Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients

Abstract

Background: Studies have evaluated long- term occurrence of incisional hernia, cosmesis and postoperative pain after single incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. We performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period. Methods: All patients that underwent SILC at the XXX Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale). Results: In total 125 patients underwent SILC. The single incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 2.4% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6% an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (Visual Analog Scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar. Conclusion: The present study demonstrates that SILC is a safe alternative in terms incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow- up period and multiport laparoscopic cholecystectomy our result is comparable.

Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery

“…While single-incision laparoscopic surgery (SILS) offers the advantage of reduced abdominal wall trauma and improved cosmetic outcomes[ 81 ], studies indicate that the risk of developing IH is three times higher with SILS compared to traditional laparoscopic procedures[ 82 ], particularly when the umbilicus is used as the incision site[ 83 ]. Special consideration should be given to individuals at high risk for laparoscopic IH, and surgical choices including minimally invasive methods should be approached with great care.…”