The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery

Camille C. Gunderson, Jason Knight, Jessica Ybanez-Morano, Carol Ritter, Pedro F. Escobar, Okechukwu Ibeanu, Francis C. Grumbine, Mohamed A. Bedaiwy, William W. Hurd, Amanda Nickles Fader

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective: To estimate the risk of umbilical hernia and other latent complications in women who underwent laparoendoscopic single-site surgery (LESS) for a gynecologic indication. Design: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). Setting: Four tertiary care academic medical centers. Patients: Women undergoing LESS for a benign or malignant gynecologic indication from 2009 to 2011. Interventions: A total of 211 women underwent LESS via a single 1.5- to 2.0-cm umbilical incision. All surgeries were performed by advanced gynecologic laparoscopists. Incisions were repaired with a running, delayed absorbable suture. Subject demographics and clinical variables were collected and surgical outcomes analyzed. Measurements and Main Results: Median age and body mass index were 45 years and 30 kg/m 2, respectively. Approximately half of study subjects underwent a hysterectomy with or without salpingo-oophorectomy, and 15% had a diagnosis of cancer. Overall, 0.9% of women were diagnosed with a preoperative umbilical hernia, and 2.4% of women experienced a major perioperative complication. After a median postoperative follow-up time of 16 months, 2.4% had development of an umbilical hernia. However, 4/5 of these women had significant risk factors for fascial weakening independent of LESS, including requirement for a second abdominal surgery in 1 subject and a cancer diagnosis with postoperative chemotherapy administration in 2 subjects. When these subjects deemed "high risk" for incisional disruption were excluded from the analysis, the umbilical hernia rate was 0.5% (1/207). On univariable analysis, obesity was the only factor associated with complications (p = .04). Conclusion: When performed by advanced laparoscopic surgeons, laparoendoscopic single-site gynecologic surgery is associated with a low risk of major adverse events. Additionally, the overall umbilical hernia rate was 2.4% and was lower (0.5%) in subjects without significant comorbidities.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume19
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • Laparoendoscopic single-site surgery
  • Surgical complications
  • Umbilical hernia

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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