Incisional hernia after sugery for diverticular disease

  • Zuzana Adamova
Keywords: diverticular disease, laparoscopy, open surgery, sigma resection, incisional hernia

Abstract

Background Incisional hernia after open surgery is a well-known complication. A retrospective study was conducted to determine the incidence and predisposing factors of incisional hernia after colonic surgery for diverticular disease. Methods A retrospective cohort of 105 consecutive patients undergoing either laparoscopic or open surgery for complicated diverticulosis between January 2000 and December 2010 was identified. The influence of demographic data, surgical approach and timing for incisional hernia development were analysed. Statistical evaluation was performed using the chisquare test according to Pearson and Mann-Whitney test. Results In a group of 31 men and 74 women, with an average age of 67 years, incisional hernia developed in 27 patients (26%) at a mean follow-up of 5.5 years. Incisional hernia was found in two of 23 patients (9%) in the laparoscopic surgery group compared with 25 of 82 patients (30%) in the open surgery group (P = 0.03). We did not prove a higher risk for incisional hernia after acute surgery (P = 0.6). Significant demographic factor influencing incisional hernia incidence was female gender (P = 0.003), but not age (P = 0.43). Mean time to hernia occurrence was 1.5 years. Conclusion Laparoscopic surgery leads to a significantly lower incidence of incisional hernia compared to open surgical technique. Female gender represents a higher risk for incisional hernia than acute surgery or age. Because laparoscopy is more feasible as elective surgery, when speaking of incisional hernia, we should recommend sigmoid resections early, especially to women.

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References

Hobson KG, Roberts PL. Etiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg 2004 Aug;17(3): 147−153.

Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther 2009 Sep;15;30(6): 532−546.

Beckham H, Whitlow CB. The medical and nonoperative treatment of diverticulitis. Clin Colon Rectal Surg 2009 Aug;22(3): 156−160.

Lopez DE, Brown CV. Diverticulitis: the most common colon emergency for the acute care surgeon. Scand J Surg 2010;99(2):86−89.

Soumian S, Thomas S, Mohan PP, Khan N, Khan Z, Raju T. Management of Hinchey II diverticulitis. World J Gastroenterol 2008 Dec;21; 14(47): 7163–7169.

Constantinides VA, Heriot A, Remzi F, et al. Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann's procedures. Ann Surg 2007 Jan;245(1): 94−103.

Boudart C, Simoens Ch, Thill V, Debergh N, Smets D, Mendes da Costa P. Management of sigmoid diverticulitis: a retrospective study of 268 patients. Hepatogastroenterology 2008 Nov−Dec;55(88):2065−2071.

Andersen JC, Bundgaard L, Elbrond H, et al. Danish national guidelines for treatment of diverticular disease. Dan Med J 2012 May;59(5): C4453.

Berthou JC, Charbonneau P. Elective laparoscopic management of sigmoid diverticulitis. Results in a series of 110 patients. Surg Endosc 1999 May;13(5): 457−460.

Garrett KA, Champagne BJ, Valerian BT, Peterson D, Lee EC. A single training center's experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically? Surg Endosc 2008 Nov;22(11): 2503−2508. Epub 2008 Mar 18.

Duepree HJ, Senagore AJ, Delaney CP, Fazio VW. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 2003 Aug;197(2): 177−181.

Ihedioha U, Mackay G, Leung E, Molloy RG, O'Dwyer PJ. Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 2008 Mar;22(3): 689−692.

Andersen LP, Klein M, Gogenur I, Rosenberg J. Incisional hernia after open versus laparoscopic sigmoid resection. Surg Endosc 2008 Sep;22(9): 2026−2029. Epub 2008 Apr 25.

Hoer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 2002 May;73(5): 474−480.

Grantcharov TP, Rosenberg J. Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 2001 Apr;167(4): 260−267.

Mingoli A, Puggioni A, Sgarzini G, et al. Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol 1999 Aug−Sep;31(6): 449−453.

Adell-Carceller R, Segarra-Soria MA, Pellicer-Castell V, et al. Incisional hernia in colorectal cancer surgery. Associated risk factors. Cir Esp 2006 Jan;79(1): 42−45.

Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgensen LN. Smoking is a risk factor for incisional hernia. Arch Surg 2005 Feb;140(2): 119−123.

Turunen P, Wikstrom H, Carpelan-Holmstrom M, Kairaluoma P, Kruuna O, Scheinin T. Smoking increases the incidence of complicated diverticular disease of the sigmoid colon. Scand J Surg 2010;99(1):14−17.

Lumley J, Stitz R, Stevenson A, Fielding G, Luck A. Laparoscopic colorectal surgery for cancer: intermediate to long-term outcomes. Dis Colon Rectum 2002 Jul;45(7): 867−872.

Regadas FS, Rodrigues LV, Nicodemo AM, Siebra JA, Furtado DC, Regadas SM. Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc 1998 Jun;8(3):189−192.

Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 2008 Jul;95(7): 903−908.

DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 2011 Apr;25(4): 1031−1036. Epub 2010 Aug 25.

Singh R, Omiccioli A, Hegge S, McKinley C. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 2008 Dec;22(12): 2596−2600. Epub 2008 Mar 18.

Burger JW, van't Riet M, Jeekel J. Abdominal incisions: techniques and postoperative complications. Scand J Surg 2002;91(4): 315−321.

Published
2013-08-20
How to Cite
1.
Adamova Z. Incisional hernia after sugery for diverticular disease. Acta Chir. Croat. [Internet]. 2013Aug.20 [cited 2020Oct.28];10(1):15-8. Available from: https://acc.hkd.com.hr/index.php/ACC/article/view/24
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