ArticleTechniques in coloproctology2026
Pfannenstiel versus periumbilical specimen extraction in laparoscopic low anterior resection: a comparative analysis of incisional hernia risk, postoperative recovery, and oncologic outcomes.
Article in Techniques in coloproctology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIncisional 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.
methodsThis 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.
resultsAmong 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.
conclusionsPfannenstiel 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.
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