European Journal of Biomedical and Pharmaceutical Sciences

OPTIMIZING SPECIMEN EXTRACTION IN LAPAROSCOPIC COLORECTAL CANCER: LONG-TERM OUTCOMES OF THE PFANNENSTIEL VS. TRANSVERSE LEFT LOWER QUADRANT INCISION

Khaled M. Mestareehy*, Abdullah Akef Abu Anzeh, Ehab M. Alazzam, Ali A. Bani Younis, Muhanad M. Alrabee and Ahmad A. Uraiqat

ABSTRACT

For over a century, the Pfannenstiel incision has remained the most important incision in gynecological cesarean sections. Nevertheless, there is limited data on its application in laparoscopic surgery for the extraction of specimens in the treatment of colorectal cancer. We aimed to analyze and share our experience by comparing the incidence of surgical site infections and incisional hernias in patients who underwent specimen extraction through the Pfannenstiel incision and Transverse Left Lower Quadrant Incision (TLLQI) in laparoscopic colorectal surgery at our hospital over seven years. A retrospective evaluation was conducted on patients who underwent specimen extraction through the Pfannenstiel and TLLQI during elective laparoscopic colorectal cancer surgery. We selected a total of 236 patients who underwent surgery at King Hussein Military Hospital in Amman, Jordan, between September 2015 and June 2022. Surgical site infection and incisional hernia were evaluated. And data from outpatient follow-up were analyzed. The incidence of surgical site infections and incisional hernias was compared using Fisher's exact test. Results: Among the 236 patients included, 152 underwent specimen extraction via the Pfannenstiel incision, while 84 patients had a TLLQI. The Pfannenstiel incision group had a significantly lower incidence of incisional hernias (2.4%) compared to the TLLQI group (13%, p = 0.0177). Surgical site infections occurred in 4.8% of the Pfannenstiel incision group and 1.2% of the TLLQI group (p = 0.367). Importantly, no mortality was documented, indicating overall safety for both approaches. Conclusion: When performing laparoscopic surgery for colorectal cancer, the Pfannenstiel incision is an excellent choice for specimen extraction due to its favorable outcomes. Compared to the TLLQI, the Pfannenstiel incision has a significantly lower risk of incisional hernia when used for laparoscopic surgical specimen extraction.

Keywords: Pfannenstiel, TLLQI, extraction site, incisional hernia, laparoscopic colorectal surgery, colorectal surgery.