title: Incisional hernia risk after hand-assisted laparoscopic surgery.
abstract: Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates  of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site  were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal  (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m(2); P = 0.001). The hernia  group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate  of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia  after hand-assisted laparoscopy.
authors.affiliation: Greenville Hospital System University Medical Center, Greenville, South Carolina, USA. wcobb@ghs.org
authors.forename: William S
authors.initials: WS
authors.lastname: Cobb
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Carbonell
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Snipes
authors.forename: Brianna
authors.initials: B
authors.lastname: Knott
authors.forename: Viet
authors.initials: V
authors.lastname: Le
authors.forename: Eric S
authors.initials: ES
authors.lastname: Bour
authors.forename: John D
authors.initials: JD
authors.lastname: Scott
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lokey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006555:Hernia, Ventral / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013997:Time Factors