Patricia L Eichhorn, MD, T. Paul Singh, MD, Brian Binetti, MD. Department of Surgery, Albany Medical Center
Incisional hernia (IH) after laparoscopic surgery has always been a significant issue. As laparoscopic surgery has migrated to single incision/port (SIS), these concerns have become more prominent. Limited data regarding the outcomes from SIS have limited its adoption as a primary option for selected procedures. Outcomes for IH in the SIS population at 12-24 months are not well known. These results may influence the adoption of this procedure.
27 consecutive patients underwent SIS cholecystectomy at a tertiary care hospital from 6/2009 to 5/2010 by a single surgeon. A standard SIS procedure with 4 instruments in a 15 mm incision was utilized for the operation. All patients were followed postoperatively for mean of 7.7 months (range 0.5-24 months) in the outpatient clinic for development of IH. One patient was lost to follow up. 4/27 pts (14.8%) developed IH post procedure. IH occurred at 3 (2), 6, and 7 months. All subsequent IHs were repaired by a standard laparoscopic approachexcept for one patient who deferred the operation. None of these patients had recurrence as of this date. There was no correlation between age, BMI, or previous operation to IH in this group. One pt in this group did have ESRD on peritoneal dialysis at the time of SIS. Adjusted rate of IH in the remaining group was 3/26 (11.1%).
The cosmetic benefit of SIS must be balanced against the potential outcomes of complications related to the procedure. The rates of IH in this population were higher than what may be expected for comparable laparoscopic cholecystectomy. In SIS procedures that require larger abdominal access for specimen removal or procedural access, SIS IH may match the known hernia rates. Further study regarding SIS port site placement may result in improved outcomes. Long term studies regarding SIS and IH are needed to determine the true incidence of IH.
Session Number: ResFel – Residents/Fellows Scientific Session
Program Number: S140