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Background <p>Incisional hernia is a common long-term complication following colorectal surgery. In laparoscopic low anterior resection (LAR) for rectal cancer, specimen extraction is most commonly performed via a periumbilical midline incision, although the Pfannenstiel incision has emerged as an alternative approach with the potential to reduce hernia rates. However, its adoption has been limited by technical demands, and comparative evidence in a homogeneous rectal cancer cohort remains scarce. This study compared incisional hernia risk, postoperative recovery, and oncologic outcomes according to extraction site in laparoscopic LAR.</p> Methods <p>This retrospective cohort study included patients who underwent laparoscopic LAR for rectal cancer between 2014 and 2021. Specimen extraction was performed via either a Pfannenstiel incision or a periumbilical midline incision. The primary outcome was incisional hernia at the extraction site, assessed by computed tomography. Secondary outcomes included postoperative recovery, perioperative complications, and long-term oncologic outcomes. Risk factors for incisional hernia were evaluated using Cox proportional hazards regression.</p> Results <p>Among 242 patients, 115 underwent Pfannenstiel extraction and 127 periumbilical extraction. Incisional hernia occurred in one patient (0.9%) in the Pfannenstiel group and 12 patients (9.4%) in the periumbilical group (<i>p</i> = 0.003). Pfannenstiel extraction was associated with shorter hospital stay, earlier return of bowel function, and lower analgesic requirements. On multivariable analysis, periumbilical extraction was an independent risk factor for incisional hernia. Disease-free and overall survival were comparable between groups.</p> Conclusions <p>Pfannenstiel specimen extraction was associated with a lower risk of incisional hernia and improved postoperative recovery after laparoscopic LAR without compromising oncologic outcomes, supporting its use as an effective specimen retrieval option in minimally invasive rectal cancer surgery.</p>

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Pfannenstiel versus periumbilical specimen extraction in laparoscopic low anterior resection: a comparative analysis of incisional hernia risk, postoperative recovery, and oncologic outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月22日

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  • Seung Yeon Kang,
  • Dong Hyun Shin,
  • Hyeon Woo Bae,
  • Yoon Dae Han,
  • Min Soo Cho,
  • Hyuk Hur,
  • Byung Soh Min,
  • Kang Young Lee,
  • Seung Yoon Yang

摘要

Background

Incisional hernia is a common long-term complication following colorectal surgery. In laparoscopic low anterior resection (LAR) for rectal cancer, specimen extraction is most commonly performed via a periumbilical midline incision, although the Pfannenstiel incision has emerged as an alternative approach with the potential to reduce hernia rates. However, its adoption has been limited by technical demands, and comparative evidence in a homogeneous rectal cancer cohort remains scarce. This study compared incisional hernia risk, postoperative recovery, and oncologic outcomes according to extraction site in laparoscopic LAR.

Methods

This retrospective cohort study included patients who underwent laparoscopic LAR for rectal cancer between 2014 and 2021. Specimen extraction was performed via either a Pfannenstiel incision or a periumbilical midline incision. The primary outcome was incisional hernia at the extraction site, assessed by computed tomography. Secondary outcomes included postoperative recovery, perioperative complications, and long-term oncologic outcomes. Risk factors for incisional hernia were evaluated using Cox proportional hazards regression.

Results

Among 242 patients, 115 underwent Pfannenstiel extraction and 127 periumbilical extraction. Incisional hernia occurred in one patient (0.9%) in the Pfannenstiel group and 12 patients (9.4%) in the periumbilical group (p = 0.003). Pfannenstiel extraction was associated with shorter hospital stay, earlier return of bowel function, and lower analgesic requirements. On multivariable analysis, periumbilical extraction was an independent risk factor for incisional hernia. Disease-free and overall survival were comparable between groups.

Conclusions

Pfannenstiel specimen extraction was associated with a lower risk of incisional hernia and improved postoperative recovery after laparoscopic LAR without compromising oncologic outcomes, supporting its use as an effective specimen retrieval option in minimally invasive rectal cancer surgery.