Incidence of incisional hernia after single-incision laparoscopic surgery in children.

Sir,

Laparoendoscopic single site (LESS) surgery has recently been widely used by paediatric surgeons who thank its advantages such as improved cosmesis, reduced surgical trauma, wound complications and post-operative pain.[1234] This mini-invasive approach employs a single access port but requires a larger umbilical incision for the insertion and the extraction of the operating specimen, which could theoretically increase the risk of laparoscopic port hernia.[5] Several studies reported a low incidence (0%–5.2%) of trocar site hernia after conventional laparoscopic surgery.[6] However, the incidence of incisional hernia after LESS surgery is not well studied in children.

Our study aimed to determine the incidence of umbilical trocar site hernia after LESS surgery in a paediatric population.

A retrospective review of 250 patients who underwent LESS surgery from January 2013 to December 2015 was performed. The study was approved by the Local Ethic Committee and informed consent was obtained from all patients. All procedures were performed using our homemade surgical glove port and rigid laparoscopic instruments [Figure 1]. Specimen was extracted through a single umbilical incision sized between 1.5 and 2.5 cm [Figure 2]. By the end of the intervention, fascial defect was closed using 2/0 vicryl sutures.

Figure 1

Homemade device used in laparoendoscopic single site procedures: Surgical glove port

Figure 2

Umbilical incision

LESS surgery was performed in 250 patients (193 boys, 57 girls) during the study. Mean age of patients was 8.3 ± 3.2 years and mean body mass index was 17 kg/m2. LESS procedures included appendectomy (n = 144), orchidopexy (n = 59), cholecystectomy (n = 10), nephrectomy (n = 9), pyeloplasty (n = 8), varicocelectomy (n = 5), intestinal intussusceptions management (n = 4), lymph node biopsy (n = 4), ureterostomy (n = 1), explorative laparoscopy (n = 1) in research of Meckel's diverticulum in a 2-year-old infant with recurrent rectal bleeding, ovarian cystectomy (n = 1), ovarian transposition in a 12-year-old girl with advanced Hodgkin's lymphoma requiring a pelvic radiotherapy, renal hydatid cyst aspiration (n = 2), hydrocolpos drainage in a new-born female with prenatal diagnosis of intra-abdominal mass. The mean operating time of all procedures was 52 ± 12.6 min. The mean length of hospital stay was 2 ± 1.1 days. Conversion to conventional surgery was needed in 6 cases. After a median follow-up of 18 months, umbilical trocar site hernia occurred in only one case (0.4%).

In conclusion, this preliminary study demonstrates that the rate of umbilical trocar site hernia after LESS surgery is low in children. Further comparative studies are needed to validate these findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.