Background

Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR).

Methods

All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients’ characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS).

Results

Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19–50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012–31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097–39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance.

Conclusion

Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients’ characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.

中文翻译：

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腹腔镜肝切除术后切口疝的发生率

背景

在过去的几年中，微创技术已广泛应用于肝脏手术。在这项研究中，我们旨在报告腹腔镜肝切除术 (LLR) 后切口疝 (IH) 的发生率和潜在危险因素以及与健康相关的生活质量 (HRQoL)。

方法

所有在 2014 年 1 月至 2017 年 6 月期间接受 LLR 的患者均被联系进行门诊疝气检查。在所有符合条件的患者中，对疤痕进行了照片记录，并通过临床检查和超声评估了 IH。患者还完成了评估 IH 特异性症状和 HRQoL 的问卷调查。对获得的结果进行回顾性分析，包括患者的特征、围手术期结果和应用的微创技术，如多切口腹腔镜肝脏手术或手辅助/单切口腹腔镜手术 (HALS/SILS)。

结果

184例接受手术的患者中，161例（87.5%）符合纳入标准，49例（26.6%）参与了本研究。在术后 26 个月（范围 19-50 个月）的中位时间后，我们观察到 IH 的总体发生率为 12%。6 名患者中有 5 名超重或肥胖（BMI ≥ 25），6 名疝气中有 5 名位于脐部。单变量分析显示了手术时的体能状态（ASA 评分 ≥ 3；HR 5.616, 95% CI 1.012–31.157, p  = 0.048）和方法（HALS/SILS, HR 6.571, 95% CI 1.097–39.379, p  = 0.039）作为 IH 的潜在危险因素。疝相关身体限制的频率更高（HRR；p  = 0.058）和身体机能下降（p = 0.17) 在 IH 患者中发现；但是，两者都缺乏统计学意义。

结论

腹腔镜手术在 IH 发生率低方面的优势可以转化为微创肝脏手术。尽管 IH 发生率较低，但应密切监测手术时体能状态不佳的患者。虽然很难影响患者的特征，但可能值得关注手术因素，例如方法和脐部闭合，以进一步降低 IH 的发生率。