The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery.
OBJECTIVE
To estimate the risk of umbilical hernia and other latent complications in women who underwent laparoendoscopic single-site surgery (LESS) for a gynecologic indication.


METHODS
Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2).


METHODS
Four tertiary care academic medical centers.


METHODS
Women undergoing LESS for a benign or malignant gynecologic indication from 2009 to 2011.


METHODS
A total of 211 women underwent LESS via a single 1.5- to 2.0-cm umbilical incision. All surgeries were performed by advanced gynecologic laparoscopists. Incisions were repaired with a running, delayed absorbable suture. Subject demographics and clinical variables were collected and surgical outcomes analyzed.


RESULTS
Median age and body mass index were 45 years and 30 kg/m(2), respectively. Approximately half of study subjects underwent a hysterectomy with or without salpingo-oophorectomy, and 15% had a diagnosis of cancer. Overall, 0.9% of women were diagnosed with a preoperative umbilical hernia, and 2.4% of women experienced a major perioperative complication. After a median postoperative follow-up time of 16 months, 2.4% had development of an umbilical hernia. However, 4/5 of these women had significant risk factors for fascial weakening independent of LESS, including requirement for a second abdominal surgery in 1 subject and a cancer diagnosis with postoperative chemotherapy administration in 2 subjects. When these subjects deemed "high risk" for incisional disruption were excluded from the analysis, the umbilical hernia rate was 0.5% (1/207). On univariable analysis, obesity was the only factor associated with complications (p = .04).


CONCLUSIONS
When performed by advanced laparoscopic surgeons, laparoendoscopic single-site gynecologic surgery is associated with a low risk of major adverse events. Additionally, the overall umbilical hernia rate was 2.4% and was lower (0.5%) in subjects without significant comorbidities.
Department of Gynecology, Division of Gynecologic Oncology, Greater Baltimore Medical Center/Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Camille C
CC
Gunderson
Jason
J
Knight
Jessica
J
Ybanez-Morano
Carol
C
Ritter
Pedro F
PF
Escobar
Okechukwu
O
Ibeanu
Francis C
FC
Grumbine
Mohamed A
MA
Bedaiwy
William W
WW
Hurd
Amanda Nickles
AN
Fader
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000601:surgery*; D006554:Hernia, Umbilical / Q000209:etiology*; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010052:Ovariectomy; D012189:Retrospective Studies; D012307:Risk Factors; D058994:Salpingectomy; D055815:Young Adult