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Background: At present, advantages of laparoscopic colorectal surgery (LCRS) over a conventional approach have been demonstrated, mostly due to a reduced morbidity and hospital stay. This has encouraged the development of new minimally invasive techniques like single incision laparoscopic surgery, which are thought to have further benefits over LCRS especially due to reduction of the number of incisions on the abdominal wall. However, there is only few information available regarding complications on the abdominal wall (CAW) after LCRS.
Purpose: To analyze CAW in patients undergoing LCRS.
Methods: Patients were selected from our prospectively maintained database of LCRS, operated between July 2007 and July 2012. Following a standardized protocol, the surgical specimen was extracted using an Alexis retractor to protect surgical site, and incisions of 10 mm were sutured both aponeurosis and skin, while 5 mm incisions only had skin closure. Patients with anastomosis leak and/or deep surgical site infection were included. Information of demographic, operative and follow-up data was analyzed using chi square and t of Student tests.
Results: In 455 patients that underwent LCRS during the above-mentioned period, 16 (3.7%) had ≥ 1 CAW. Eight patients (1.9%) had an incisional surgical site infection (SSI), six (1.4%) had an abdominal wall hematoma, three (0.7%) presented an incisional hernia, and two (0.5%) had a covered evisceration during early follow-up. Frequency of CAW was similar in patients operated secondary to diverticular disease and those with malignancy. Every SSI, hematoma and incisional hernia developed in surgical specimen extraction site, with no significant differences between periumbilical and suprapubic incision (SSI p= 0.15; Hematoma p = 0.990; Incisional hernia p = 0.08). Two out of three patients with incisional hernia had a prior SSI. When analyzing morbidity associated with ports, there was 1 (0.08%) covered evisceration in 1,180 incisions of 5 mm ports, and another one in the 890 incisions of 10 mm ports (0.11%).
Conclusion: In this study, CAW concentrated mainly in surgical specimen extraction sites, and port-related complications were uncommon.