Skip to main content
SpringerLink
Log in

No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain after SLC versus CLC.

Methods

We conducted a matched cohort study based on prospective data (Jan 1, 2009–June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one or more port sites.

Results

In total, 699 patients were eligible and 147 patients were excluded from the analysis due to pre-defined criteria. The rate of returned questionnaires was 83%. Thus, 552 (SLC, n = 185; CLC, n = 367) patients were analyzed. The median observation time was 48 months (range 1–65) after SLC and 48 months (1–64) after CLC (P = 0.940). The total cumulated port-site hernia rate was 4 % and 6 % for SLC and CLC, respectively (P = 0.560). Incidences of moderate/severe chronic pain were 4 % and 5 % after SLC and CLC, respectively (P = 0.661).

Conclusions

We found no difference in long-term incidence of port-site hernia or chronic pain after SLC versus CLC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bisgaard T, Kehlet H, Rosenberg J (2001) Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg Acta Chir 167:84–96

    Article  CAS  Google Scholar 

  2. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg 136:917–921

    Article  CAS  PubMed  Google Scholar 

  3. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90:261–269

    Article  CAS  PubMed  Google Scholar 

  4. Keus F, de Jong J a. F, Gooszen HG, van Laarhoven CJHM (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 4:CD006231

  5. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26:1205–1213

    Article  CAS  PubMed  Google Scholar 

  6. Garg P, Thakur JD, Garg M, Menon GR (2012) Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 16:1618–1628

    Article  PubMed  Google Scholar 

  7. Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, Noya G, Boselli C (2013) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg 100:191–208

    Article  CAS  PubMed  Google Scholar 

  8. Zehetner J, Pelipad D, Darehzereshki A, Mason RJ, Lipham JC, Katkhouda N (2013) Single-access laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 23:235–243

    Article  PubMed  Google Scholar 

  9. Arezzo A, Scozzari G, Famiglietti F, Passera R, Morino M (2013) Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis. Surg Endosc 27:2293–2304

    Article  PubMed  Google Scholar 

  10. Milas M, Deveđija S, Trkulja V (2014) Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 12:271–289

    Article  PubMed  Google Scholar 

  11. Qiu J, Yuan H, Chen S, He Z, Han P, Wu H (2013) Single-port versus conventional multiport laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials and nonrandomized studies. J Laparoendosc Adv Surg Tech A 23:815–831

    Article  PubMed  Google Scholar 

  12. Harboe KM, Anthonsen K, Bardram L (2009) Validation of data and indicators in the Danish Cholecystectomy Database. Int J Qual Health Care 21:160–168

    Article  PubMed  Google Scholar 

  13. Møller C, Kehlet H, Utzon J, Ottesen B (2002) Hysterectomy in Denmark. An analysis of postoperative hospitalisation, morbidity and readmission. Dan Med Bull 49:353–357

    PubMed  Google Scholar 

  14. Schulze S, Iversen MG, Bendixen A, Larsen TS, Kehlet H (2008) Laparoscopic colonic surgery in Denmark 2004–2007. Colorectal Dis 10:869–872

    CAS  PubMed  Google Scholar 

  15. Funch-Jensen P, Bendixen A, Iversen MG, Kehlet H (2008) Complications and frequency of redo antireflux surgery in Denmark: a nationwide study, 1997–2005. Surg Endosc 22:627–630

    Article  PubMed  Google Scholar 

  16. Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2012) Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 256:955–958

    Article  PubMed  Google Scholar 

  17. Owens M, Barry M, Janjua AZ, Winter DC (2011) A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 9:218–224

    Article  CAS  PubMed  Google Scholar 

  18. Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2011) Low risk of trocar site hernia repair 12 years after primary laparoscopic surgery. Surg Endosc 25:3678–3682

    Article  PubMed  Google Scholar 

  19. Helgstrand F, Rosenberg J, Bisgaard T (2011) Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15:113–121

    Article  CAS  PubMed  Google Scholar 

  20. Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdú H, López Negre JL, Urgellés J, Estalella L, Parés D (2014) Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 207:1–6

    Article  PubMed  Google Scholar 

  21. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254:22–27

    Article  PubMed  Google Scholar 

  22. Jørgensen LN, Rosenberg J, Al-Tayar H, Assaadzadeh S, Helgstrand F, Bisgaard T (2014) Randomized clinical trial of single—versus multi-incision laparoscopic cholecystectomy. Br J Surg 101:347–355

    Article  PubMed  Google Scholar 

  23. Tranchart H, Ketoff S, Lainas P, Pourcher G, Di Giuro G, Tzanis D, Ferretti S, Dautruche A, Devaquet N, Dagher I (2013) Single incision laparoscopic cholecystectomy: for what benefit? HPB 15:433–438

    Article  PubMed Central  PubMed  Google Scholar 

  24. Krajinovic K, Ickrath P, Germer CT, Reibetanz J (2011) Trocar-site hernia after single-port cholecystectomy: not an exceptional complication? J Laparoendosc Adv Surg Tech A 21:919–921

    Article  PubMed  Google Scholar 

  25. Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, Rivas H, Islam A, Soper N, Paraskeva P, Rosemurgy A, Ross S, Shah S (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047

    Article  PubMed  Google Scholar 

  26. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135

    Article  PubMed Central  PubMed  Google Scholar 

  27. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2014) Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surg. doi:10.1016/j.amjsurg.2014.05.021

  28. Agaba EA, Rainville H, Ikedilo O, Vemulapali P (2014) Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS 18:204–210

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52

    Article  PubMed  Google Scholar 

  30. Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J (2002) Microlaparoscopic vs. conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Surg Endosc 16:458–464

    Article  CAS  PubMed  Google Scholar 

  31. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848

    Article  PubMed  Google Scholar 

  32. Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98:991–995

    Article  CAS  PubMed  Google Scholar 

  33. Chuang SC, Lee KT, Chang WT, Wang SN, Kuo KK, Chen JS, Scheen PC (2004) Risk factors for wound infection after cholecystectomy. J Formos Med Assoc 103:607–612

    PubMed  Google Scholar 

  34. Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560

    Article  PubMed  Google Scholar 

  35. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101:1439–1447

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Thanks to research nurse Pernille Strandfelt (Bachelor Nurse at the Gastro Unit, Surgical Section, Hvidovre Hospital, University of Copenhagen) for exquisite professional help to carry out the study. No compensation was received for data collection. The study was funded by the University of Copenhagen, the Danish Cholecystectomy Database, and the Danish Hernia database.

Disclosures

Dr. Christoffersen has no conflicts of interest or financial ties to disclose. Dr. Brandt has no conflicts of interest or financial ties to disclose. Dr. Oehlenschläger has no conflicts of interest or financial ties to disclose. Dr. Rosenberg reports grants from Baxter Healthcare, grants from Johnson & Johnson, grants from Bard, personal fees from Bard, and personal fees from Merck, outside the submitted work. Dr. Helgstrand has no conflicts of interest or financial ties to disclose. Dr. Jørgensen declares consultant ships and honoraria from the companies Covidien, Davol and Ethicon, and has no stock ownership, gifts, free or reimbursed travel/vacations, equity interests, arrangements regarding patents or other vested interests. Dr. Bardram has no conflicts of interest or financial ties to disclose. Dr. Bisgaard reports personal fees from Bard, grants from Ethicon, grants from Covidien, and personal fees from Life Cell, outside the submitted work.

Author information

Authors and Affiliations

  1. Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Mette W. Christoffersen, Jacob Oehlenschläger & Thue Bisgaard

  2. Surgical Section, Køge Hospital, University of Copenhagen, Køge, Denmark

    Erik Brandt & Frederik Helgstrand

  3. Gastro Unit, Surgical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    Jacob Rosenberg

  4. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg, Denmark

    Lars N. Jørgensen

  5. Department of Gastrointestinal Surgery and Liver Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Linda Bardram

Authors
  1. Mette W. Christoffersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erik Brandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacob Oehlenschläger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacob Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frederik Helgstrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lars N. Jørgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Linda Bardram
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thue Bisgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mette W. Christoffersen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Christoffersen, M.W., Brandt, E., Oehlenschläger, J. et al. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study. Surg Endosc 29, 3239–3245 (2015). https://doi.org/10.1007/s00464-015-4066-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4066-4

Keywords

Search

Navigation