Laparoscopic cholecystectomy and the umbilicus

Abstract

The significant incidence of umbilical defects in patients undergoing laparoscopic surgery calls for accurate diagnosis and good technique. The incidence of incisional hernia might be reduced by avoiding unnecessary wound extension and the use of non-absorbable sutures for defects larger than 2 cm and in men with umbilical hernia.

The umbilicus in laparoscopic surgery

“…For this reason, many surgeons elect to dissect out these defects, use them for their portals of entry, and then repair them in a formal fashion. The 14% incidence of umbilical fascial defects in this study agrees with the 12% to 18% incidence reported by others [9,10].…”

“…Nassar et al [9] and Ramachandran [10] reported an incidence of trocar-site herniation at the umbilicus after laparoscopic surgery of 2.2% and 1.6%, respectively, whereas the current study noted an incidence of only 0.8%. Azurin et al [3], using a retrospective chart review, reported an incidence of 0.77% (10), and other authors hayed claimed incidences of I% and 1.5% [6,8].…”

“…Many authors suggest that preexisting fascial defects are risk factors for postoperative trocar-site incisional hernia, even if formally repaired [3,9,10]. Yet comparisons of the incidence of incisional herniation between patients with and those without preexisting fascial defects have not been reported.…”

Incisional Hernia Rate May Increase After Single-Port Cholecystectomy

“…The extension of the umbilical fascial defect for removing the gallbladder from the abdomen is the factor predisposing the development of a hernia. 25 The singleport device already necessitates a larger fascial incision for insertion.…”

A 5-mm Port-Site Hernia Following a Laparoscopic Myomectomy Resulting in Bowel Obstruction

“…3 Overall, worldwide, only 5 cases of strangulation requiring emergency bowel resection have been reported following herniation through a 5-mm port site. [5][6][7][8] Multiple risk factors such as trocar diameter, 9 insertion of drains, 5 obesity, 10,11 prolonged manipulation, reinsertion of the ports and increased duration of surgery, 11,12 preexisting hernias, 10 and medical comorbidities 12,13 have been implicated in the development of port-site hernias, but there are very few prospective studies and no randomized studies conducted to identify these hernias. There is no difference between closed-entry and openentry laparoscopic techniques, when fascial closure is undertaken, in the incidence of port site umbilical hernias.…”