[Comparative analysis of longitudinal and transverse minilaparotomy during colon cancer surgery].

Abstract

Background: The steady increase in the incidence of colorectal cancer and its early diagnosis contribute to the identification of resectable forms of this disease, which in turn increases the number of minimally invasive surgical interventions. Therefore, the question of studying the influence of risk factors for the development of hernias and the search for an "ideal" place on the abdominal wall, which would provide the most convenient access for safe removal of the macropreparation and subsequent extracorporeal surgical procedures, as well as a low incidence of wound complications and postoperative ventral hernias, is the most pressing issue in colon cancer surgery.

Objective: To study the differences in the incidence of postoperative ventral hernias during transabdominal extraction of the specimen depending on the type of access after minimally invasive colon resections for cancer, and to evaluate the risk factors for the occurrence of postoperative hernias.

Material and methods: We retrospectively analyzed the medical records of 216 patients who underwent colon resection at the Botkin Medical Scientific and Clinical Center from January 2022 to September 2023. We used a cohort study to determine the impact of the type of access after minimally invasive colon resections for cancer on the incidence of postoperative ventral hernias. The formation of postoperative hernias was detected when longitudinal minilaparotomy was used for the extracorporeal stage of the operation or extraction of the removed preparation.

Results: Of the 216 patients included in the study, 3 patients dropped out according to the exclusion criteria, so 213 patients were analyzed. Median criteria for operative time and blood loss did not differ (p>0.05) in both groups. There were no differences depending on the technique of videoendoscopic intervention used p=(0.762). A strong tendency to use a longitudinal approach was also observed when performing minimally invasive right hemicolectomy (p=0.051), and for distal colon resections, Pfanenstiel minilaparotomy was performed significantly more often (p=0.047). Among patients who underwent transverse minilaparotomy for the extracorporeal stage of surgery or extraction of the removed specimen, hernias in the incision area did not develop (p=0.0001), and in the longitudinal minilaparotomy group, hernias in the area of the access performed were detected in 21.9% of the operated patients.

Conclusion: In our study, patients who underwent minimally invasive radical surgery for colon cancer using the longitudinal minilaparotomy method had a higher risk of hernia compared with patients who underwent surgery using transverse approaches.