Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience
Background Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hern...
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| Veröffentlicht in: | Surgical endoscopy 2021-09, Vol.35 (9), p.5167-5172 |
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| creator | Harriott, Camila Bras Dreifuss, Nicolás H. Schlottmann, Francisco Sadava, Emmanuel E. |
| description | Background
Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia.
Methods
A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013–2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed.
Results
A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%,
p
= 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12–41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%,
p
= 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (
p
= 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22–174.0,
p
|
| doi_str_mv | 10.1007/s00464-020-08007-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2445425017</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2558852153</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d7c8e70f2c190ce708905db64cc1c7ec51b3ac0906d582df43d160025d41dae03</originalsourceid><addsrcrecordid>eNp9kTtvFDEURi0EIkvgD1AgSzRpHK5f8yhXEYFIkUgRast7fWfjMC_smQhafjleNoBEQWXLPt93bR3GXks4lwD1uwxgKiNAgYCmHAj9hG2k0UooJZunbAOtBqHq1pywFznfQ-FbaZ-zE63aymioN-zH1Ygx0IjE_Rh4ivkL7zwuU8q8mxJfh13sI_qeL2lCn3iOC_E7SmP03HcLJd772acp4zRH5LfbmxueaPYxnfNtocd9X_i4vxMPU78OxJHGQ4q-zZTiYfBL9qzzfaZXj-sp-3z5_vbio7j-9OHqYnstUNd2EaHGhmroFMoWsOyaFmzYVQZRYk1o5U57hBaqYBsVOqODrACUDUYGT6BP2dmxd07T15Xy4oaYkfrejzSt2SljrFEWZF3Qt_-g99OaxvI6p6xtGquk1YVSRwrL93Oizs0pDj59dxLcwZA7GnLFkPtlyB1Cbx6r191A4U_kt5IC6COQy9W4p_R39n9qfwJkt5xH</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2558852153</pqid></control><display><type>article</type><title>Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Harriott, Camila Bras ; Dreifuss, Nicolás H. ; Schlottmann, Francisco ; Sadava, Emmanuel E.</creator><creatorcontrib>Harriott, Camila Bras ; Dreifuss, Nicolás H. ; Schlottmann, Francisco ; Sadava, Emmanuel E.</creatorcontrib><description>Background
Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia.
Methods
A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013–2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed.
Results
A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%,
p
= 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12–41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%,
p
= 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (
p
= 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22–174.0,
p
< 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04–89.5,
p
= 0.007) were independent risk factors for TSH.
Conclusion
Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-08007-3</identifier><identifier>PMID: 32964307</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdomen ; Abdominal Surgery ; Amidines ; Body mass index ; Diabetes ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hernia, Umbilical - epidemiology ; Hernia, Umbilical - etiology ; Hernia, Umbilical - surgery ; Hernias ; Herniorrhaphy - adverse effects ; Humans ; Incidence ; Laparoscopy ; Laparoscopy - adverse effects ; Medicine ; Medicine & Public Health ; Minimally invasive surgery ; Morbidity ; Proctology ; Recurrence ; Regression analysis ; Retrospective Studies ; Risk Factors ; Surgery ; Surgical Instruments - adverse effects ; Surgical mesh ; Surgical site infections ; Sutures ; Variables</subject><ispartof>Surgical endoscopy, 2021-09, Vol.35 (9), p.5167-5172</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>2020. Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d7c8e70f2c190ce708905db64cc1c7ec51b3ac0906d582df43d160025d41dae03</citedby><cites>FETCH-LOGICAL-c375t-d7c8e70f2c190ce708905db64cc1c7ec51b3ac0906d582df43d160025d41dae03</cites><orcidid>0000-0003-2473-6154</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-08007-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-08007-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32964307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Harriott, Camila Bras</creatorcontrib><creatorcontrib>Dreifuss, Nicolás H.</creatorcontrib><creatorcontrib>Schlottmann, Francisco</creatorcontrib><creatorcontrib>Sadava, Emmanuel E.</creatorcontrib><title>Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia.
Methods
A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013–2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed.
Results
A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%,
p
= 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12–41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%,
p
= 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (
p
= 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22–174.0,
p
< 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04–89.5,
p
= 0.007) were independent risk factors for TSH.
Conclusion
Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Amidines</subject><subject>Body mass index</subject><subject>Diabetes</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Umbilical - epidemiology</subject><subject>Hernia, Umbilical - etiology</subject><subject>Hernia, Umbilical - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - adverse effects</subject><subject>Humans</subject><subject>Incidence</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally invasive surgery</subject><subject>Morbidity</subject><subject>Proctology</subject><subject>Recurrence</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical Instruments - adverse effects</subject><subject>Surgical mesh</subject><subject>Surgical site infections</subject><subject>Sutures</subject><subject>Variables</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kTtvFDEURi0EIkvgD1AgSzRpHK5f8yhXEYFIkUgRast7fWfjMC_smQhafjleNoBEQWXLPt93bR3GXks4lwD1uwxgKiNAgYCmHAj9hG2k0UooJZunbAOtBqHq1pywFznfQ-FbaZ-zE63aymioN-zH1Ygx0IjE_Rh4ivkL7zwuU8q8mxJfh13sI_qeL2lCn3iOC_E7SmP03HcLJd772acp4zRH5LfbmxueaPYxnfNtocd9X_i4vxMPU78OxJHGQ4q-zZTiYfBL9qzzfaZXj-sp-3z5_vbio7j-9OHqYnstUNd2EaHGhmroFMoWsOyaFmzYVQZRYk1o5U57hBaqYBsVOqODrACUDUYGT6BP2dmxd07T15Xy4oaYkfrejzSt2SljrFEWZF3Qt_-g99OaxvI6p6xtGquk1YVSRwrL93Oizs0pDj59dxLcwZA7GnLFkPtlyB1Cbx6r191A4U_kt5IC6COQy9W4p_R39n9qfwJkt5xH</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Harriott, Camila Bras</creator><creator>Dreifuss, Nicolás H.</creator><creator>Schlottmann, Francisco</creator><creator>Sadava, Emmanuel E.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2473-6154</orcidid></search><sort><creationdate>20210901</creationdate><title>Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience</title><author>Harriott, Camila Bras ; Dreifuss, Nicolás H. ; Schlottmann, Francisco ; Sadava, Emmanuel E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d7c8e70f2c190ce708905db64cc1c7ec51b3ac0906d582df43d160025d41dae03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Amidines</topic><topic>Body mass index</topic><topic>Diabetes</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Umbilical - epidemiology</topic><topic>Hernia, Umbilical - etiology</topic><topic>Hernia, Umbilical - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - adverse effects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Laparoscopy</topic><topic>Laparoscopy - adverse effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally invasive surgery</topic><topic>Morbidity</topic><topic>Proctology</topic><topic>Recurrence</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical Instruments - adverse effects</topic><topic>Surgical mesh</topic><topic>Surgical site infections</topic><topic>Sutures</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harriott, Camila Bras</creatorcontrib><creatorcontrib>Dreifuss, Nicolás H.</creatorcontrib><creatorcontrib>Schlottmann, Francisco</creatorcontrib><creatorcontrib>Sadava, Emmanuel E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harriott, Camila Bras</au><au>Dreifuss, Nicolás H.</au><au>Schlottmann, Francisco</au><au>Sadava, Emmanuel E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>35</volume><issue>9</issue><spage>5167</spage><epage>5172</epage><pages>5167-5172</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia.
Methods
A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013–2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed.
Results
A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%,
p
= 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12–41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%,
p
= 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (
p
= 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22–174.0,
p
< 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04–89.5,
p
= 0.007) were independent risk factors for TSH.
Conclusion
Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32964307</pmid><doi>10.1007/s00464-020-08007-3</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2473-6154</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdomen Abdominal Surgery Amidines Body mass index Diabetes Endoscopy Gastroenterology Gynecology Hepatology Hernia, Umbilical - epidemiology Hernia, Umbilical - etiology Hernia, Umbilical - surgery Hernias Herniorrhaphy - adverse effects Humans Incidence Laparoscopy Laparoscopy - adverse effects Medicine Medicine & Public Health Minimally invasive surgery Morbidity Proctology Recurrence Regression analysis Retrospective Studies Risk Factors Surgery Surgical Instruments - adverse effects Surgical mesh Surgical site infections Sutures Variables |
| title | Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience |
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