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Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery (SIL + 1 additional port)—is an umbilical midline approach really a problem?

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Abstract

Purpose

Umbilical midline incisions for single incision- or reduced port laparoscopic surgery are still discussed controversially because of a higher rate of incisional hernia compared to conventional laparoscopic techniques. The aim of this study was to evaluate incidence and risk factors for incisional hernia after reduced port colorectal surgery.

Methods

A total 241 patients underwent elective reduced port colorectal surgery between 2014 and 2020. Follow-up was achieved through telephone interview or clinical examination. The study collective was examined using univariate and multivariate analysis.

Results

A total of 150 patients with complete follow-up were included into this study. Mean follow-up time was 36 (IQR 24–50) months. The study collective consists of 77 (51.3%) female and 73 (48.7%) male patients with an average BMI of 26 kg/m2 (IQR 23–28) and an average age of 61 (± 14). Indication for surgery was diverticulitis in 55 (36.6%) cases, colorectal cancer in 65 (43.3%) patients, and other benign reasons in 30 (20.0%) cases. An incisional hernia was observed 9 times (6.0%). Obesity (OR 5.8, 95% CI 1.5–23.1, p = 0.02) and pre-existent umbilical hernia (OR 161.0, 95% CI 23.1–1124.5, p < 0.01) were significant risk factors for incisional hernia in the univariate analysis. Furthermore, pre-existent hernia is shown to be a risk factor also in multivariate analysis.

Conclusion

We could demonstrate that reduced port colorectal surgery using an umbilical single port access is feasible and safe with a low rate of incisional hernia. Obesity and pre-existing umbilical hernia are significant risk factors for incisional hernia.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

SIL:

Single incision laparoscopy

IH:

Incisional hernia

SILS:

Single incision laparoscopic surgery

RPLS:

Reduced port laparoscopic surgery

CT:

Computer tomography

IQR:

Interquartile range

RP:

Reduced port

ASA:

American Society of Anaesthesiologists

BMI:

Body mass index

IBD:

Inflammatory bowel disease

OR:

Odds ratio

CI:

Confidence interval

SP:

Single port

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Acknowledgements

The authors like to thank Simone Minikus for English and spelling corrections.

Author information

Author notes

  1. Peter Tschann and Daniel Lechner contributed equally to this work.

Authors and Affiliations

  1. Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria

    Peter Tschann, Daniel Lechner, Paolo N. C. Girotti, Stephanie Adler, Stephanie Rauch & Ingmar Königsrainer

  2. Department of Surgery, Paracelsus Medical University, Salzburg, Austria

    Jaroslav Presl, Tarkan Jäger, Philipp Schredl & Klaus Emmanuel

  3. Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria

    Christof Mittermair & Helmut G. Weiss

  4. Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria

    Philipp Szeverinski

  5. Private University in the Principality of Liechtenstein, Triesen, Liechtenstein

    Philipp Szeverinski

  6. Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria

    Patrick Clemens

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  1. Peter Tschann
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Contributions

PT, DL, SA, JP, TJ, PG, SR, CM, PC, PS, HW, KE, and IK designed the study. Collection of data was done by PT and DL. PT wrote the manuscript and prepared the tables. PS, TJ, SP, and PT did the statistical analysis. All authors contributed toward data acquisition, data interpretation, and critical revision of the content of the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Peter Tschann.

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This study was presented to the Ethics Committee of the Province of Vorarlberg and does not require any referral or vote by this committee (EK-0.04-364).

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Tschann, P., Lechner, D., Girotti, P.N.C. et al. Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery (SIL + 1 additional port)—is an umbilical midline approach really a problem?. Langenbecks Arch Surg 407, 1241–1249 (2022). https://doi.org/10.1007/s00423-021-02416-1

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