DOI: 10.1093/bjs/znad258.329 ISSN:

205 Single-Centre Review on Incisional Hernia After Laparoscopic Anterior Resection: What Is the Ideal Incision for Specimen Extraction?

M Win, W Htet, V Ngo, T Jeyam, R Rajaganeshan
  • Surgery



Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution.


We retrospectively reviewed data of 90 cases of LAR from May 2015 to February 2018. Patients were divided into three groups such as Pfannenstiel, iliac fossa (ILF) and midline. Age, sex, BMI, diabetes, steroid use, smoking, wound infection, hernia, post-operative hospital stays (HS) and length of follow up (LOF) were compared among these groups.


There were 13, 44 & 33 patients in Pfannenstiel, ILF and midline groups. There was no significant difference in age, gender, BMI, smoking, steroid use, and mean LOF among groups. Patients in the ILF group had the highest prevalence of diabetes (27%), mean BMI of 28.91, rate of wound infection (16%), and incidence of incisional hernia (16%). The midline group had the highest mean age of 72.45 years and the longest HS of 11.45 days (p < 0.003). At 49-month follow up, none of the Pfannenstiel group developed wound infection or IH (0%). However, there was no strong association between hernia and type of incision (p 0.248).


Although Pfannenstiel incision was found to have the lowest rate of IH, the analysis was not significant due to the small sample. We suggest future studies to have larger samples with proper randomization to propose that Pfannenstiel is the ideal incision for specimen extraction.

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