Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D
Department of Surgery, CH Wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
Surg Endosc. 2016 Oct;30(10):4539-43. doi: 10.1007/s00464-016-4790-4. Epub 2016 Feb 19.
To access the incidence and predictive factors of incisional hernia after single-incision laparoscopic cholecystectomy (SILC).
Eighty-two consecutive patients operated on for uncomplicated cholelithiasis between 2009 and 2013 were eligible for the study. Clinical outcome was assessed by a combination of case notes review, office consultation and telephone interview. Long-term incisional hernia rate was the major outcome of the study. Secondary outcome was the evaluation of predictive factors. Univariate and multivariate statistical analyses were performed using the following variables: age, gender, ASA score, BMI, risk, or comorbidity factors and surgical site infection.
Six patients (7 %) were lost to follow-up after the 1-month office visit and excluded. The study group consisted of 16 men and 60 women with a median age of 42 years (range 18-69) and a BMI of 25 (range 19-34). Eight patients had risk or comorbidity factors, 46 were classified ASA I, and 30 ASA II. Early postoperative course was uneventful in all cases but two patients developed a superficial wound abscess after hospital discharge. With a median follow-up of 44 months (range 12-72), incisional hernia was noted in six patients (7.9 %). Multivariate logistic analysis revealed that age (OR 1.08, 95 % CI 1.00-1.16, p < 0.038) and BMI (OR 1.37, 95 % CI 1.03-1.82, p < 0.029) were independent predictive factors of developing an incisional hernia. The incidence of hernia was, respectively, 15 % in patients with an age ≥ 50 and 33 % in patients with a BMI ≥ 30.
After SILC, we noted an incisional hernia rate of 8 %. To decrease the risk of developing that specific complication, SILC should only be proposed to young and non-obese patients.
评估单孔腹腔镜胆囊切除术（SILC）后切口疝的发生率及预测因素。
2009年至2013年间连续82例因单纯性胆石症接受手术的患者符合本研究条件。通过病例记录回顾、门诊咨询和电话访谈相结合的方式评估临床结局。长期切口疝发生率是本研究的主要结局。次要结局是对预测因素的评估。使用以下变量进行单因素和多因素统计分析：年龄、性别、美国麻醉医师协会（ASA）评分、体重指数（BMI）、风险或合并症因素以及手术部位感染。
6例患者（7%）在1个月门诊随访后失访并被排除。研究组包括16名男性和60名女性，中位年龄42岁（范围18 - 69岁），BMI为25（范围19 - 34）。8例患者有风险或合并症因素，46例ASA分级为I级，30例为ASA II级。除2例患者出院后出现浅表伤口脓肿外，所有患者术后早期过程均顺利。中位随访44个月（范围12 - 72个月），6例患者（7.9%）出现切口疝。多因素逻辑回归分析显示，年龄（比值比[OR]1.08，95%可信区间[CI]1.00 - 1.16，p < 0.038）和BMI（OR 1.37，95%CI 1.03 - 1.82，p < 0.029）是发生切口疝的独立预测因素。年龄≥50岁患者的疝发生率为15%，BMI≥30的患者为33%。
SILC术后，我们注意到切口疝发生率为8%。为降低发生该特定并发症的风险，SILC应仅推荐给年轻且非肥胖患者。
