The Risk of Umbilical Hernia and Other Complications with?Laparoendoscopic Single-Site Surgery

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• 作者：Camille C. Gunderson ; MD^a ; Jason Knight ; MD^c ; Jessica Ybanez-Morano ; MD^e ; Carol Ritter ; MD^b ; Pedro F. Escobar ; MD^c ; Okechukwu Ibeanu ; MD^a ; Francis C. Grumbine ; MD^a ; Mohamed A. Bedaiwy ; MD^d ; William W. Hurd ; MD^d ; Amanda Nickles Fader ; MD^a ; ^{amandanfader@gmail.com}
• 关键词：Laparoendoscopic single-site surgery ; Umbilical hernia ; Surgical complications
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2012
• 出版时间：January-February, 2012
• 年：2012
• 卷：19
• 期：1
• 页码：40-45
• 全文大小：206 K

文摘

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/m², 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.