Wound complications after hand assisted laparoscopic surgery.

Area of Science:

• Surgical innovation
• Minimally invasive surgery
• Abdominal surgery

Background:

• Hand assisted laparoscopic surgery (HALS) offers advantages over traditional laparoscopy but may involve larger incisions.
• Incisional complications are a concern in all surgical approaches, including HALS.

Purpose of the Study:

• To evaluate the incidence and risk factors of incisional complications following Hand assisted laparoscopic surgery (HALS).
• To compare HALS complication rates with those of open surgery and standard laparoscopy.

Main Methods:

• Prospective and retrospective review of 424 consecutive HALS procedures from February 1997 to December 2003.
• Analysis of postoperative wound complications, including infections, hernias, and dehiscences.
• Literature review of wound complications in open and standard laparoscopic surgery.

Main Results:

• The study identified 29 infections (6.8%), 15 hernias (3.5%), and 2 dehiscences (0.5%) in HALS procedures.
• Hernias were associated with tobacco smoking (p=0.04) and showed trends with diabetes, male gender, and renal failure.
• Infections were linked to omitted perioperative antibiotics (p=0.007), obesity (p=0.03), and longer operative times (p=0.001).

Conclusions:

• HALS exhibits lower rates of wound infection and hernia compared to open surgery, but higher rates than standard laparoscopy.
• Patient factors (obesity, smoking) and procedural elements (antibiotic omission, operative duration) influence HALS wound complication risks.
• This data aids in selecting between HALS and standard laparoscopy based on individual patient profiles and risk factors.