Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

Abstract

Background and Objectives:Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.Methods:All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.Results:A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up.Conclusion:Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

“…It has been argued against single port laparoscopy that there could be a higher rate of incisional hernia. [26][27][28][29][30][31] We did not find any such difference, and we actually believe that it is easier to close the fascial wound after single port laparoscopy because the larger skin incision facilitates the closing. Longer follow-up time should in any case be employed to re-evaluate whether incisional hernia rates continue to be equal in both groups.…”

Laparoscopic 5-mm port site hernia: a rare but preventable complication of laparoscopy

“…4 Some authors indicated that they believe that because of the substantially thickened preperitoneal space and increased intra-abdominal pressure, there is a tendency to improperly close the fascial defect in obese patients. 9 The majority of studies did not assess the effect of body mass index (BMI) on the incidence of PSH. One study suggested that there may be a correlation with sudden weight gain and hernia development following surgery rather than obesity itself.…”

“…One study suggested that there may be a correlation with sudden weight gain and hernia development following surgery rather than obesity itself. 9 Other patient related factors which increased risk of PSH are diabetes mellitus, chronic obstructive pulmonary disease, arterial insufficiency, immune deficiency, malnutrition, smoking and infection (usually present with late onset type PSH) at incision site. 4,9 Trocar diameter has been widely reported as a factor in development of PSH.…”

“…Plaus and Duron et al stated that because there is overlapping of muscles and 2 fascial layers, the lateral site is less susceptible to dehiscence. 9 The clinical course of PSH can be variable and depends on the extent and nature of the herniated content. Mild symptoms such as slight nausea and vague abdominal pain, both of which are most frequently seen in the early normal postoperative course after abdominal surgery, could be the first and only complaints at the early stage of this complication.…”

Robotic Approach to Cholecystectomy

“…In the laparoscopic literature, reported rates range between 2.9 and 8.4% [17,56]. Data from robotic single-site surgery are limited to smaller case series.…”