Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors

Julliard, Olivier; Hauters, P.; Possoz, Julien; Malvaux, P.; Landenne, J.; Gherardi, D

doi:10.1007/s00464-016-4790-4

Cited by 39 publications

(20 citation statements)

References 24 publications

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“…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.…”

Section: Discussionmentioning

confidence: 66%

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

et al. 2017

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Background: Laparoscopic cholecystectomy for uncomplicated gallbladder diseases (UGD) is a low-complexity procedure with little morbidity. Single port approach (SPA) benefits are unclear. Our aim is to identify any advantages by evaluating both the clinical outcomes of this approach and also patient opinion, following a year of implementation in our institution.Methods: Data from patients operated on during 2015 for UGD by SPA or conventional laparoscopic approach (CLA) were collected. Patients were asked to answer a telephone questionnaire 4-6 months after the operation.Results: 47 patients were operated on by SPA (SP group) and 117 by CLA (CL group). No differences were found between preoperative variables, surgical time, morbidity, length of stay or wound complications. More SP group patients reported no pain at discharge (72.3 vs 54.7%, p=0.037). 138 patients answered the questionnaire. No significant differences were found when comparing overall satisfaction. Wound aspect satisfaction was higher in the SP group (100 vs 80.9%, p=0.001). A higher proportion of CL group patients felt that had they had fewer scars, they would be more satisfied (46.8 vs 9.1%, p <0.001), and 35.1% of them opined that their satisfaction would be greater had they been operated on by SPA. In the multivariate analysis, the only variable associated with maximum overall satisfaction was wound aspect satisfaction.Conclusions: SPA is a valid alternative to CLA for UGD. It should be chosen when available, since it provides equal clinical outcomes, diminishes postoperative pain and is preferred by patients.

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Section: Discussionmentioning

confidence: 66%

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

et al. 2017

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“…Christoffersen et al demonstrated similar hernia rates of 4% in the SLC group and 6% in the MLC group [14]. Julliard et al analysed the occurrence and risk factors for incisional hernias and showed a hernia rate of 7.9% after a mean follow-up of 41 months [52]. Bury et al examined the contradiction in occurrence of incisional hernia and compared the works of Antoniou et al and Christoffersen et al He recognized both studies as equivalent in their level of evidence and stated the need for long-term investigations of this topic [13].…”

Section: Discussionmentioning

confidence: 93%

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Klein

Barutcu

Kröll

et al. 2020

Langenbecks Arch Surg

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Background Within the last years, single-incision laparoscopic cholecystectomy (SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain. Methods A randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long-term follow-up after surgery was added. Results Ninety-eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups. Conclusions Taking into account a follow-up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates. Trial registration German Registry of Clinical Trials DRKS00012447

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“…We were unable to evaluate this variable among the selected studies since this information was not reported. On this issue, the literature shows conflicting data and several papers reported a higher number of wound complications, including a significant risk of developing port site hernias [26, 27]. The introduction of microlaparoscopic instruments that require trocars with a small diameter may enhance the cosmetic outcomes of conventional laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

Gasparri¹,

Mueller²,

Taghavi³

et al. 2018

Gynecol Obstet Invest

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Background/Aims: A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. Method: A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms “single port laparoscopy” or “laparoendoscopic single site-surgery” or “single site laparoscopy” or “single-incision laparoscopic surgery” and “ectopic pregnancy.” Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. Results: A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. Conclusion: The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.

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Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors

Abstract: After SILC, we noted an incisional hernia rate of 8 %. To decrease the risk of developing that specific complication, SILC should only be proposed to young and non-obese patients.

Cited by 39 publications

References 24 publications

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

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

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

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