia according to the specimen extraction site. Methods We conducted a retrospective observational cohort study of consecutive patients who underwent elective laparoscopic colorectal surgery for colorectal cancer between 01.2013 and 12.2021. The primary outcome was the CT-proven incidence of incisional hernia at the level of the extraction site until the end of follow-up (12.2023). Patients with open surgery, previous hernia repair, reoperations during the study period or without imaging follow-up were excluded. Results One hundred and fifty-eight patients were included. One hundred and four patients (65,8 %) had an extraction site located on the midline, and 54 patients (34,2 %) had an extraction site which was off midline. The midline was preferably used as extraction site during right and transverse colectomy (96,5% and 100% respectively), and off midline was used in left hemicolectomy, sigmoid colectomy and anterior resection (60%, 88%, 93,8% respectively). The overall incidence of incisional hernia at the level of the extraction site was of 29,8 % (31 patients) when midline was chosen as the extraction site, and of 1,9% (1 patient) when the extraction site was off-midline (p-value<0,001). Seven patients (6,7%) required hernia repair in the midline group and no patient (0%) in the off-midline group (p-value=0.051). The mean follow-up was of 3.1+/-2.1 years. Uni-and multivariate logistic regression identified the choice of extraction site as a risk factor for incisional hernia (odds ratio: 22,5, 95%CI: 2,3-27,1, p-value: 0,03). Conclusion Choosing the midline as an extraction site exposes patients to the risk of incisional hernia. Fully minimally invasive colorectal resection using off-midline incision as extraction site should be encouraged.