Incisional Hernia Rate After Single-incision Laparoscopic Cholecystectomy
Incisional Hernia Rate After Single-incision Laparoscopic Cholecystectomy
Single-incision laparoscopic cholecystectomy (SILC) requires a larger incision than standard
 laparoscopy, which may increase the incidence of incisional hernias.

 This study evaluated SILC and standard multiport cholecystectomy with respect to
 perioperative outcomes, hospital stay, cosmetic results, and postoperative complications,
 including the 5-years incisional hernia rate.
A cohort study was performed for patients who underwent a laparoscopic cholecystectomy under
 an institutional review approved protocol. Between 2009 and 2011, 45 unselected patients
 underwent SILC performed by the same two surgeons.

 The study inclusion criteria were the following: patients over 18 years with cholelithiasis,
 and candidates for elective surgery with no significant cardiopulmonary, hepatic or renal
 impairment (ASA score less than 4).

 The exclusion criteria included the following: acute cholecystitis, associated CBD stones or
 pancreatitis, an emergency operation for complicated disease, mental illness, or patient
 refusal and/or absence of informed consent. All included patients signed a standard consent
 form after being informed about the characteristics of the SILC procedure.

 The outcomes of these patients were compared with those of a control cohort series of 140
 patients who underwent standard LC (with the same inclusion and exclusion criteria) during
 the same period.

 The primary endpoint of the study was to determine the incisional hernia rate at the
 umbilical wound after 5 years of follow-up. Hernias were defined as evidence of a hernia at
 the clinical examination or those confirmed by ultrasound examination in case of clinical
 doubt.

 The study secondary endpoints included the following: duration of surgery (from the start of
 the incision to skin closure), intraoperative and postoperative complications (30 days),
 hospital stay, and cosmetic satisfaction results (measured using a visual analogue scale
 score ranging from 0 to 10).

 The following variables were also collected: age, gender, body mass index (BMI) and
 comorbidities. The anesthetic risk was measured according to the ASA classification system.
 Prolonged hospital stay (more than 24 h) and readmission (patients who returned for medical
 consultation before scheduled follow-up) were also recorded. All data were collected
 prospectively.
Inclusion Criteria:

 -  patients over 18 years with cholelithiasis and candidates for elective surgery
 (cholecystectomy)

 -  abscence of significant cardiopulmonary, hepatic or renal impairment (ASA score less
 than 4)

 Exclusion Criteria:

 -  acute cholecystitis

 -  associated common bile duct stones or pancreatitis

 -  emergency operation for complicated disease

 -  ASA 4 (American Society of Anesthesiologists)

 -  pregnancy

 -  mental illness

 -  patient refusal and/or absence of informed consent