Annals of Coloproctology

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Original Articles

Complications

Incisional hernia risk in intracorporeal anastomosis with Pfannenstiel incision versus extracorporeal anastomosis with midline incision for laparoscopic right hemicolectomy: a multicenter comparison: Francesco Saverio Lucido, Giusiana Nesta, Luigi Brusciano, Claudio Gambardella, Francesco Pizza, Giuseppe Scognamiglio, Gianmattia del Genio, Salvatore Tolone, Federico Maria Mongardini, Massimo Mongardini, Ludovico Docimo, Simona Parisi; Ann Coloproctol. 2025;41(4):287-292. Published online June 18, 2025; DOI: https://doi.org/10.3393/ac.2024.00682.0097

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Abstract PDF: Purpose
Laparoscopic right hemicolectomy can be performed via intracorporeal ileocolic anastomosis (ICA) or extracorporeal ileocolic anastomosis (ECA). Prior studies have emphasized ICA’s advantages in hospital stay and postoperative pain. This multicenter study aimed to compare the 2-year incidence of incisional hernia between ICA (using a suprapubic Pfannenstiel incision) and ECA (using a pararectal incision) and assess perioperative outcomes.
Methods
We retrospectively analyzed patients undergoing laparoscopic right hemicolectomy between 2019 and 2020, divided into 2 groups: ICA with a Pfannenstiel incision and ECA with a pararectal incision.
Results
The mean operative time was longer in the ICA group (190 minutes vs. 170 minutes, P=0.004). Despite requiring advanced surgical skills and prolonged operative time, ICA was associated with superior short-term outcomes and a significantly lower incisional hernia rate compared to ECA (1.2% vs. 14.7%, P=0.044) at 24-month follow-up.
Conclusion
ICA is linked to longer operative times, but shorter hospital stays, fewer wound complications, and reduced incisional hernia rates compared to ECA.

Benign bowel disease

Risk factors of incisional hernia at the umbilical specimen extraction site in patients with laparoscopic colorectal cancer surgery: Masatsugu Hiraki, Toshiya Tanaka, Shinya Azama, Eiji Sadashima, Hirofumi Sato, Shuusuke Miyake, Kenji Kitahara; Ann Coloproctol. 2024;40(2):136-144. Published online June 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00213.0030

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7 Web of Science
9 Citations

Graphical Abstract Abstract PDF

Purpose
Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer.
Methods
A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH.
Results
The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P=0.004), a high body mass index (P<0.001), noncurrent smoking habit (P=0.043), low level of hemoglobin (P=0.035), high subcutaneous fat area (P<0.001), high visceral fat area (P=0.006), low skeletal muscle area (P=0.001), long distance between the inner edges of the rectus abdominis muscle (P=0.001), long protrusion of the peritoneum at the umbilical site (P<0.001), and lymph node metastasis (P=0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027–2.419; P=0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132–5.018; P=0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058–10.091; P<0.001) were independent risk factors for IH.
Conclusion
Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

Citations

Citations to this article as recorded by

Umbilical fat is useful for evaluating the risk of incisional hernia after laparoscopic colorectal surgery
Chika Katayama, Yasuaki Enokida, Takuya Shiraishi, Yuta Shibasaki, Takuhisa Okada, Katsuya Osone, Akihiko Sano, Makoto Sakai, Hiroomi Ogawa, Ken Shirabe, Hiroshi Saeki
Surgery Today.2026; 56(4): 496. CrossRef
Incisional hernia after continuous barbed versus interrupted non-barbed sutures for midline fascial closure in minimally invasive colorectal cancer surgery: a propensity score-matched analysis
Kinuko Nagayoshi, Yusuke Mizuuchi, Takaaki Fujimoto, Koji Tamura, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura
Hernia.2026;[Epub] CrossRef
Comparative analysis of longitudinal and transverse minilaparotomy during colon cancer surgery
Z.A. Bagatelija, D.N. Grekov, S.S. Lebedev, V.M. Kulushev, N.Ju. Sokolov, G.S. Mikhailyants, A.Yu. Lukin, A.A. Polikarpov, M.S. Lebedko, A.I. Maksimkin, A.S. Sharenkova
Pirogov Russian Journal of Surgery.2025; (4): 71. CrossRef
Effect of transverse versus midline periumbilical incision on incisional hernia and short-term outcomes after laparoscopic colon cancer surgery: multicentre, open-label, randomized clinical trial
Soo Young Lee, Soo Yeun Park, Gi Won Ha, Gyung Mo Son, Dong Keon Yon, Chang Hyun Kim, S Kim, S I Kang, J S Park, K H Lee, J S Kim, K B Bae, S U Bae
BJS Open.2025;[Epub] CrossRef
Subcutaneous Fat, Not Visceral Fat, as a Risk Factor for Incisional Hernia After Laparoscopic Colorectal Cancer Surgery
Kumiko Sekiguchi, Akihisa Matsuda, Takeshi Yamada, Satoshi Matsumoto, Keisuke Minamimura, Youichi Kawano, Takeshi Matsutani, Hiroshi Maruyama, Nobuhiko Taniai, Yoshiharu Nakamura, Hiroshi Yoshida
Asian Journal of Endoscopic Surgery.2025;[Epub] CrossRef
Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study
I. Omar, A. Townsend, O. Hadfield, T. Zaimis, M. Ismaiel, J. Wilson, C. Magee
Hernia.2024; 28(5): 1619. CrossRef
The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan
Gen Shimada, Taketo Matsubara, Mariko Sanbonmatsu, Rumi Nakabayashi, Yosuke Miyachi, Takashi Taketa, Akihiro Suzuki, Tadao Yokoi, Toshimi Kaido
Asian Journal of Endoscopic Surgery.2023; 16(2): 305. CrossRef
Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution
Heita Ozawa, Naoyuki Toyota, Junichi Sakamoto, Hiroki Nakanishi, Ryo Nakanishi, Shin Fujita
Surgery Today.2023; 53(8): 992. CrossRef
Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial
Soo Yeun Park, Gi Won Ha, Soo Young Lee, Chang Hyun Kim, Gyung Mo Son
Trials.2023;[Epub] CrossRef

Case Reports

Benign GI diease,Complication

Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report: Yujin Lee, Byung-Noe Bae; Ann Coloproctol. 2021;37(Suppl 1):S28-S33. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.19

7,741 View
94 Download
7 Web of Science
8 Citations

Abstract PDF

Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.

Citations

Citations to this article as recorded by

Clinical Insights and Brief Research Report on Mesh Erosion Into Bowel Following Hernia Repair: A Single-Centre Series of Eight Cases
Vidit Dholakia, Suvendu Sekhar Jena, Amitabh Yadav, Samiran Nundy
Journal of Abdominal Wall Surgery.2025;[Epub] CrossRef
An unlikely path: hernia mesh migration
Ana Rita Ferreira, Bárbara Castro, Catarina Ortigosa, Sílvia Costa, Bela Pereira, Manuel Oliveira
European Surgery.2024; 56(1-2): 39. CrossRef
Spontaneous Migration of Intraperitoneal Mesh into Rectum following Ventral Hernia Repair
Aruna R. Patil, Ravishankar Bhat, Madhusudhana Basavarajappa
Journal of Gastrointestinal and Abdominal Radiology.2023; 06(01): 053. CrossRef
Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair
Yuan Zhang, Jun Peng, Xingui Wu, Dingjiao Zhu, Yaozhi Chen
ANZ Journal of Surgery.2023; 93(4): 1042. CrossRef
Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair
Michael L. Lorentziadis, Moustafa Mahmoud Nafady Hego, Fatma Al Nasser
International Journal of Abdominal Wall and Hernia Surgery.2023; 6(1): 48. CrossRef
Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis
Théophile Delorme, Jonathan Cottenet, Fawaz Abo-Alhassan, Alain Bernard, Pablo Ortega-Deballon, Catherine Quantin
Hernia.2023; 28(2): 419. CrossRef
A Cecal Surprise
Muhammad B. Hammami, Jean-Pierre Raufman
Gastroenterology.2022; 162(7): 1847. CrossRef
Mesh on the move: a case report of total transmural surgical mesh migration causing bowel obstruction
Joseph Ryan Leach, Bryan Manoukian, Lygia Stewart
Clinical Journal of Gastroenterology.2021; 14(1): 136. CrossRef

Primary Repair of a Huge Incisional Hernia by Using an External Oblique Myofascial Releasing Technique without Mesh: A Case Report.: Park, Ki Jae , Woo, Jin Hee , Lee, Hak Youn , Lee, Se Yong , Shin, Jong Sok , Roh, Young Hoon , Kim, Sung Heun , Choi, Hong Jo; J Korean Soc Coloproctol. 2008;24(5):386-389.; DOI: https://doi.org/10.3393/jksc.2008.24.5.386

2,320 View
11 Download

Abstract PDF: Incisional hernias are one of the most common complications after abdominal surgery and are an important cause of postoperative morbidity. Various methods are available for repairing incisional hernias, such as primary suture repair, an open mesh technique, and a laparoscopic mesh technique. The surgical management of a large incisional hernia by using a prosthetic mesh in a contaminated operative field (i.e., opened bowel from previous stoma or bowel resection) remains a difficult challenge because the non-absorbable mesh used is accompanied by a potential risk of infection and its related morbidity. We present a case of a large abdominal-wall defect, which was corrected by utilizing an external oblique myofascial releasing technique without the use of mesh, in a patient with an incisional hernia coexistent with Hartmann's colostomy.

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