Skip to main content

Advertisement

SpringerLink
Log in

Long-term follow-up after single-incision laparoscopic surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Single-incision laparoscopic surgery (SILS) is growing in popularity. The increased diameter of the umbilical incision might raise questions about the possibility of a greater risk of postoperative incisional hernia in comparison to conventional laparoscopy. This study aims to disclose the frequency of incisional hernia after SILS in long-term follow-up as well as to reveal the factors predisposing patients to this feared complication.

Methods

The patient collective consists of cholecystectomy and appendectomy patients, who were operated on using SILS technique. Follow-up was achieved through letter correspondence, telephone interview, and clinical examination. Effects of demographic variables and operative parameters including age, sex, BMI, ASA score, duration of surgery, pre-existing hernia as well as postoperative incidence of incisional hernia were investigated using univariate and multivariate analyses.

Results

A total of 286 cases with complete follow-up were included in the analyses. Mean follow-up duration was 58.4 months. 192 patients (67.1%) underwent cholecystectomy; 94 (32.9%) had an appendectomy. The study collective consisted of 218 women (76.2%) and 68 men (23.8%). Mean age at the date of the operation was 38.5 (median 36, range 13–74). In 5 cases (1.7%), the surgical approach was converted into conventional laparoscopy. Intraoperative complication rate was 0.3% and postoperative complication rate was 5.9%. 7 patients (2.4%) developed an incisional hernia. Obese patients had an incisional hernia incidence of 10.9%. 3 out of 19 patients (15.8%) with a pre-existing umbilical hernia developed an incisional hernia during follow-up. Obesity and pre-existing umbilical hernia proved to have a significant association with incisional hernia incidence in univariate and multivariate analyses. Sex, age, procedure (appendectomy vs cholecystectomy), presence of acute inflammation, and duration of surgery did not show a statistically significant association with incisional hernia.

Conclusion

Detection of incisional hernia necessitates a long follow-up duration. Obesity and pre-existing umbilical hernia are associated with a higher incidence of this complication. Following a careful patient selection, SILS offers a safe approach for cholecystectomy and appendectomy procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D (2016) Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors. Surg Endosc 30:4539–4543

    Article  CAS  Google Scholar 

  2. Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, Rivas H, Islam A, Soper N, Paraskeva P, Rosemurgy A, Ross S, Shah S (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047 (discussion 1047–1038)

    Article  Google Scholar 

  3. Bliss LA, Yang CJ, Kent TS, Ng SC, Critchlow JF, Tseng JF (2015) Appendicitis in the modern era: universal problem and variable treatment. Surg Endosc 29:1897–1902

    Article  Google Scholar 

  4. Bunting DM (2010) Port-site hernia following laparoscopic cholecystectomy. J Soc Laparoendosc Surg 14:490–497

    Article  Google Scholar 

  5. Buckley FP III, Vassaur HE, Jupiter DC, Crosby JH, Wheeless CJ, Vassaur JL (2016) Influencing factors for port-site hernias after single-incision laparoscopy. Hernia 20:729–733

    Article  Google Scholar 

  6. Agaba EA, Rainville H, Ikedilo O, Vemulapali P (2014) Incidence of port-site incisional hernia after single-incision laparoscopic SURGERY. J Soc Laparoendosc Surg 18:204–210

    Article  Google Scholar 

  7. Gunderson CC, Knight J, Ybanez-Morano J, Ritter C, Escobar PF, Ibeanu O, Grumbine FC, Bedaiwy MA, Hurd WW, Fader AN (2012) The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery. J Minim Invasive Gynecol 19:40–45

    Article  Google Scholar 

  8. Weiss HG, Brunner W, Biebl MO, Schirnhofer J, Pimpl K, Mittermair C, Obrist C, Brunner E, Hell T (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259:89–95

    Article  Google Scholar 

  9. Krajinovic K, Koeberlein C, Germer CT, Reibetanz J (2016) The incidence of trocar site hernia after single-port laparoscopic cholecystectomy: a single center analysis and literature review. J Laparoendosc Adv Surg Techn A 26:536–539

    Article  Google Scholar 

  10. Haueter R, Schutz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104:1141–1159

    Article  CAS  Google Scholar 

  11. Swank HA, Mulder IM, la Chapelle CF, Reitsma JB, Lange JF, Bemelman WA (2012) Systematic review of trocar-site hernia. Br J Surg 99:315–323

    Article  CAS  Google Scholar 

  12. Antoniou SA, Morales-Conde S, Antoniou GA, Granderath FA, Berrevoet F, Muysoms FE (2016) Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20:1–10

    Article  CAS  Google Scholar 

  13. Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, Sharp KW, Poulose BK (2016) Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88

    Article  Google Scholar 

  14. Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG (1997) Laparoscopic cholecystectomy and the umbilicus. Br J Surg 84:630–633

    Article  CAS  Google Scholar 

  15. Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona JA, Fernandez-Represa JA (1997) Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 21:529–533

    Article  CAS  Google Scholar 

  16. Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdu H, Lopez Negre JL, Urgelles J, Estalella L, Pares D (2014) Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 207:1–6

    Article  Google Scholar 

  17. Gangl O, Hofer W, Tomaselli F, Sautner T, Fugger R (2011) Single incision laparoscopic cholecystectomy (SILC) versus laparoscopic cholecystectomy (LC): a matched pair analysis. Langenbecks Arch Surg 396:819–824

    Article  Google Scholar 

  18. Christoffersen MW, Brandt E, Oehlenschlager J, Rosenberg J, Helgstrand F, Jorgensen LN, Bardram L, Bisgaard T (2015) No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study. Surg Endosc 29:3239–3245

    Article  Google Scholar 

  19. Bury K, Pawlak M, Smietanski M, Muysoms F (2016) Single-incision port-site herniation: meta-analysis vs. nationwide cohort study. Hernia 20:11–12

    Article  CAS  Google Scholar 

  20. Johnson WH, Fecher AM, McMahon RL, Grant JP, Pryor AD (2006) VersaStep trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc 20:1584–1586

    Article  CAS  Google Scholar 

  21. Beck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK (2013) Comparative effectiveness of dynamic abdominal sonography for hernia vs computed tomography in the diagnosis of incisional hernia. J Am Coll Surg 216:447–453 (quiz 510–441)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité Campus Mitte, Campus Virchow Klinikum, Charitéplatz 1, 10117, Berlin, Germany

    Atakan Görkem Barutcu, Denis Klein, Maik Kilian, Matthias Biebl, Johann Pratschke & Jonas Raakow

  2. Department of General and Visceral Surgery, Evangelische Elisabeth Klinik, Lützowstraße 26, 10785, Berlin, Germany

    Maik Kilian

  3. Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967, Berlin, Germany

    Roland Raakow

Authors
  1. Atakan Görkem Barutcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Denis Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maik Kilian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias Biebl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roland Raakow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johann Pratschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jonas Raakow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonas Raakow.

Ethics declarations

Disclosure

Mr. Barutcu and Klein, as well as Drs. Kilian, Biebl, Raakow, Pratschke, and Raakow have no conflicts of interest or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barutcu, A.G., Klein, D., Kilian, M. et al. Long-term follow-up after single-incision laparoscopic surgery. Surg Endosc 34, 126–132 (2020). https://doi.org/10.1007/s00464-019-06739-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06739-5

Keywords

Search

Navigation