Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?



Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied.


A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed.


Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision.


Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.

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Authors would like to acknowledge Dr. Esteban Collazo, Dr. Alonso Lera, Dr. Anula, Dr. Sanz-Ortega, and Dr. Zuloaga for their clinical work in the Unit of Colorectal Surgery. We would also like to acknowledge their work to the Unit of Abdominal Wall Surgery of our center, for their help to treat patients with incisional hernias after colorectal surgery.

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Correspondence to Oscar Cano-Valderrama.

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Dr. Oscar Cano-Valderrama, Rodrigo Sanz-López, Inmaculada Domínguez-Serrano, Jana Dziakova, Vanesa Catalán, Mikel Rojo, Mauricio García-Alonso, José M. Mugüerza, and Antonio J. Torres have no conflicts of interest or financial ties to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by the Institutional Review Board (Code: 18/514-E).

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Cano-Valderrama, O., Sanz-López, R., Domínguez-Serrano, I. et al. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?. Surg Endosc 34, 4048–4052 (2020). https://doi.org/10.1007/s00464-019-07194-y

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  • Incisional hernia
  • Colorectal surgery
  • Laparoscopic surgery
  • Abdominal wall
  • Extraction-site hernia
  • Port-site hernia