Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: A prospective observational study.

Valcarenghi, Jérôme; Hernigou, Jacques; Apicella, Giulia; Clegg, Emilie; Rousie, Maxime; Chasse, Emmanuel

Purpose: To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC).Background: Since the 90s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed.Methods: Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < 0.05.Results: A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first two years after surgery. After two years, this risk becomes quite low.Conclusions: Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.