eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Videoforum Manuscripts accepted About the journal Supplements Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank

vol. 13
Original paper

Randomized trial of umbilical incisional hernia in high-risk patients: extraction of gallbladder through subxiphoid port vs. umbilical port after laparoscopic cholecystectomy

Master Min Li, Baoqiang Cao, Renhua Gong, Dengqun Sun, Peisong Zhang, Xudong Jiang, Yanfei Sheng

Videosurgery Miniinv 2018; 13 (3): 342–349
Online publish date: 2018/05/25
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Trocar site incisional hernia (TSIH) is one of the most common complications of laparoscopic surgery. Using the umbilical port as a common hole for removing the gallbladder in laparoscopic cholecystectomy is more likely to lead to TSIH than other ports. Thus, extracting the gallbladder through other ports may reduce the incidence of TSIH.

To ascertain whether extraction of the gallbladder through the subxiphoid port is more beneficial for reducing umbilical incisional hernia than the umbilical port.

Material and methods
From April 2014 to March 2017, a randomized clinical trial was conducted among patients with high risk of incisional hernia and accepted for three-port laparoscopic cholecystectomy (TLC) in our department. 182 patients with indications of cholecystectomy were allocated randomly to group A (subxiphoid port) and group B (umbilical port). Data collection was carried out on operative time, postoperative pain, hospital stay, wound infection and TSIH in the early postoperative course, and at 1, 10, and 24 months after surgery.

The incidence of TSIH in group A was lower than that in group B (4.9% vs. 14.6%; odds ratio = 8.02; 95% CI: 2.15–47.6; p < 0.001). The mean operative time of group A was significantly shorter than that of group B (35 ±15.16 min vs. 42 ±14.58 min, p < 0.01). There was no significant difference in wound infection rate between group A and group B (p = 0.068). The data of hospital stay (p = 0.428) and postoperative pain (p = 0.349) of all analyzed patients were similar in the two groups.

Extraction of the gallbladder through the subxiphoid port can reduce umbilical incisional hernia in high-risk patients effectively.


laparoscopic cholecystectomy, subxiphoid port, umbilical port, trocar site incisional hernia

Rosen M, Ponsky J. Minimally invasive surgery. Japan J Urol 1992; 33: 823-9.
Comajuncosas J, Vallverdú H, Orbeal R, et al. Trocar site incisional hernia in laparoscopic surgery. Cir Esp 2011; 89: 72-6.
Moreno-Sanz C, Picazo-Yeste JS, Manzanera-Díaz M, et al. Prevention of trocar site hernias: description of the safe port plug technique and preliminary results. Surg Innov 2008; 15: 100-4.
Duca S, Bala O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HBP 2003; 5: 152-8.
Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia. Arch Surg 2004; 139: 1248-56.
Shaher Z. Port closure techniques. Surg Endosc 2007; 21: 1264-74.
Rodríguez JAP, Pera M, Posa LG. Incidence of incisional hernia after open and laparoscopic colorectal cancer resection. Cir Esp 2013;91: 44-9.
Höer J, Lawong G, Klinge U, et al. Influencing factors on the causes of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirurg 2002; 73: 474-80.
Hesselink VJ, Luijendijk RW, de Wilt JH, et al. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 1993; 176: 228-34.
Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014; 207: 1-6.
Wang XC, Zhang D, Yang ZX, et al. Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017; 209: 17-29.
Sanz López R, Martínez Ramos C, Núñez Pena JR, et al. Incisional hernias after laparoscopic vs. open cholecystectomy. Surg Endosc 1999; 13: 922-4.
Imme A, Cardi F. Incisional hernia at the trocar site in laparoscopic surgery. Chir Ital 2006; 58: 605-9.
Armañanzas L, Ruiz-Tovar J, Arroyo A, et al. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 2014; 218: 960-8.
Llaguna OH, Avgerinos DV, Nagda P, et al. Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 2011; 35: 1651-5.
Park MG, Kang J, Kim JY, et al. Trocar site hernia after the use of 12-mm bladeless trocar in robotic colorectal surgery. Surg Laparosc Endosc Percutan Tech 2012; 22: e34-6.
Chiong E, Hegarty PK, Davis JW, et al. Port-site hernias occurring after the use of bladeless radially expanding trocars. Urology 2010; 183: 574-80.
Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, et al. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997; 21: 529-33.
Coda A, Bossotti M, Ferri F, et al. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 1999; 9: 348-52.
Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 2001; 15: 663-6.
Goodenough CJ, Ko TC, Kao LS, et al. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg 2015; 220: 405-13.
Rogmark P, Petersson U, Bringman S, et al. Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: PROLOVE: a randomized controlled trial. Ann Surg 2016; 263: 244-50.
Elkhadrawy OH, Moussa G, Mansour O, et al. Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 2009; 13: 267-74.
Burcharth J, Rosenberg J. Hernias as medical disease. Ugeskrift for Laeger 2008; 170: 3314-8.
Hussain A, Mahmood H, Singhal T, et al. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 2009; 13: 346-9.
Cleveland RD, Laws HL. Incisional closure in morbidly obese patients. Am Surg 1989; 55: 61-3.
Eid GM, Collins J. Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients. Obes Surg 2005; 15: 871-3.
Uslu HY, Erkek AB, Cakmak A, et al. Trocar site hernia after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2007; 17: 600-3.
Beltrán MA, Cruces KS. Incisional hernia after McBurney incision: retrospective case-control study of risk factors and surgical treatment. World J Surg 2008; 32: 596-601.
Hornby ST, Mcdermott FD, Coleman M, et al. Female gender and diabetes mellitus increase the risk of recurrence after laparoscopic incisional hernia repair. Ann Royal Coll Surg Engl 2015; 97: 115-9.
Richards C, Edwards J, Culver D, et al. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg 2003; 237: 358-62.
Rotermann M. Infection after cholecystectomy, hysterectomy or appendectomy. Health Rep 2004; 15: 11-23.
Brandt C, Sohr D, Behnke M, et al. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006; 27: 1347-51.
Tucker JJ, Yanagawa F, Grim R, et al. Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg 2011; 77: 1014-20.
Warren DK, Nickel KB, Wallace AE, et al. Risk factors for surgical site infection after cholecystectomy. Open Forum Infect Dis 2017; 4: ofx036. doi: 10.1093/ofid/ofx036.
Haridas M, Malangoni MA. Predictive factors for surgical site infection in general surgery. Surgery 2008; 144: 496-503.
Drosdeck J, Harzman A, Suzo A, et al. Multivariate analysis of risk factors for surgical site infection after laparoscopic colorectal surgery. Surg Endosc 2013; 27: 4574-80.
Duron JJ, Hay JM, Msika S, et al. Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. Arch Surg 2000; 135: 208-12.
Reardon PR, Preciado A, Scarborough T, et al. Hernia at 5-mm laparoscopic port site presenting as early postoperative small bowel obstruction. J Laparoendosc Adv Surg Tech A 1999; 9: 523-5.
Paya K, Wurm J, Fakhari M, et al. Trocar site hernia as a typical postoperative complications of minimally invasive surgery among preschool children. Surg Endosc 2008; 22: 2724-7.
Lee JH, Kim W. Strangulated small bowel hernia through the port site: a case report. World J Gastroenterol 2008; 14: 6881-3.
Velasco JM, Vallina VL, Bonomo SR, et al. Post laparoscopic small bowel obstruction: rethinking its management. Surg Endosc 1998; 12: 1043-5.
Morrison CP, Wemyss-Holden SA, Iswariah H, et al. Lateral laparoscopic port sites should all be closed: the incisional spigelian hernia. Surg Endosc 2002; 16: 1364.
Petrakis I, Sciacca V, Chalkiadakis G, et al. A simple technique for trocar site closure after laparoscopic surgery. Surg Endosc 1999; 13: 1249-51.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe