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

PURPOSE: To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). BACKGROUND: Since the 90 s, 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 < .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 2 years after surgery. After 2 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.

A traveler in transit: A case of an impending thrombus entrapped in a patent foramen ovale.

Thrombus across a patent foramen ovale (PFO), also referred to as a pending paradoxical embolus is a rare condition. We report a case of a 50-year-old male taxi driver who was diagnosed with a massive saddle pulmonary embolism, leg deep venous thromboembolism, and pending paradoxical embolus through a PFO with systemic embolization. The patient had an inferior vena cava (IVC) filter inserted immediately followed by surgical thromboembolectomy and closure of PFO. He was discharged home 1 month after surgery. Surgery is the treatment of choice for preventing systemic embolization particularly cryptogenic stroke and its sequelae from pending paradoxical embolus. Preoperative IVC filter is a useful adjunct to prevent ongoing thromboembolism in the perioperative period. The case report presented at the Annual Cardiothoracic Meeting, 10 November 2017, Royal Society of Medicine, London.