LAPAROSCOPIC CHOLECYSTECTOMY AND THE UMBILICUS

Background Pre-existing umbilical defects may present technical proble ms in patients having laparoscopic surgery. Fascial defects map also o ccur after operation. Understanding the causes and mechanisms of herni ation at laparoscopic port sites may help avoid potentially serious po stoperative complications. Methods The incidence, management and poten tial 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 pe r cent, The hernias were symptomatic in only 16.3 per cent, the majori ty of patients were unaware of the defect, The umbilical port was esta blished through, or directly adjacent to. the defect, allowing simple anatomical repair in 90 per cent, using absorbable sutures, The recurr ence rate was 3.8 per cent recurrence was usually caused by wound exte nsion or infection. Incisional hernia occurred in 16 patients after ch olecystectomy (1.8 per cent), Only one hernia developed at a port site other than the umbilicus, Risk factors associated with incisional her nia were wound extension in 12 patients, male sex in six, wound infect ion in five, diabetes in four, pre-existing umbilical hernia in four a nd 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 incisiona l 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.