Comparison of Ventral Hernia in Patients Undergoing Single Incision Versus Standard Multiport Laparoscopic Colectomy

Awais Ashfaq, MD, Kian Ahmadieh, Adil A Shah, MD, Alyssa B Chapital, MD, PhD, FACS, Daniel J Johnson, MD, FACS, Kristi L Harold, MD, FACS. Mayo Clinic

Introduction: Single incision laparoscopic surgery (SILS) is thought to reduce both incisional trauma and postoperative pain. Use of SILS has gained widespread interest in colectomies as there has been no reported difference in morbidity compared to standard multiport laparoscopic (ML) colectomies. However, hernia rates comparing both approaches have never been reported. The aim of this study was to compare the rates of ventral hernia (VH) in patients undergoing SILS versus ML.

Methods: All patients undergoing SILS and ML colectomies were entered into an IRB approved database from January 2010 to June 2014. The primary endpoint was the incidence of ventral hernia and secondary end points included type of hernia repair, operative time, length of hospital stay, recurrence and complications.

Results: A total of 406 patients (SILS=51, 13%; ML=355, 87%), male (n=32, 53%), underwent colectomies during the study period. Mean age at VH diagnosis was 66±13 years (SILS=67±14; ML=66±13). There was no statistically significant difference in the observed comorbidities in the two groups (SILS vs ML). Most common surgical procedure was laparoscopic right hemicolectomy (n=24, 40%) followed by sigmoidectomy (n=19, 31.7%). Most common indication for operation was polyp/cancer (n=33, 55%) followed by diverticulitis (n=18, 30%). Mean time to diagnose VH after laparoscopic colectomy (SILS=9±4, ML=14±11 months; p=0.014) and incidence of VH (SILS=11, 21.6%; ML=49, 13.8%; p<0.001) were statistically significant. A total of 26 (43%) patients (SILS=5, 19%; ML=21, 81%) underwent VH repair. Out of these, 19 (73%) were done laparoscopically (SILS=3, 16%; ML=16, 84%). Mean size of hernia defect was 57 (1-625) cm2 (SILS=64±90, ML=27±18; p=0.064). There was no statistically significant difference between lengths of hospital stay, recurrences, surgical site infection, fascial dehiscence, bowel injury and other morbidities. Mean length of follow up was 21±16 months (SILS=30±9; ML=20±16 months).

Conclusion: Incidence of VH is higher in SILS compared to ML colectomies. Laparoscopic repair of VH after colectomies (SILS/ML) is feasible with minimal complications in both groups. Further prospective multi-institutional studies are needed to better study the risk of VH in SILS patients.

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