Incisional Hernia at Extraction Sites Following Laparoscopic Colorectal Resection: A Comparative Study of Midline vs Non-midline Extraction.

INTRODUCTION

The choice of specimen extraction site in laparoscopic colorectal surgery may influence incisional hernia risk, yet optimal site selection remains debated. This study compares hernia rates between midline and non-midline extraction sites, assessing the impact of surgical site infection (SSI), diabetes, and immunosuppression.

METHODS

A retrospective cohort study included 276 patients undergoing laparoscopic colorectal cancer resection (2019-2022) at a UK District General Hospital, with a minimum three-year follow-up. Patients were grouped by extraction site: midline (n=99) and non-midline (n=177; transverse off-midline, n=116; Pfannenstiel, n=37; stoma site, n=24). Data on age, BMI, American Society of Anesthesiologists (ASA) grade, diabetes, immunosuppression, surgical site infection (SSI), and incisional hernia (diagnosed via CT or clinical examination) were collected. Statistical analyses included Chi-square, Fisher's exact, t-tests, and Pearson correlations.

RESULTS

Midline extractions had a higher hernia rate (27.3%) than non-midline (11.9%; p=0.0021). Pfannenstiel incisions showed the lowest rate (2.8%; p=0.0008), followed by transverse (14.7%; p=0.0343), with stoma site rates similar to midline (12.5%; p=0.1859). SSI strongly correlated with hernia incidence (r=0.950, p=0.013), unlike diabetes (r=0.296, p=0.628) or immunosuppression (r=0.284, p=0.640). ASA grade distribution differed significantly (p=0.0324).

CONCLUSION

Non-midline extraction sites, particularly Pfannenstiel, reduce incisional hernia risk compared to midline incisions. SSI is a critical risk factor, emphasizing the importance of infection prevention. These findings support strategic site selection to optimize outcomes.