Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Incidence of incisional hernia following liver surgery for colorectal liver metastases. Does the laparoscopic approach reduce the risk? A comparative study

  • Ahmed Hassan (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Kalaiyarasi Arujunan (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Ali Mohamed (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Vickey Katheria (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Kevin Ashton (University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary) ;
  • Rami Ahmed (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Daren Subar (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital)
  • Received : 2023.11.02
  • Accepted : 2024.01.24
  • Published : 2024.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions: In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

Keywords

References

  1. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 2014;101:1439-1447. https://doi.org/10.1002/bjs.9600
  2. Chen-Xu J, Bessa-Melo R, Graca L, Costa-Maia J. Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors. Hernia 2018;23:67-79.
  3. Le Huu Nho R, Mege D, Ouaissi M, Sielezneff I, Sastre B. Incidence and prevention of ventral incisional hernia. J Visc Surg 2012;149:e3-14. https://doi.org/10.1016/j.jviscsurg.2012.05.004
  4. Nilsson JH, Strandberg Holka P, Sturesson C. Incisional hernia after open resections for colorectal liver metastases - incidence and risk factors. HPB 2016;18:436-441. https://doi.org/10.1016/j.hpb.2016.02.001
  5. Togo S, Nagano Y, Masumoto C, Takakura H, Matsuo K, Takeda K, et al. Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 2008;12:1115-1120. https://doi.org/10.1007/s11605-008-0469-z
  6. D'Angelica M, Maddineni S, Fong Y, Martin RCG, Cohen MS, Ben-Porat L, et al. Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg 2006;30:410-418. https://doi.org/10.1007/s00268-005-0183-x
  7. Cos H, Ahmed O, Garcia-Aroz S, Vachharajani N, Shenoy S, Wellen JR, et al. Incisional hernia after liver transplantation: risk factors, management strategies and long-term outcomes of a cohort study. Int J Surg 2020;78:149-153. https://doi.org/10.1016/j.ijsu.2020.04.048
  8. Arslan MK, Aydin C, Topaloglu S, Calik A, Tomas K, Karabulut E. Incidence of and risk factors for incisional hernia after liver surgery performed with a J-Shaped right subcostal incision. Am Surg 2017;83:e49-53. https://doi.org/10.1177/000313481708300204
  9. Bismuth H, Chiche L. Surgery of hepatic tumors. Prog Liver Dis 1993;11:269-285.
  10. Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 2018;267:199-207. https://doi.org/10.1097/SLA.0000000000002353
  11. Kuemmerli C, Fichtinger RS, Moekotte A, Aldrighetti LA, Aroori S, Besselink MGH, et al. Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre randomised controlled trial. Trials 2022;23:206.
  12. Maurette RJ, Ejarque MG, Mihura M, Bregante M, Bogetti D, Pirchi D. Laparoscopic liver resection in metastatic colorectal cancer treatment: comparison with long-term results using the conventional approach. Ecancermedicalscience 2017;11:775.
  13. Chiang MH, Tsai KY, Chen HA, Wang WY, Huang MT. Comparison of surgical outcomes for laparoscopic liver resection of large hepatocellular carcinomas: a retrospective observation from single-center experience. Asian J Surg 2021;44:1376-1382. https://doi.org/10.1016/j.asjsur.2021.03.027
  14. Tian F, Leng S, Chen J, Cao Y, Cao L, Wang X, et al. Long-term outcomes of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: a single-center 10-year experience. Front Oncol 2023;13:1112380.
  15. Darnis B, Mohkam K, Golse N, Vibert E, Cherqui D, Cauchy F, et al. Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study. Surg Endosc 2021;35:5034-5042. https://doi.org/10.1007/s00464-020-07985-8
  16. Mishra A, Keeler BD, Maxwell-Armstrong C, Simpson JA, Acheson AG. The influence of laparoscopy on incisional hernia rates: a retrospective analysis of 1057 colorectal cancer resections. Colorectal Dis 2014;16:815-821. https://doi.org/10.1111/codi.12687
  17. Guilbaud T, Feretti C, Holowko W, Garbarino GM, Marchese U, Sarran A, et al. Laparoscopic major hepatectomy: do not underestimate the impact of specimen extraction site. World J Surg 2020;44:1223-1230. https://doi.org/10.1007/s00268-019-05285-4
  18. Wabitsch S, Schulz P, Froschle F, Kastner A, Fehrenbach U, Benzing C, et al. Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 2021;35:1108-1115. https://doi.org/10.1007/s00464-020-07475-x
  19. Maki H, Kim BJ, Kawaguchi Y, Fernandez-Placencia R, Haddad A, Panettieri E, et al. Incidence of and risk factors for incisional hernia after hepatectomy for colorectal liver metastases. J Gastrointest Surg 2023;27:2388-2395. https://doi.org/10.1007/s11605-023-05777-8
  20. Haueter R, Schutz T, Raptis DA, Clavien PA, Zuber M. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 2017;104:1141-1159. https://doi.org/10.1002/bjs.10574
  21. Milas M, Devedija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 2014;12:271-289. https://doi.org/10.1016/j.surge.2014.01.009
  22. Sangster W, Kulaylat AN, Stewart DB, Schubart JR, Koltun WA, Messaris E. Hernia incidence following single-site vs standard laparoscopic colorectal surgery. Colorectal Dis 2015;17:250-256. https://doi.org/10.1111/codi.12797
  23. Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H. Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 2016;59:743-750. https://doi.org/10.1097/DCR.0000000000000632