Single-Incision Gallbladder Removal Linked to More Hernias

Patients undergoing single-incision laparoscopic cholecystectomy (SILC) had a significantly higher rate of hernia formation than those having standard four-port laparoscopy (4PLC), according to a new study.

Researchers at University Hospitals Case Medical Center (Cleveland, OH, USA) conducted a prospective, randomized, multicenter, single-blinded trial of 200 patients with biliary colic and documented gallstones or polyps or with biliary dyskinesia, who were randomized to SILC (119 patients) and 4PLC (81 patients). Data measures included operative details, adverse events, and conversion to 4PLC or laparotomy; the patients were followed for 12 months.

The results showed that total adverse events were not significantly different between groups, as were severe adverse events. Incision-related adverse events were higher after SILC, but all of these were listed as mild or moderate. Significantly, the researchers found that while total hernia rates were 1.2% in 4PLC patients, they reached 8.4% in the SILC patients. At one-year follow-up, cosmesis scores continued to favor SILC. The study was published in the June 2013 issue of Journal of the American College of Surgeons.

“I was somewhat surprised by the results,” said lead author Prof. Jeffrey Marks, MD. “But as you make incisions larger, there is a greater consequence of hernia. It would be nice to reassess the patients in three and five years, and see if the difference in hernia formation is greater or if it has equilibrated.”

In traditional 4PLC, incisions are made in the abdomen—one on the rim of the navel, one beneath the navel and two beneath the navel and to the right side. A laparoscope and surgical instruments are passed into the interior of the abdomen to aid the surgeon in removal of the gallbladder. In SILC, the laparoscope and all of the instruments are inserted through one 1.5–2 cm incision within the navel itself. Thus, the patient recovers with a single, almost invisible scar in the umbilical area.

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