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Incisional hernia risk after hand-assisted laparoscopic surgery.
William S Cobb1, Alfredo M Carbonell, Garrett M Snipes
1Greenville Hospital System University Medical Center, Greenville, South Carolina, USA. wcobb@ghs.org
The American Surgeon
|August 4, 2012
Summary
Hand-assisted laparoscopic surgery (HALS) has a higher incisional hernia rate than previously reported. Obesity and renal disease are risk factors, with hernias often developing around one year post-operation.
Area of Science:
- Minimally Invasive Surgery
- Surgical Complications
- Abdominal Surgery
Background:
- Hand-assisted laparoscopic surgery (HALS) combines benefits of open and laparoscopic approaches.
- HALS facilitates organ retrieval and reduces operative time.
- Incisional hernia rates after HALS are expected to be low but require investigation.
Purpose of the Study:
- To determine the incidence of incisional hernias after HALS procedures.
- To identify patient factors predicting hernia formation at the hand port site.
Main Methods:
- Retrospective review of 405 HALS procedures from July 2006 to June 2011.
- Incisional hernias confirmed by imaging or examination.
- Analysis of patient factors including BMI and comorbidities.
Main Results:
- Overall incisional hernia incidence was 10.6%.
- Higher mean BMI (32.1 vs 29.2 kg/m²) and increased renal disease (18.6% vs 7.2%) in the hernia group.
- Mean time to hernia development was 11.4 months; 17% incidence in patients followed >12 months.
Conclusions:
- Incisional hernia rates after HALS are higher than literature suggests.
- Obesity and renal disease are significant risk factors.
- Long-term follow-up is crucial to accurately assess HALS-related incisional hernia incidence.
