The Clinical Researchof Abdominal Auxiliary Incision Selectionin Laparoscopic Colorectal Surgery

Aim: With the progress in minimal invasive techniques and innovation of laparoscopic equipment,colorectal surgery has make great improvement in specimens extraction,which is emerging towards a less traumatic and more accurate direction.There is no universal methods for extracting specimens in colorectal surgery.In our study,we aimed at investigating the value of different abdominal auxiliary incisions intraoperatively and postoperatively in laparoscopic colorectal cancer.We expect to determine a operable and less morbidity-related incision to offer for future consideration in laparoscopic colorectal surgery.Methods: From December,2012 to June,2016,277 patients were retrospectively evaluated under certain prospectively determined inclusion and exclusion criteria.The patients were divided into 3 groups according to their abdominal incisions,98 patients in the transverse suprapubic incision,ninety-two patients in the midline incision and 87 patients in the trans-rectus abdominis incision group.General characteristics,intraopetive and postoperative outcomes,hospital stay and follow-ups were compared.Incisional infection rate,incisional hernia rate of different incision were analyzed.Results: All procedures were performed successfully without any in-hospital mortality.The patients were comparable in age,gender,ASA and BMI parameters between the groups.There was no significant difference in operating time between the transverse suprapubic incision group and the midline incision group(136.20±36.67 min vs.137.12±36.43 min,P>0.05),but both the groups differed significantly from the trans-rectus abdominis incision group(121.69±38.14min).The mean length of the transverse suprapubic incision group,the midline incision group and the trans--rectus abdominis incision group were 4.37±0.67 cm,5.19±1.82 cm and 5.83±1.99 cm respectively.There were significant differences between each group.No significant differences were found in intraoperative bleeding and postoperative hospital stay from each group.No incisional dehiscence occured in any of the groups,neither did any incisional recurrence during follow-ups.The total incisional infection rate was 8.3%(23/277),11.9% for the midline incision group and 10.3% for the trans-rectus abdominis incision group,the differences between these two groups didn't reach significant level(P>0.05).However,these two groups differed significantly comparing with the transverse suprapubic incision group(P < 0.05).During follow-ups,13 patients had different degree of incisional hernia(4.7%).Within these patients,seven were from the trans-rectus abdominis incision group and 6 were from the midline incision group.No significant difference were found between these two group but when comparing with the transverse suprapubic incision group,which no incisional hernia occured,there were significant differences between each of the comparison(P < 0.05).There were no significant differences in reducing postoperative incisional infection rate and incisional hernia rate between the midline incision and transrectus abdominis incision when he tumor is located in the ileocecal junction,Ascending,transverse and descending(P>0.05).Conclusion: The tumor is located in the rectum and sigmoid colon:distinct advantages could be found in reducing postoperative incisional infection rate and incisional hernia rate when applying a transverse suprapubic incision comparing to the midline incision and the transrectus abdominis incision;The tumor is located in the ileocecal junction,Ascending,transverse and descending: There were no significant differences in reducing postoperative incisional infection rate and incisional hernia rate between the midline incision and transrectus abdominis incision.