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

doi:10.3393/ac.2024.00682.0097

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Original Article Incisional hernia risk in intracorporeal anastomosis with Pfannenstiel incision versus extracorporeal anastomosis with midline incision for laparoscopic right hemicolectomy: a multicenter comparison: Francesco Saverio Lucido¹, Giusiana Nesta¹, Luigi Brusciano¹, Claudio Gambardella¹, Francesco Pizza², Giuseppe Scognamiglio³, Gianmattia del Genio¹, Salvatore Tolone¹, Federico Maria Mongardini¹, Massimo Mongardini⁴, Ludovico Docimo¹, Simona Parisi¹; DOI: https://doi.org/10.3393/ac.2024.00682.0097
Published online: June 18, 2025

¹Division of General, Mini-invasive, Oncological and Obesity Surgery, Department of Advanced Since and Surgery, University of Campania Luigi Vanvitelli, Naples, Italy

²Department of Surgery, A. Rizzoli Hospital, Naples, Italy

³Unit of General and Bariatric Surgery, Camilliani Hospital, Naples, Italy

⁴Division of General Surgery, AUO Azienda Universitaria Policlinico “Policlinico Umberto I”, Sapienza University of Rome, Italy

Correspondence to: Simona Parisi, MD Division of General, Mini-invasive, Oncological and Obesity Surgery, Department of Advanced Since and Surgery, University of Campania Luigi Vanvitelli, Via Pansini 5, Naples 80136, Italy Email: simona.parisi-sp@libero.it

• Received: September 29, 2024 • Revised: January 18, 2025 • Accepted: January 20, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

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.
Keywords: Incisional hernia; Intracorporeal anastomosis; Right hemicolectomy; Pfannestiel; Pararectal incision

INTRODUCTION

Colorectal cancer is the second leading cause of cancer-related death worldwide, and minimally invasive surgery has been widely adopted globally. The benefits of laparoscopic surgery—including reduced postoperative pain, faster bowel recovery, and shorter hospitalization—are well established [1–5]. Although laparoscopic right hemicolectomy is now standardized, the choice between full laparoscopic intracorporeal ileocolic anastomosis (ICA) and extracorporeal ileocolic anastomosis (ECA) remains case dependent. Among complications, incisional hernia (IH) at the specimen extraction site has been extensively documented in the literature, including in systematic reviews and meta-analyses, prompting efforts to identify incision strategies that minimize risk [6–8].

In open abdominal surgery, off-midline incisions correlate with lower IH rates, with Pfannenstiel incisions demonstrating the lowest risk [9]. Despite this, midline incisions remain the most common approach in open surgery [9, 10].

A right hemicolectomy can now be performed using laparoscopic surgery. The surgical procedure can involve either ICA or ECA. In ICA, the Pfannenstiel incision is typically made solely for the purpose of specimen extraction. In contrast, ECA requires a larger paramedian or subcostal incision.

The aim of this study was to compare the occurrence of IH and wound events between 2 different approaches using a multicentric retrospective study with a medium-term follow-up. Specifically, we conducted a follow-up of 24 months to analyze the short-term outcomes of ICA and ECA, focusing on hospital stay, postoperative pain, and perioperative complications.

METHODS

Ethics statement

This study was approved by the Campania University Ethical Committee (No. 27/2022). Written informed consent was obtained from all participants. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and reported following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cohort studies [11].

Study design

This retrospective multicenter study aimed to compare the incidence of IH and wound-related complications between 2 surgical approaches for right hemicolectomy: ICA and ECA.

Study setting and study population

Patients referred to the general surgery division at the University of Campania “Luigi Vanvitelli” (Naples, Italy), Rizzoli Hospital (Naples, Italy), and Camilliani Hospital (Naples, Italy), and the colorectal surgery division at La Sapienza University of Rome (Rome, Italy) between January 1, 2019, and December 31, 2020, for colorectal cancer were enrolled. Inclusion criteria included age >16 years, a diagnosis of right-sided colon cancer, and a laparoscopic right hemicolectomy with an American Society of Anesthesiologists (ASA) physical status of grade ≤III [11]. Exclusion criteria included prior open abdominal surgery, ileostomy, a history of ventral hernia, cesarean section, or reoperation for postoperative complications. Patients without at least 1 follow-up visit were also excluded.

All patients underwent a comprehensive preoperative evaluation, including medical history, physical and proctological examinations, colonoscopy, laboratory tests, and cardiological and anesthesiological assessments. Oncological staging involved a contrast-enhanced total-body computed tomography (CT) scan. Each case was discussed at a weekly multidisciplinary meeting involving oncologists, surgeons, radiologists, radiotherapists, and gastroenterologists. Surgical techniques were meticulously analyzed, and incision methods were documented.

The diagnosis of IH was made based on an ultrasound exam conducted by a radiologist with more than 10 years of experience. After the referral for surgery, each patient received a detailed explanation of the surgical procedure and signed an informed consent form. Surgery was performed by surgeons with at least 10 years of experience in general and emergency surgery and over 150 colorectal procedures.

Clinical and demographic data, including age, sex, body mass index (BMI), and ASA physical status, were collected, along with postoperative outcomes. Data were recorded in an electronic database and retrospectively analyzed. Patients were divided into 2 groups: group A underwent laparoscopic right hemicolectomy (LRH) with ICA and a Pfannenstiel incision for specimen extraction, while group B underwent LRH with ECA via a pararectal incision. Recent procedures at each center predominantly involved ICA.

All patients received intraoperative and postoperative antibiotic prophylaxis (ceftriaxone sodium salt and metronidazole) and underwent general anesthesia. Mechanical bowel preparation was administered preoperatively. Postoperatively, patients used an abdominal binder for 2 months and avoided strenuous activity for 3 months. The study aimed to evaluate IH incidence in both groups at short- and medium-term follow-up.

Surgical technique

LRH with ICA: Pfannenstiel incision

Pneumoperitoneum was established using the open Hassan technique. Four to 5 ports were used: a 10 to 12 mm umbilical port for a 30° laparoscope, one 10 mm working port in the left lower abdomen for stapling devices, and two to three 5 mm working ports in the left upper abdomen and suprapubic region. A lateral-to-medial dissection was performed. ICA was completed using a side-to-side isoperistaltic ileocolic anastomosis with a 60 mm Echelon stapler (Ethicon Endo-Surgery Inc). The stapler-access enterotomy was closed with a double-layer suture using Stratafix 3/0 (Ethicon Inc). A 7-cm transverse Pfannenstiel incision was made above the pubic tubercle. The incision size was standardized using a sterile ruler. The skin and subcutaneous fat were dissected to expose the rectus fascia, which was incised vertically to access the abdomen. After specimen removal, the abdominal wall was closed with a double-layer semicontinuous absorbable suture using coated polyglactin 910 (Vicryl thickness 1, Ethicon, Inc).

LRH with ECA: pararectal incision

The surgical technique was the same as the one just described above, with some modifications described below. The ECA was a side-to-side isoperistaltic anastomosis performed through a pararectal incision. A 7-cm pararectal incision was made 2.5 cm from the midline, dividing the skin and anterior rectus sheath. The incision size was standardized using a sterile ruler. The anterior rectus sheath was separated from the muscle by sharp dissection, and the muscle was displaced medially.

Outcome measures

Postoperative complications, including hematoma, wound infection, pain, and bleeding, were documented daily. IH was defined per European Hernia Society guidelines as “any abdominal wall gap with or without a bulge in the area of a postoperative scar, perceptible or palpable by clinical examination or imaging” [12]. Wound events were classified according to the World Health Organization (WHO) guidelines [13], based on signs of inflammation (redness, warmth, pain, swelling), infection (fever, exudate, germ isolation), and clinical or instrumental assessment.

A radiologist with 10 years of experience in gastrointestinal ultrasonography conducted the ultrasound evaluation. The equipment used was an RS85 ultrasound device (Samsung Madison) equipped with an L3-12 A linear transducer. Patients were required to fast for at least 6 hours and were assessed in the supine position, both with and without deep breath-holding. The size and location of all hernias detected by ultrasound were documented. The criteria for diagnosing IH via ultrasound included the observation of a visible gap within the abdominal wall, tissue protruding through the abdominal wall during a Valsalva maneuver, or a detectable rupture along the suture line. An IH diagnosis was confirmed if it met either the clinical or ultrasound criteria. The mean operative time was reported in minutes, and the median hospitalization was reported in days. A colonic anastomotic leak was defined as a “leak of luminal contents from a surgical join between two hollow viscera,” diagnosed via CT [14]. Postoperative bleeding was defined as significant blood loss requiring reoperation. Pain was assessed using a visual analog scale [15], and wound events were classified according to the US Centers for Disease Control and Prevention (CDC) criteria (superficial, deep, or organ-space infections) [16, 17].

Study endpoints

The primary endpoint was to compare the incidence of IH between the study groups at 24 months after surgery. Herniation was identified through both clinical examination and ultrasound imaging. Patients routinely underwent clinical and ultrasound examinations during their clinic visits. Follow-up assessments were conducted at 1, 6, 12, and 24 months after surgery.

Secondary endpoints included the mean operative time and median duration of hospitalization. Additionally, perioperative complications were assessed, including leakage, postoperative bleeding, reoperation rates, pain, and wound events.

Statistical analysis

Statistical analysis was performed using Microsoft Excel 2011 (Microsoft Corp) and GraphPad Prism 9 (GraphPad Software). Categorical data were reported as numbers and percentages, and continuous data as mean±standard deviation or median and range, depending on distribution. Differences were assessed using unpaired t-tests (means), Mann-Whitney U-tests (medians), or Fisher exact tests (percentages). A P-value of <0.05 was considered statistically significant.

RESULTS

From January 1, 2019, to December 31, 2020, 149 patients were referred for right-sided colon cancer. Of these, 134 met the inclusion criteria and underwent LRH: 63 patients received ICA with a Pfannenstiel incision (group A), while 71 underwent ECA with a pararectal incision (group B). All cases involved primary cancer diagnoses.

Demographic and pathological data are presented in Table 1. Among the 134 patients, 76 were male (56.7%) and 58 were female (43.3%). The groups were demographically homogeneous, with no statistically significant differences in age, sex, BMI, or ASA physical status.

The median follow-up time was similar in both groups (21 months vs. 22 months, P=0.03). The mean operation time was longer in group A (190±45 minutes vs. 170±34 minutes, P=0.044). Anastomotic leakage occurred in 1 case in group A and 3 cases in group B. Two of these cases required surgical intervention through a midline incision, while the remaining patients were treated with abdominal drainage. No intraoperative bleeding was recorded. Postoperative bleeding occurred in 2 cases, 1 in each group, both requiring reoperation. The mean hospital stay was 3.2 days (range, 3–7 days) in group A and 4.6 days (range, 4–8 days) in group B (Table 2).

The 2-year estimated incisional hernia rate was 14.7% (10 of 68) for group B and 1.2% (2 of 61) for group A (P=0.044), as detailed in Table 3. Of all IHs, 90% were diagnosed within the first year of follow-up. No hernias required surgical repair during the study, and no cases of strangulated, incarcerated, or irreducible hernias were observed. Additionally, no patients exhibited signs of bowel obstruction or acute abdomen.

DISCUSSION

Laparoscopic surgery is associated with shorter hospital stays, less postoperative pain, and fewer complications, such as adhesions or IHs, compared to open surgery [1–5]. Within minimally invasive surgery, ICA offers several advantages over ECA. Notably, ICA reduces the incidence of surgical site infections, a common complication of both open surgery and ECA. During ECA, wound contamination due to bowel exposure increases surgical site infection risk [4, 6], whereas ICA avoids this by performing bowel resection within the abdominal cavity. However, some studies report a higher rate of abdominal abscesses with ICA than with ECA [3, 4, 6].

Numerous studies have compared the 2 approaches in terms of operation time, hospital stay, and short-term outcomes. Our findings show a shorter hospital stay for ICA patients (mean, 3.2 days), compared to ECA patients (mean, 4.6 days), which align with the previous studies [14]. Despite extensive research on short-term outcomes, medium- and long-term outcomes, particularly the incidence of IHs, have received less attention. To address this gap, we compared the 2 techniques using standardized incisions. A recent systematic review examined extraction-site IH rates after minimally invasive colorectal surgery [18]. A study by den Hartog et al. [19] found that non-midline incisions (transverse and paramedian) were associated with a lower odds ratio for IH compared to midline incisions (including umbilical). Among these, the Pfannenstiel incision had the lowest IH rate at 2%. Interestingly, seroma or surgical site infection occurrence was not correlated with incision type.

Current guidelines from the European Hernia Society and the American Hernia Society do not strongly recommend a specific closure technique. However, a weak recommendation favors continuous suturing with absorbable filament, which distributes tension more evenly along the suture line [20]. In our study, we used the small-bites continuous suturing technique, taking tissue bites 5 to 9 mm from the wound edges and incorporating only the aponeurosis, with stitches placed 5 mm apart to minimize tension. This approach aligns with recent guidelines. While abdominal wall closure technique was not directly linked to IH occurrence, several risk factors contribute to its development. High BMI (>30 kg/m²) and smoking were identified as significant risk factors. Conversely, the use of abdominal binders was not deemed protective due to insufficient evidence [21]. In our protocol, all patients used an abdominal binder for 2 months after surgery. In the present study, the IH rate after a Pfannenstiel incision was 1.2% in the ICA group, consistent with literature reports [22–23].

Although ICA is technically more demanding than ECA and requires extended surgical training, it offers significant short- and long-term benefits. One key advantage is the ability to choose the optimal site for specimen extraction. In contrast, ECA often necessitates transverse colon mobilization, with the incision dictated by bowel location. Recent studies by Hajibandeh et al. [24], Hoyuela et al. [25], Bianchi et al. [26], and Akingboye and Mahmood [27] have further elucidated the benefits and techniques of ICA, enhancing our understanding of its role in improving surgical outcomes. When a midline incision is required, the anatomical constraints of the transverse mesocolon often necessitate a higher abdominal incision. ICA eliminates this limitation, allowing surgeons to avoid midline incisions and reduce IH risk. Additionally, ICA enables a tailored approach to incision placement, considering preexisting scars and abdominal morphology.

Several limitations must be addressed: the retrospective nature of the study, the limited sample size, and the strict selection of patients to avoid bias. Further studies with a larger population are desirable.

In conclusion, ICA is associated with a longer operative time but also a shorter hospital stay compared to ECA, with a reduced rate of wound complications and IH.

ARTICLE INFORMATION

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Acknowledgments

The authors would like to thank Professor Giovanni Maria Romano for the manuscript revision.

Author contributions

Conceptualization: FSL, CG, FMM, MM, SP, LD; Data curation: FSL, CG, GdG, GN; Formal analysis: all authors; Investigation: FSL, CG, FMM, MM, SP, LD; Methodology: FSL, CG, FMM, MM, SP, LD; Writing–original draft: FSL, CG, FMM, MM, SP, LD; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Table 1.

Demographic and clinical characteristics of the patients (n=134)

Characteristic	Group A (n=63)	Group B (n=71)	P-value
Sex			0.657
Male	37 (58.7)	39 (54.9)
Female	26 (41.3)	32 (45.1)
Age (yr)	51.3 (43.2–59.4)	54.0 (44.4–63.6)	0.733
Site
Cecum
Ascending colon
Right
Hepatic flexure
Body mass index (kg/m²)	33.7±3.65 (30.1–37.0)	35.8±4.99 (30.0–40.8)	0.292
ASA physical status
I	21 (33.3)	17 (23.9)	0.228
II	29 (46.0)	31 (43.7)	0.783
III	13 (20.6)	23 (32.4)	0.125
Hypertension	29 (46.0)	39 (54.9)	0.392
Diabetes mellitus	3 (4.8)	4 (5.6)	0.543
Smoking	40 (63.5)	42 (59.2)	0.736
COPD	12 (19.0)	21 (29.6)	0.225
Chorticosteroid	3 (4.8)	4 (5.6)	0.870
Anticoagulant drug	17 (27.0)	23 (32.4)	0.621

Values are presented as number (%), median (range), or mean±standard deviation (range). Patients who had laparoscopic right hemicolectomy were divided into 2 groups: group A, intracorporeal ileocolic anastomosis with a Pfannenstiel incision for specimen extraction; and group B, extracorporeal ileocolic anastomosis with a pararectal incision.

ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease.

Table 2.

Perioperative outcomes (n=134)

Outcome	Group A (n=63)	Group B (n=71)	P-value
Operative time (min)	190±45	170±34	0.004
Length of hospital stay (day)	3.2 (3–7)	4.6 (4–8)	0.046
Anastomotic leakage	1 (1.6)	3 (4.2)	0.698
Postoperative bleeding	1 (1.6)	1 (1.4)	0.529
Reoperation	1 (1.6)	3 (4.2)	0.698

Values are presented as mean±standard deviation, mean (range), or number (%). Patients who had laparoscopic right hemicolectomy were divided into 2 groups: group A, intracorporeal ileocolic anastomosis with a Pfannenstiel incision for specimen extraction; and group B, extracorporeal ileocolic anastomosis with a pararectal incision.

Table 3.

Postoperative outcomes (n=129)

Outcome	Group A (n=61)	Group B (n=68)	P-value
Visual analog scale	4.7 (2–7)	6.3 (3–8)	0.004
Wound event	8 (13.1)	22 (32.4)	0.015
Superficial infection	53 (86.9)	58 (85.3)	0.853
Deep infection	8 (13.1)	10 (14.7)
Incisional hernia
Within 1 mo	0 (0)	1 (1.5)	0.056
Within 6 mo	1 (1.6)	3 (4.4)	0.045
Within 12 mo	2 (3.3)	9 (13.2)	0.044
Within 24 mo	2 (3.3)	10 (14.7)	0.044

Values are presented as median (range) or number (%). Patients who had laparoscopic right hemicolectomy were divided into 2 groups: group A, intracorporeal ileocolic anastomosis with a Pfannenstiel incision for specimen extraction; and group B, extracorporeal ileocolic anastomosis with a pararectal incision.

REFERENCES

1. Widmar M, Aggarwal P, Keskin M, Strombom PD, Patil S, Smith JJ, et al. Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay. Dis Colon Rectum 2020;63:685–92. Article PubMed PMC
2. Creavin B, Balasubramanian I, Common M, McCarrick C, El Masry S, Carton E, et al. Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and meta-analysis of randomized control trials. Int J Colorectal Dis 2021;36:645–56. Article PubMed PDF
3. Wang LM, Jong BK, Liao CK, Kou YT, Chern YJ, Hsu YJ, et al. Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy. World J Surg Oncol 2022;20:270.Article PubMed PMC PDF
4. Chen F, Lv Z, Feng W, Xu Z, Miao Y, Xu Z, et al. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a retrospective study. World J Surg Oncol 2023;21:154.Article PubMed PMC PDF
5. Gambardella C, Mongardini FM, Karpathiotakis M, Lucido FS, Pizza F, Tolone S, et al. Biosynthetic mesh reconstruction after abdominoperineal resection for low rectal cancer: cross relation of surgical healing and oncological outcomes: a multicentric observational study. Cancers (Basel) 2023;15:2725.Article PubMed PMC
6. Lee L, Abou-Khalil M, Liberman S, Boutros M, Fried GM, Feldman LS. Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc 2017;31:5083–93. Article PubMed PDF
7. Tan WS, Chew MH, Ho KS, Yatim JB, Lai JS, Tang CL. 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 2015;29:2720–7. Article PubMed PDF
8. Lim SW, Huh JW, Kim YJ, Kim HR. Vertical transumbilical incision versus left lower transverse incision for specimen retrieval during laparoscopic colorectal surgery. Tech Coloproctol 2013;17:59–65. Article PubMed PDF
9. Halm JA, Lip H, Schmitz PI, Jeekel J. Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 2009;13:275–80. Article PubMed PMC
10. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, et al. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg 2009;249:913–20. Article PubMed
11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014;12:1495–9. Article PubMed
12. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, et al. The European Hernia Society groin hernia classification: simple and easy to remember. Hernia 2007;11:113–6. Article PubMed PDF
13. World Health Organization (WHO). Global guidelines for the prevention of surgical site infection. WHO; 2016.PubMed
14. Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. Surg Oncol 2022;40:101708.Article PubMed
15. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81. Article PubMed PMC
16. Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–43. Article PubMed PDF
17. Onyekwelu I, Yakkanti R, Protzer L, Pinkston CM, Tucker C, Seligson D. Surgical wound classification and surgical site infections in the orthopaedic patient. J Am Acad Orthop Surg Glob Res Rev 2017;1:e022. Article PubMed PMC
18. Adjuvant therapy for patients with colon and rectum cancer. Consens Statement 1990;8:1–25.PubMed
19. Emile SH, Elfeki H, Shalaby M, Sakr A, Bassuni M, Christensen P, et al. Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis. Tech Coloproctol 2019;23:1023–35. Article PubMed PDF
20. den Hartog FP, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF, et al. The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2023;25:586–99. Article PubMed PDF
21. Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 2022;109:1239–50. Article PubMed PMC
22. Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg 2017;17:19.Article PubMed PMC PDF
23. Pizza F, D'Antonio D, Lucido FS, Brusciano L, Mongardini FM, Dell'Isola C, et al. IPOM plus versus IPOM standard in incisional hernia repair: results of a prospective multicenter trial. Hernia 2023;27:695–704. Article PubMed PDF
24. Hajibandeh S, Hajibandeh S, Mankotia R, Akingboye A, Peravali R. Meta-analysis of randomised controlled trials comparing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: upgrading the level of evidence. Updates Surg 2021;73:23–33. Article PubMed PDF
25. Hoyuela C, Guillaumes S, Ardid J, Hidalgo NJ, Bachero I, Trias M, et al. The impact of intracorporeal anastomosis in right laparoscopic colectomy in the surgical site infections and the hospital stay: a cohort study. Updates Surg 2021;73:2125–35. Article PubMed PDF
26. Bianchi PP, Salaj A, Giuliani G, Ferraro L, Formisano G. Feasibility of robotic right colectomy with complete mesocolic excision and intracorporeal anastomosis: short-term outcomes of 161 consecutive patients. Updates Surg 2021;73:1065–72. Article PubMed PDF
27. Akingboye A, Mahmood F. Intracorporeal stapled ileocolic anastomosis with mechanical closure of the enterotomy after laparoscopic right colectomy for cancer: keep it Simpler. Updates Surg 2021;73:357–8. Article PubMed PDF

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Incisional hernia risk in intracorporeal anastomosis with Pfannenstiel incision versus extracorporeal anastomosis with midline incision for laparoscopic right hemicolectomy: a multicenter comparison

DOI: https://doi.org/10.3393/ac.2024.00682.0097

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Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study of anastomotic complications

Incisional hernia risk in intracorporeal anastomosis with Pfannenstiel incision versus extracorporeal anastomosis with midline incision for laparoscopic right hemicolectomy: a multicenter comparison

Characteristic	Group A (n=63)	Group B (n=71)	P-value
Sex			0.657
Male	37 (58.7)	39 (54.9)
Female	26 (41.3)	32 (45.1)
Age (yr)	51.3 (43.2–59.4)	54.0 (44.4–63.6)	0.733
Site
Cecum
Ascending colon
Right
Hepatic flexure
Body mass index (kg/m²)	33.7±3.65 (30.1–37.0)	35.8±4.99 (30.0–40.8)	0.292
ASA physical status
I	21 (33.3)	17 (23.9)	0.228
II	29 (46.0)	31 (43.7)	0.783
III	13 (20.6)	23 (32.4)	0.125
Hypertension	29 (46.0)	39 (54.9)	0.392
Diabetes mellitus	3 (4.8)	4 (5.6)	0.543
Smoking	40 (63.5)	42 (59.2)	0.736
COPD	12 (19.0)	21 (29.6)	0.225
Chorticosteroid	3 (4.8)	4 (5.6)	0.870
Anticoagulant drug	17 (27.0)	23 (32.4)	0.621

Outcome	Group A (n=63)	Group B (n=71)	P-value
Operative time (min)	190±45	170±34	0.004
Length of hospital stay (day)	3.2 (3–7)	4.6 (4–8)	0.046
Anastomotic leakage	1 (1.6)	3 (4.2)	0.698
Postoperative bleeding	1 (1.6)	1 (1.4)	0.529
Reoperation	1 (1.6)	3 (4.2)	0.698

Outcome	Group A (n=61)	Group B (n=68)	P-value
Visual analog scale	4.7 (2–7)	6.3 (3–8)	0.004
Wound event	8 (13.1)	22 (32.4)	0.015
Superficial infection	53 (86.9)	58 (85.3)	0.853
Deep infection	8 (13.1)	10 (14.7)
Incisional hernia
Within 1 mo	0 (0)	1 (1.5)	0.056
Within 6 mo	1 (1.6)	3 (4.4)	0.045
Within 12 mo	2 (3.3)	9 (13.2)	0.044
Within 24 mo	2 (3.3)	10 (14.7)	0.044

Table 1. Demographic and clinical characteristics of the patients (n=134)

ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease.