# Comparison of Paramedian Versus Midline Extraction Sites in Elective Laparoscopic Right Colectomy: A Propensity-Matched Study of Postoperative Ventral Hernia Development

## TL;DR

Using a paramedian extraction site during laparoscopic right colectomy reduces the risk of postoperative ventral hernias compared to midline sites.

## Contribution

This study provides evidence that paramedian extraction sites lower hernia risk and identifies modifiable risk factors like chronic cough and constipation.

## Key findings

- Paramedian extraction sites had a 2.3% POVH rate versus 11.3% for midline sites.
- Midline extraction was a strong independent predictor of POVH (aOR 30.3).
- Chronic cough and constipation were also significant predictors of POVH.

## Abstract

Background: Postoperative ventral hernia (POVH) remains a significant complication following laparoscopic colectomy despite minimally invasive approaches. Extraction site selection may influence POVH incidence, yet optimal location remains controversial. Methods: This retrospective cohort study analyzed 550 patients undergoing elective laparoscopic right colectomy (2009–2024) at a single center. After exclusions for anastomotic leak and loss to follow-up, 266 patients were propensity-matched 1:1 comparing paramedian (n = 133) versus midline (n = 133) extraction sites. The primary outcome was POVH incidence at 36 months. Secondary outcomes included risk factor identification using multivariate logistic regression and Firth penalized methods. Results: POVH occurred in 3/133 (2.3%) paramedian versus 15/133 (11.3%) midline patients (p = 0.007). Multivariate analysis identified midline extraction (aOR 30.3, 95% CI: 3.34–969, p < 0.001), chronic cough (aOR 25.6, 95% CI: 3.56–287, p = 0.001), and constipation (aOR 10.1, 95% CI: 1.60–70.7, p = 0.015) as independent POVH predictors. Patient comorbidities showed stronger associations than surgical factors in univariate analysis. The number needed to treat with paramedian extraction to prevent one POVH was 11.1. Conclusions: Paramedian extraction sites significantly reduce POVH incidence compared to midline approaches in laparoscopic right colectomy. The identification of modifiable physiological risk factors, particularly conditions causing increased intra-abdominal pressure (chronic cough, constipation), suggests that comprehensive perioperative optimization targeting these specific factors may further reduce POVH risk.