Comajuncosas et al identified risk factors for an incisional hernia at the umbilical trocar site for a laparoscopic cholecystectomy. A patient at high risk may benefit from more aggressive management. The authors are from the University of Barcelona in Spain.
Patient selection: laparoscopic cholecystectomy
Site of incisional hernia: umbilicus
Frequency of incisional hernia at umbilical trocar site: 26%.
Other series site report rates < 3%. The increased rate reported was ascribed to a prospective design with careful exam to detect asymptomatic or small hernias.
Risk factors for incisional hernia from multivariate analysis:
(1) incisional enlargement (OR 14.2)
(2) wound infection at trocar site (OR (5.6)
(3) diabetes mellitus (OR (2.8)
(4) obesity (OR 2.7). In the univariate analysis this was a BMI > 30 kg per sq meter.
Two of these (diabetes and obesity) would be preoperative variables while the other two are postoperative.
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