Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period

Abstract

The present study was conducted to report the perioperative outcomes of single-port access (SPA) laparoscopic gynecologic surgeries with focus on the incidence of postoperative incisional hernia from our cumulative data of 2498 patients. A retrospective review was performed on the women who had received SPA surgeries from 2008 to 2018. Patient characteristics and perioperative outcomes including the incidence of postoperative incisional hernia were analyzed. There were 2498 Korean patients who received SPA surgeries for various gynecologic diseases. The median age of the patients was 40.3 ± 9.2 years, and the mean body mass index (BMI) was 22.6 ± 3.2 kg/m². A total of 3 postoperative incisional hernia occurred during the study period. Two patients whose fascial layers were closed in running sutures developed hernias 6 and 8 months after their operations. One patient whose fascial layers were closed in interrupted sutures developed hernia 11 months after her operation. The incidence of postoperative incisional hernia following SPA surgery is low in Asian women whose BMI is relatively lower than other patient populations. Interrupted suture technique may reduce postoperative incisional hernia by providing a distinct visualization of fascial layers during closure. Detailed descriptions of our surgical techniques of closing the port incision are provided.

Figure 1

Illustration of the closing methods in single-port access laparoscopic surgery: (a) with gently pulling the wound retractor towards the contralateral side of the stitch, clear visualization of fascial layer is possible, and the upper end of the incision is sutured, (b) the other side of the fascia is sutured by pulling the wound retractor contralaterally in a similar manner, (c–d) the lower part of the incision is sutured in a similar manner, (e,f) with the sutures in the upper and lower part of the incision remained untied, the middle portion of the incision is sutured similarly.

Figure 2

Demonstration of the closing methods: (a) the wound retractor is pulled towards the right side of the photo while the surgeon identifies the left upper side of the fascia (white arrow), (b) the wound retractor is pulled towards the left side and the surgeon throws a suture with clear visualization of the fascial layer of the opposite side (white arrow), (c) four interrupted sutures are completed without knots tied (S1 through S4 from cranial to caudal), (d) knots are tied sequentially from outer side of the incision, (e) tied suture materials are recognized (left: cranial, right: caudal), (f) after approximating subcutaneous tissue, skin is closed with absorbable materials by subcuticular suture.