Pfannenstiel versus periumbilical specimen extraction in laparoscopic low anterior resection: a comparative analysis of incisional hernia risk, postoperative recovery, and oncologic outcomes.
- 1Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea.
- 2Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea. [email protected].
Abstract
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.
Related
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BibTeX
@article{kang2026pfannenstiel,
title = {{Pfannenstiel versus periumbilical specimen extraction in laparoscopic low anterior resection: a comparative analysis of incisional hernia risk, postoperative recovery, and oncologic outcomes.}},
author = {Seung Yeon Kang and Dong Hyun Shin and Hyeon Woo Bae and Yoon Dae Han and Min Soo Cho and Hyuk Hur and Byung Soh Min and Kang Young Lee and Seung Yoon Yang},
journal = {Techniques in coloproctology},
year = {2026},
month = jul,
doi = {10.1007/s10151-026-03393-7},
url = {https://europepmc.org/article/MED/42894056},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pfannenstiel versus periumbilical specimen extraction in laparoscopic low anterior resection: a comparative analysis of incisional hernia risk, postoperative recovery, and oncologic outcomes.
AU - Seung Yeon Kang
AU - Dong Hyun Shin
AU - Hyeon Woo Bae
AU - Yoon Dae Han
AU - Min Soo Cho
AU - Hyuk Hur
AU - Byung Soh Min
AU - Kang Young Lee
AU - Seung Yoon Yang
PY - 2026
DA - 2026/07/22
JO - Techniques in coloproctology
DO - 10.1007/s10151-026-03393-7
UR - https://europepmc.org/article/MED/42894056
AB - 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.
SN - 1123-6337
SN - 1128-045X
ER -