EVALUATION OF A TRANSUMBILICAL INCISION AS AN APPROACH FOR ORGAN REMOVAL IN LAPAROSCOPIC GASTRIC AND COLORECTAL SURGERY
Kodai Tomioka*, Takeshi Aoki, Tomotake Koizumi, Makoto Watanabe, Akira Fujimori, Yuta Enami, Tomokazu Kusano, Kazuhiro Matsuda, Kosuke Yamada, Koji Nogaki, Yoshihiko Tashiro, Yusuke Wada, Tomoki Hakozaki, Hideki Shibata, Takahito Hirai, Keitaro Mitamura, Reiko Koike, Satoru Goto, Kimiyasu Yamazaki, Osamu Yoshitake, Koji Otsuka, Masahiko Murakami
Gastroenterological and General Surgery, Showa University, Tokyo, Japan
Objective
Transumbilical incision (TUI) is often used in laparoscopic surgery. TUI has been performed to remove resected organs since shortly after the introduction of laparoscopic surgery in our department. For TUI, the umbilical wound is extended vertically, corresponding to the size of the specimen, and anastomosed extracorporeally. Here we evaluated the complication rates and risk factors associated with TUI in laparoscopic gastrectomy (LG) and laparoscopy-assisted colectomy (LAC) in a cohort study.
Experimental study
Method
The complication rates of TUI between LG and LAC were compared for 643 consecutive patients who underwent laparoscopic surgery between 2010 and 2013. Superficial surgical site infection and transumbilical port site hernia were recorded. The participants underwent either LG (n = 253) or LAC (n = 390).
Results
Surgical site infection was observed in 17 cases (15 LAC and 2 LG) (2.64%), with a higher rate for LAC (OR, 5.020; p = 0.022). Hernia occurred in 23 cases (22 LAC and 1 LG) (3.53%), with a significantly higher rate for LAC (OR, 13.052; p < 0.001). Female gender (OR, 5.410; p = 0.021) and a history of diabetes mellitus (OR, 4.437; p = 0.009) contributed to the risk of developing hernia in LG and LAC. Especially, surgical site infection occurred at a significantly higher rate in LAC than in LG, with the most likely cause being bacterial contamination at extracorporeal manipulation for resection and anastomosis. Thus, we limited the procedure to LAC and performed a reevaluation. In order to consider the influence of contaminating bacteria and other factors, anastomotic method and anastomosis site (intra/extra abdominal) were added to reevaluation.
Validation study
Method
A total of 348 consecutive patients who underwent LAC (42 patients were excluded due to unknown details regarding anastomosis) were enrolled.
Results
Surgical site infection was observed in 15 patients (4.31%), with no obvious associated risk factors. Hernia occurred in 23 patients (6.61%); multivariate analysis revealed that female gender (OR, 4.736; 95% CI, 1.058-24.362; p = 0.042) and diabetes mellitus (OR, 4.655; 95% CI, 1.520-13.585; p = 0.004) were significantly associated with the risk of hernia. Anastomotic method and the anastomosis site did not contribute to the occurrence of complications. Our findings suggest that colorectal resection may be a risk factor for TUI complications.
Conclusion
Female gender and diabetes mellitus are independent risk factors for hernia formation in patients undergoing transumbilical incision for organ removal in laparoscopic gastric resection and LAC. Surgical site infection and hernia occurred at a significantly higher rate in colorectal resection than in gastric resection in laparoscopic surgery. Moreover, anastomosis methods and the anastomosis site (intra/extra abdominal) did not contribute to the occurrence of complications.
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