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Hernia incidence following a randomized clinical trial of single-incision versus multi-port laparoscopic colectomy

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Abstract

Background

The short-term results of single-incision laparoscopic colectomy (SILC) showed the safety, feasibility, and effectiveness when performed by skilled laparoscopic surgeons. However, the long-term complications, such as SILC-associated incisional hernia, have not been evaluated. The aim of this study was to determine the incidence of incisional hernia after SILC compared with multi-port laparoscopic colectomy (MPC) for colon cancer.

Methods

From March 2012, to March 2015, a total of 200 patients were enrolled in this study. The patients were randomized to the MPC arm and SILC arm. A total of 200 patients (MPC arm; 100 patients, SILC arm; 100 patients) were therefore analyzed. In all cases the specimen was extracted through the umbilical port, which was extended according to the size of the specimen. A diagnosis of incisional hernia was made either based on a physical examination or computed tomography.

Results

The baseline factors were well balanced between the arms. The median follow-up period was 42.4 (range 9.4–70.0) months. Twenty-one patients were diagnosed with incisional hernia, giving an incidence rate of 12.1% in the MPC arm and 9.0% in the SILC arm at 36 months (P = 0.451). In the multivariate analysis, the body mass index (≥ 25 kg/m2) (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.03–8.92; P = 0.044), umbilical incision (≥ 5.0 cm) (HR 3.22; 95% CI 1.16–8.93; P = 0.025), and history of umbilical hernia (HR 3.16; 95% CI 1.02–9.77; P = 0.045) were shown to be correlated with incisional hernia.

Conclusions

We found no significant difference in the incidence of incisional hernia after SILC arm versus MPC arm with a long-term follow-up. However, this result may be biased because all specimens were harvested through the umbilical port.

The study was registered with the Japanese Clinical Trials Registry as UMIN000007220.

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Funding

Grant support for the research reported: None.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Jun Watanabe, Atsushi Ishibe & Itaru Endo

  2. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Jun Watanabe, Yusuke Suwa, Mitsuyoshi Ota & Chikara Kunisaki

  3. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan

    Hirokazu Suwa

  4. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan

    Kazumi Kubota & Takeharu Yamanaka

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  1. Jun Watanabe
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  2. Atsushi Ishibe
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  3. Yusuke Suwa
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  4. Hirokazu Suwa
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  5. Mitsuyoshi Ota
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  9. Itaru Endo
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Correspondence to Jun Watanabe.

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Disclosures

Drs. Jun Watanabe, Atsushi Ishibe, Yusuke Suwa, Hirokazu Suwa, Mitsuyoshi Ota, Kazumi Kubota, Takeharu Yamanaka, Chikara Kunisaki and Itaru Endo have no conflicts of interest or financial ties to disclose.

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Watanabe, J., Ishibe, A., Suwa, Y. et al. Hernia incidence following a randomized clinical trial of single-incision versus multi-port laparoscopic colectomy. Surg Endosc 35, 2465–2472 (2021). https://doi.org/10.1007/s00464-020-07656-8

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