Robert L Autin, MD, Tejinder P Singh, MD, Brian Binetti, MD. Albany Medical center
The incidence of Port Site Hernia(PSH) after Single Site Laparoscopic cholecystectomy(SSLC) and Single Site Robotic Cholecystectomy(SSRC) is known to be higher than for standard laparoscopic cholecystectomy. There is limited data regarding both the incidence of PSH following SSLC versus SSRC and the risk factors that can increase the risk of this complication.
Methods and Procedure:
All patients from 6/26/2009 to 5/19/2010 at a single academic hospital undergoing SSLC were retrospectively compared to all patients undergoing SSRC from 4/30/2012 to 3/23/2013. The rates of PSH were evaluated for both groups after follow up of no less than 3 months after surgery. There were 27 patients in both the SSLC group and the SSRC group.
6/27(22.2%) of the patients in the SSLC group developed PSH. Within this group, 5/13(38.4%) of those with either prior midline laparotomy or umbilical laparoscopic incisions developed PSH. Only 1/14(7.1%) of those with no prior midline laparotomy or umbilical laparoscopic incision developed PSH. 3/27(11.1%) of the patients in the SSRC group developed PSH. Within this group, 2/16(12.6%) of those with either prior midline laparotomy or umbilical laparoscopic incisions developed PSH. 1/11(9.1%) of those with no prior midline laparotomy or umbilical laparoscopic incision developed PSH. The combined results of both the SSLC and SSRC groups are as follows. 9/54(16.7%) developed PSH. Of those who had prior laparotomy or umbilical laparoscopic incision, 7/29(24.3%) developed PSH. Of those who no prior umbilical incisions, only 2/25(8%) developed PSH.
Although these data show a trend of lesser incidence of PSH in SSRC vs SSLC, more data is needed to draw a statistically significant conclusion that could alter practice standards. However, we see a much higher incidence of PSH in both the SSLC and SSRC groups for those patients who have had prior umbilical incisions from either laparotomy or laparoscopy. With the accumulation of more data, we may be better able to decide if either SSLC or SSRC is appropriate for patients who have had prior umbilical incisions.