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Laparoscopic cholecystectomy and the umbilicus.
Br J Surg. 1997 May; 84(5):630-3.BJ

Abstract

BACKGROUND

Pre-existing umbilical defects may present technical problems in patients having laparoscopic surgery. Fascial defects may also occur after operation. Understanding the causes and mechanisms of herniation at laparoscopic port sites may help avoid potentially serious postoperative complications.

METHODS

The incidence, management and potential complications of pre-existing and postoperative umbilical defects were studied in 870 patients undergoing laparoscopic cholecystectomy.

RESULTS

The incidence of umbilical or paraumbilical defects was 12 per cent. The hernias were symptomatic in only 16.3 per cent; the majority of patients were unaware of the defect. The umbilical port was established through, or directly adjacent to, the defect, allowing simple anatomical repair in 90 per cent, using absorbable sutures. The recurrence rate was 3.8 per cent; recurrence was usually caused by wound extension or infection. Incisional hernia occurred in 16 patients after cholecystectomy (1.8 per cent). Only one hernia developed at a port site other than the umbilicus. Risk factors associated with incisional hernia were wound extension in 12 patients, male sex in six, wound infection in five, diabetes in four, pre-existing umbilical hernia in four and acute cholecystitis in three.

CONCLUSION

The significant incidence of umbilical defects in patients undergoing laparoscopic surgery calls for accurate diagnosis and good technique. The incidence of incisional hernia might be reduced by avoiding unnecessary wound extension and the use of non-absorbable sutures for defects larger than 2 cm and in men with umbilical hernia.

Authors+Show Affiliations

Department of Surgery, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9171748

Citation

Nassar, A H., et al. "Laparoscopic Cholecystectomy and the Umbilicus." The British Journal of Surgery, vol. 84, no. 5, 1997, pp. 630-3.
Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997;84(5):630-3.
Nassar, A. H., Ashkar, K. A., Rashed, A. A., & Abdulmoneum, M. G. (1997). Laparoscopic cholecystectomy and the umbilicus. The British Journal of Surgery, 84(5), 630-3.
Nassar AH, et al. Laparoscopic Cholecystectomy and the Umbilicus. Br J Surg. 1997;84(5):630-3. PubMed PMID: 9171748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic cholecystectomy and the umbilicus. AU - Nassar,A H, AU - Ashkar,K A, AU - Rashed,A A, AU - Abdulmoneum,M G, PY - 1997/5/1/pubmed PY - 1997/5/1/medline PY - 1997/5/1/entrez SP - 630 EP - 3 JF - The British journal of surgery JO - Br J Surg VL - 84 IS - 5 N2 - BACKGROUND: Pre-existing umbilical defects may present technical problems in patients having laparoscopic surgery. Fascial defects may also occur after operation. Understanding the causes and mechanisms of herniation at laparoscopic port sites may help avoid potentially serious postoperative complications. METHODS: The incidence, management and potential complications of pre-existing and postoperative umbilical defects were studied in 870 patients undergoing laparoscopic cholecystectomy. RESULTS: The incidence of umbilical or paraumbilical defects was 12 per cent. The hernias were symptomatic in only 16.3 per cent; the majority of patients were unaware of the defect. The umbilical port was established through, or directly adjacent to, the defect, allowing simple anatomical repair in 90 per cent, using absorbable sutures. The recurrence rate was 3.8 per cent; recurrence was usually caused by wound extension or infection. Incisional hernia occurred in 16 patients after cholecystectomy (1.8 per cent). Only one hernia developed at a port site other than the umbilicus. Risk factors associated with incisional hernia were wound extension in 12 patients, male sex in six, wound infection in five, diabetes in four, pre-existing umbilical hernia in four and acute cholecystitis in three. CONCLUSION: The significant incidence of umbilical defects in patients undergoing laparoscopic surgery calls for accurate diagnosis and good technique. The incidence of incisional hernia might be reduced by avoiding unnecessary wound extension and the use of non-absorbable sutures for defects larger than 2 cm and in men with umbilical hernia. SN - 0007-1323 UR - https://www.unboundmedicine.com/medline/citation/9171748/Laparoscopic_cholecystectomy_and_the_umbilicus_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0007-1323&date=1997&volume=84&issue=5&spage=630 DB - PRIME DP - Unbound Medicine ER -