Exploration of umbilical hernia incidence and etiology in 753 cases of single-incision laparoscopic surgery: a retrospective analysis.

PURPOSE

The rising popularity of Single Incision Laparoscopic Surgery (SILS) brings concerns regarding a higher incidence of postoperative incisional hernias due to the enlarged umbilical incision compared to conventional laparoscopy. This study aims to explore the occurrence of incisional hernias following single-port laparoscopic surgery and identify associated risk factors.

METHODS

The patient cohort included individuals who underwent cholecystectomy and inguinal hernia repair procedures using the SILS technique. Follow-up assessments were conducted via written correspondence, telephone interviews, and clinical examinations. Univariate and multivariate analyses were employed to investigate the impact of demographic variables and surgical parameters, including age, gender, BMI, ASA score, operative duration, pre-existing umbilical hernia, and the occurrence of postoperative incisional hernia.

RESULTS

A total of 753 patients completed follow-up, with a mean duration of 60.2 months and variance: 51.26. Among them, 342 (45.4%) underwent cholecystectomy, while 411 (54.6%) underwent inguinal hernia repair. The study cohort comprised 405 women (53.8%) and 348 men (46.2%), with a mean age of 40 years (range 10-83 years) at the time of surgery. Only one patient (0.13%) required conversion to conventional laparoscopy for surgical access. Intraoperative complications occurred in 0.1% of cases, while postoperative complications occurred in 1.6%. Incisional hernias developed in 10 patients (1.3%), with a notably higher incidence of 5.9% among obese patients than normoweight patients. Additionally, 23.1% of patients with pre-existing umbilical hernias experienced incisional hernia during the follow-up period. Multivariate analyses revealed that obesity(OR: 18.56, Cl:5.76-86.42, p value:0.003), pre-existing umbilical hernia(OR:16.32,Cl:4.26-61.68, p value:0,002), diabetes(OR:2.42, Cl:1.86-20.42, p value:0.496), and hypertension(OR:1.96, Cl:0.72-12.64,p value:0.924) were significantly associated with incisional hernia incidence. However, gender, age, type of surgery (inguinal hernia repair vs. cholecystectomy), presence of acute inflammation, and duration of surgery did not show statistically significant associations with incisional hernia occurrence.

CONCLUSION

Detecting incisional hernias necessitates an extended follow-up period. In the univariate analysis, obesity and pre-existing umbilical hernias were linked to an elevated risk of this complication. Following meticulous patient selection, Single Incision Laparoscopic Surgery (SILS) presents a secure method for performing cholecystectomy and inguinal hernia repair.