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Wound Complications in 1145 Consecutive Transumbilical Single-Incision Laparoscopic Procedures

Weiss, Helmut G. MD, MSc*; Brunner, Walter MD, BA*; Biebl, Matthias O. MD*,†; Schirnhofer, Jan MD*; Pimpl, Katharina MD*; Mittermair, Christof MD*; Obrist, Christian MD*; Brunner, Eberhard MD*; Hell, Tobias MSc

doi: 10.1097/SLA.0b013e31827b7818
Original Articles

Objective: To evaluate the wound complication rate in patients undergoing transumbilical single-incision laparoscopic (SIL) surgery.

Background: SIL surgery claims to be less invasive than conventional laparoscopy. Small SIL series have raised concerns toward a higher wound complication rate related to the transumbilical incision.

Methods: In a 44-month period, 1145 consecutive SIL procedures were included. The outcomes were assessed according to the intention-to-treat analysis principle. All procedures were followed for a minimum of 6 months postoperatively, and wound complications were recorded as bleeding, infection (superficial/deep), or hernia. Patients were classified as having a wound complication or not. For all comparisons, significance level was set at P < 0.05.

Results: Pure transumbilical SIL surgery was completed in 92.84%, and additional trocars were used in 7.16%. After a median follow-up of 22.1 (range, 7.67–41.11) months, 29 wound complications (2.53%) had occurred [bleeding 0%/infection 1.05% (superficial 0.9%/deep 0.17%)/early-onset hernia 0.09%/late-onset hernia 1.40%, respectively]. Factors associated with complications were higher patient body mass index (28.16 ± 4.73 vs 26.40 ± 4.68 kg/m2; P = 0.029), longer skin incisions (3.77 ± 1.62 vs 2.96 ± 1.06 cm; P = 0.012), and multiport SIL versus single-port SIL (8.47% vs 2.38%; P = 0.019) in complicated versus uncomplicated procedures. Furthermore, a learning curve effect was noted after 500 procedures (P = 0.015).

Conclusions: With transumbilical SIL surgery, the incidence of wound complications is acceptable low and is further reduced once the learning curve has been passed.

A total of 1145 consecutive single-incision laparoscopic (SIL) procedures were assessed. With a total wound complication rate of 2.53%, factors associated with complications were higher patient body mass index, longer incision length, multiport SIL versus single-port SIL, and less SIL experience. SIL can be performed with an acceptable low wound complication rate.

*Department of Surgery, Saint John of God Hospital Salzburg, Salzburg, Austria

Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria; and

Department of Mathematics, University of Innsbruck, Innsbruck, Austria

Reprints: Helmut G. Weiss, MD, MSc, Saint John of God Hospital Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria. E-mail:

Disclosure: No external funding for this study. Nothing to disclose, no conflicts of interests for any of the authors.

© 2014 by Lippincott Williams & Wilkins.