Incidence and Risk Factors of Incisional Hernia After Single-Incision Endoscopic Surgery.

Introduction: Abdominal wall complications are one of the most controversial issues regarding single-incision endoscopic surgery. The aim of this study was to analyze the incidence and risk factors of incisional hernia after single-incision endoscopic cholecystectomy. Materials and Methods: An observational retrospective study was performed, on a cohort of patients cholecystectomized laparoscopically through a transumbilical single incision due to gallbladder lithiasis or polyps. Postoperative complications were analyzed, with special interest in the incisional hernia rate, whose results were assessed in the long-term follow-up. Univariate and multivariate analyses were also performed to evaluate possible variables associated with the appearance of incisional hernia. Cumulative sum charts (CUSUM) were used to identify trends in the incisional hernia risk. Results: Some 109 patients were included in the study. With a mean follow-up of nearly 38 months, an incisional hernia incidence of 5.5% was found, with 67% being diagnosed during the first year of follow-up. In the Cox regression analysis, two variables showed an independent association with the emergence of incisional hernia, body mass index (hazard ratio [HR] 1.30; 95% confidence interval [CI 1.053-1.606]; P .015), and wound infection (HR 26.32; [3.186-217.40]; P .002]. CUSUM charts showed a decrease in the risk of incisional hernia after the first 10 cases. Conclusions: Single-incision endoscopic cholecystectomy is associated with a substantially high risk of postoperative incisional hernia (5.5%).

Hernia del orificio del trocar, ¿un problema más frecuente de lo que creemos? / Trocar site hernia: A more common problem than we believe?

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Colorectal anastomosis facilitated by the use of the LigaSure(®) sealing device: comparative study in an animal model.

BACKGROUND: Recently, there has been speculation about the possibility of fusing intestinal tissue using bipolar sealing devices. In this study we compare in a porcine model the anastomoses created using the LigaSure(®) device with those created with a stapler after section and closure of a rectal stump. METHODS: Thirty pigs underwent laparoscopic colorectal anastomosis. In group A (n = 15), the division of the intestine and distal stump closure were done with a 10-mm LigaSure Atlas(®) device. In group B, these steps were carried out using an endoscopic stapler. Subsequently, the colorectal anastomosis was performed using circular stapling in both groups. The 4-week follow-up included health status, weight gain, blood tests, X-rays, and colonoscopy. Anastomotic tissue was processed to study the mechanical tensile strength and histopathology. RESULTS: There was no difference in the rate of conversion to open surgery or in average operating time between the groups. In the sealing device group, there was a significantly higher rate of failure in rectal stump closure (p = 0.042). There was one death in group B due to anastomotic leak. There was no difference in adhesion formation or stenosis. Mid-section anastomosis area was 89.7 mm(2) in group A compared with 100 mm(2) in group B (p = 0.52). In tensile strength studies, the maximum load resisted by the sample was 13.8 ± 4.9 N (group A) versus 15.7 ± 4.4 N (group B) (p = 0.17). There was no difference between the groups in degree of reepithelialization, number of inflammatory cells, or the presence of microabscesses. CONCLUSIONS: Division and sealing of the rectal stump with the LigaSure(®) device is feasible in the proposed experimental model, but it is less reliable than conventional closure with a stapler, since it has a significantly greater failure rate. Therefore, The LigaSure(®) device should not be used for this purpose in the clinical setting as this could lead to serious and dramatic complications.

Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications.

BACKGROUND: Although much of the literature focuses on risk factors for intestinal resection in groin hernias, little is known specifically for the femoral type. This study identifies clinical and analytic parameters associated with intestinal ischemia in patients with an incarcerated femoral hernia. METHODS: Eighty-six patients with an incarcerated femoral hernia were included in an analytic, longitudinal, observational, retrospective cohort study. Clinical presentation, the duration of symptoms, analytic and radiologic studies, complications, and mortality rates were analyzed. RESULTS: Eight (9.3%) patients underwent intestinal resection. Factors related to intestinal ischemia were oral anticoagulants intake (odds ratio = 9.6) and a duration of symptoms longer than 3 days (odds ratio = 2.1). There was no relationship between leukocytosis (P = .02) or radiographic signs of intestinal obstruction (P = .28) and bowel resection. CONCLUSIONS: Patients with a duration of symptoms longer than 3 days and, interestingly, those having oral anticoagulant therapy appeared to be at a higher risk for developing intestinal ischemia. A remarkable reduction in morbimortality can be achieved through an earlier referral to the hospital, quick preoperative workup, and urgent operation.