Evaluation of the Effect of Closure Technique on Incidence of Incisional Hernia after Single-Port Laparoscopy in Gynecologic Oncology Surgery

Abstract

To evaluate incidence and risk factors for incisional hernia in women undergoing single-port laparoscopy (SPL) for gynecologic oncology indications with a standardized fascia closure (SC) technique vs historical controls (HC). Retrospective cohort study. Single academic institution. Women who underwent SPL from June 1, 2017, to December 31, 2019, for gynecologic oncology indications with SC were compared with HC who underwent SPL from January 1, 2009, to December 31, 2015. Data were collected for patient demographics, postoperative outcomes, and incisional hernia development. Univariate analysis and multivariable regression models were built for predictors of incisional hernia. Of 1163 patients, 242 (20.8%) patients had SC, and 921 (79.2%) patients were HC. SC cohort had lower rates of diabetes vs HC (10.3% vs 15.3%; p=.049) but no differences in hypertension (36.8% vs 43.0% p=.081) and obesity (42.6% vs 36.9%, p=.11). A total of 1123 (96.6%) patients did not undergo conversion to multiport laparoscopy or laparotomy, of whom 7.2% (n=81) of patients developed an incisional hernia; there was no difference in incisional hernia development for SC with SPL (n=237) vHC with SPL (n=886) (9.7% vs 6.5%, p=.095). On multivariable analysis, increased body mass index (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03-1.09, p < .001) and diabetes (OR 2.41; CI 1.34-4.32, p=.003) were associated with incisional hernia, but age (OR 1.00; CI .98-1.02, p=.92), length of surgery (OR 1.00; CI 1.00-1.01, p=.62), and hypertension (OR .89; CI .52-1.53, p=.68) were not. Patients with prior abdominal surgeries (OR 1.92; CI 1.14-3.26, p=.015) and hand-assist surgery (OR 3.17; CI 1.48-6.80, p=.003) were significantly associated with incisional hernia. Implementation of an SC protocol did not decrease the rate of incisional hernia vs HC during SPL. Risk of incisional hernia must be considered for SPL planning in patients with complex medical comorbidities and prior abdominal surgery.