Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction.

INTRODUCTION: Incisional hernia is a common complication of laparoscopic colorectal surgery. Extraction site may influence the rate of incisional hernias. Major risk factors for the development of incisional hernias include age, diabetes, obesity and smoking status. In this study, we investigated the effect of specimen extraction site on incisional hernia rate. METHODS: Two cohorts of patients who underwent laparoscopic colorectal resections in a single centre in 2005 (n=85) and 2009 (n=139) were studied retrospectively. In 2005 all specimens were extracted through transverse muscle cutting incisions. In 2009 all specimens were extracted through midline incisions. Demographic variables, rate of incisional hernias and risk factors for hernia development were compared between the year groups. All patients had been followed up clinically for two years. RESULTS: A total of 224 patients (mean age: 67.5 years, standard deviation: 16.35 years) were included in this study. Of these, 85 patients were in the 2005 transverse group and 139 were in the 2009 midline group. The total incisional hernia rate for the series was 8.0% at the two-year follow-up visit. For the 2005 group, the incisional hernia rate was 15.3% (n=13) and for the 2009 group, it was 3.6% (n=5) (p<0.01). The body mass index was higher in patients who developed incisional hernias than in those who did not (p=0.02). CONCLUSIONS: The 2005 group had a significantly higher incisional hernia rate than the 2009 group. This is due to the differences in the incision technique and extraction site between the two groups.

Activities and users' views of a special seating clinic.

We carried out an audit of the activities of a subregional special seating clinic from the departmental records covering a period of 1 year. A total of 113 patients were seen in the clinic; 64.6% of these were first-time referrals. Cerebral palsy was given as the primary diagnosis for 84.9% of the patients and the mean age was 12.2 years; 62.8% of the patients were provided with special seats, whereas 21.2% needed only a change of wheelchair to a more appropriate model. Though there appears to be a fairly high degree of satisfaction of the special seating clinic, the need for agreed and recorded goals at the assessment clinics, regular review arrangements and further research into usage pattern, as well as in other areas of special seating, is identified.