Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study



Single-incision laparoscopic cholecystectomy (SILC) is a feasible technique that provides comparable results to standard laparoscopic cholecystectomy (LC). However, despite the theoretical advantages of minor wound complications and cosmetic results, SILC usually requires a larger incision, which may increase the incidence of incisional hernias. This study evaluated SILC and standard multiport cholecystectomy with respect to perioperative outcomes, hospital stay, cosmetic results, and postoperative complications, including the 5-year incisional hernia rate.


A cohort study was performed with patients who underwent elective laparoscopic surgery for noncomplicated cholelithiasis at our hospital between July 2009 and June 2011. During the study period, there were 45 nonselected patients who underwent SILC, and these patients were compared with a control group of 140 patients who underwent LC using the standard three-trocar technique during the same period. Both patient groups were comparable in age, gender, BMI and ASA classification.


The mean follow-up was 58.7 ± 10.9 (range 3–80) months. There were no differences between groups in terms of hospital stay, rate and severity of complications, wound infection, and patient cosmetic satisfaction. However, the operating time (57.8 versus 35.2 min) and long-term incisional hernia rate (13.3% versus 4.7%) were significantly higher in the SILC group.


SILC is associated with a statistically significantly higher long-term incisional hernia rate at the umbilical port site than the standard multiport laparoscopic cholecystectomy. Our data show there was no relevant advantage regarding the postoperative course, hospital stay or cosmetic satisfaction. To date, widespread use of SILC cannot be recommended. Registration number: NCT03768661 (

Trial registration

This study has been registered at The ID number is: NCT03768661.

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Author information

CH designed the study and drafted the article. All authors contributed equally to the study development and data acquisition. All authors participated in revising the article critically for intellectual content and gave their final approval of the version submitted for publication.

Correspondence to C. Hoyuela.

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The authors have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was developed under an Institutional Review approved protocol (Hospital Plató).

Human and animal rights

All procedures were performed according to ethical standards and approved by the Institutional Review Board of Hospital Plató. Any procedure was not performed in animals by any of the authors.

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Written informed consents were obtained from all individual participants included in the study.

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Hoyuela, C., Juvany, M., Guillaumes, S. et al. Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study. Hernia 23, 1205–1213 (2019).

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  • Trocar-site hernia
  • Incisional hernia
  • Single-incision laparoscopic surgery
  • SILS
  • Laparoscopy
  • Cholecystectomy