Port-site hernia following laparoscopic cholecystectomy: personal experience and literature review

Background The purpose of our study is to define the real incidence of port-site hernias (PSH) following laparoscopic cholecystectomy (LC) through a long-term follow-up and to evaluate the significance of several technical and patient-related factors. Materials and Methods A total of 513 consecutive patients who underwent LC at Section of General and Thoracic Surgery of the University Hospital of Palermo in the period between January 2008 and January 2012 were retrospectively examined. The pneumoperitoneum at 12 mmHg was always established with Hasson’s technique at the umbilical site. Surgery was performed using the French technique. Closure of the fascial defect was performed only at the umbilical site. The effects of several variables, including age, gender, size of gallstones, coexisting umbilical hernia, diabetes, obesity, malnutrition, smoking, and heavy manual work on the development of TSH were assessed. Results A total of twelve patients (2.3 %) were identified with PSH over a mean follow-up period of 49.5 months (range: 31-68 months). Of these, 10 developed at the umbilicus and 2 at the 10 mm epigastric site. Statistical analysis performed using Student’s t-test and chi-square test, previous umbilical hernia (p < 0.01), gallstones ≥ 2 cm (p < 0.001), fascial incision enlargement (p < 0.01), umbilical wound infection (p < 0.01) and BMI > 30 Kg / m2 (p<0.01) were found to be related the risk of PSH development. Conclusions After long-term follow-up, the our incidence of PSH following LC was in line with literature data. Previous umbilical hernia, huge gallstones and relative fascial incision enlargement, umbilical wound infection and obesity play a key role in the development of PSH.