Single umbilical incision laparoscopic cholecystectomy: Results of the prospective trial of the Coelio Club

Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closurewound closure

Purpose

Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures.

Methods

A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon).

Results

The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia.

Conclusion

Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.

Effect of laparoscopy by single-port endoscopic access in benign adnexal surgery: study protocol for a randomized controlled trial

Background

Laparoscopic surgery has become the preferred surgical approach due to a reduction in postoperative pain, better recovery, shorter hospitalization, and improved esthetic outcomes. Laparoscopic surgery with single-port laparoscopy (SPL) is a laparoscopic surgery technique that is based on making a single parietal incision using a single trocar specifically designed to allow introduction of several instruments. The level of evidence regarding the advantages of SPL in terms of postoperative pain has remained low despite several randomized studies. Adult patients exhibiting a surgical indication for an a priori benign ovarian pathology or for prophylactic purposes that can be performed by laparoscopy will be randomized to receive conventional laparoscopy (CL) or SPL. The aim of our study is to evaluate whether SPL offers advantages over CL in benign adnexal surgery.

Methods

The patients will be evaluated preoperatively to confirm their eligibility. The perioperative data up to 24 h after the intervention, as well as the postoperative data at day 7 and at one month from the intervention will be collected. The primary outcome for the study will be the postoperative pain at 24 h ± 2 h after the intervention. The pain will be assessed by a numeric rating scale of 0–10.

Other outcomes will also be assessed, such as pain at other times, the consumption of analgesics, the operative time, perioperative bleeding, the number of additional trocars in the two groups, the incidence of laparoconversion, the esthetic criteria of the scar at one month, the incidence of complications, and the quality of life at one month.

Discussion

If our hypothesis is confirmed, this study will provide evidence that the use of SPL can decrease postoperative pain in adnexal surgery. The standard surgical treatment of this condition would thus be modified.

Trial registration

ClinicalTrials.gov, NCT02739724. Registered on 12 April 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2429-y) contains supplementary material, which is available to authorized users.

Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors

AIM

To access the incidence and predictive factors of incisional hernia after single-incision laparoscopic cholecystectomy (SILC).

METHODS

Eighty-two consecutive patients operated on for uncomplicated cholelithiasis between 2009 and 2013 were eligible for the study. Clinical outcome was assessed by a combination of case notes review, office consultation and telephone interview. Long-term incisional hernia rate was the major outcome of the study. Secondary outcome was the evaluation of predictive factors. Univariate and multivariate statistical analyses were performed using the following variables: age, gender, ASA score, BMI, risk, or comorbidity factors and surgical site infection.

RESULTS

Six patients (7 %) were lost to follow-up after the 1-month office visit and excluded. The study group consisted of 16 men and 60 women with a median age of 42 years (range 18-69) and a BMI of 25 (range 19-34). Eight patients had risk or comorbidity factors, 46 were classified ASA I, and 30 ASA II. Early postoperative course was uneventful in all cases but two patients developed a superficial wound abscess after hospital discharge. With a median follow-up of 44 months (range 12-72), incisional hernia was noted in six patients (7.9 %). Multivariate logistic analysis revealed that age (OR 1.08, 95 % CI 1.00-1.16, p < 0.038) and BMI (OR 1.37, 95 % CI 1.03-1.82, p < 0.029) were independent predictive factors of developing an incisional hernia. The incidence of hernia was, respectively, 15 % in patients with an age ≥ 50 and 33 % in patients with a BMI ≥ 30.

CONCLUSION

After SILC, we noted an incisional hernia rate of 8 %. To decrease the risk of developing that specific complication, SILC should only be proposed to young and non-obese patients.

Single-port versus conventional multiport laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials and nonrandomized studies

BACKGROUND

Although current guidelines recommend performing cholecystectomy via laparoscopy, consensus on the application of single-incision laparoscopic surgery for cholecystectomy is still lacking. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) and nonrandomized comparative studies (NRCSs), comparing single-port laparoscopic cholecystectomy (SPLC) and conventional multiport laparoscopic cholecystectomy (CMLC) for benign gallbladder diseases.

SUBJECTS AND METHODS

A systematic review of the literature was performed to identify studies published between January 1997 and December 2012 comparing SPLC and CMLC. Operative outcomes, postoperative parameters, complications, cosmetic results, and quality of life were evaluated.

RESULTS

Forty studies were included in the analyses (16 RCTs, 24 NRCSs) that included 3711 patients (1865 SPLCs, 1846 CMLCs). SPLC had higher conversion rates (odds ratio [OR], 4.21; 95% confidence interval [CI], 2.71-6.56; P<.001), longer operating time (mean difference [MD], 16.1; 95% CI, 9.93-22.26 minutes; P<.001), and shorter hospital stay (MD, 0.16; 95% CI, -0.28 to -0.04 day; P=.01) than CMLC. There were no significant differences between the two procedures for early (MD, -0.1; 95% CI, -0.44 to 0.24; P=.57) or late (MD, -0.13; 95% CI, -0.45 to 0.19; P=.42) visual analog scale pain scores and overall complications (OR, 1.21; 95% CI, 0.92-1.61; P=.18). Cosmetic outcomes favored SILC at 2 weeks (MD, -1.39; 95% CI, -2.66 to -0.12; P=.03) and 1 month (MD, -0.13, 95% CI, -2.05 to 0.55; P=.0007) after surgery (index score, 0-10).

CONCLUSIONS

SPLC can be performed safely and effectively with better cosmetic results than with the CMLC technique for benign gallbladder diseases.