Our Summary

This research paper looks at a specific type of surgery called Laparoendoscopic single-site (LESS) surgery, where the operation is done through a single port or incision. This method requires a slightly larger incision than traditional laparoscopy, leading to concerns about an increased risk of hernias at the site of the incision.

The researchers studied 219 patients who had either a gallbladder removal (cholecystectomy) or a part of their colon removed (sigmoidectomy) using LESS surgery. They found that three patients developed a hernia at the site of the incision over an average follow-up period of 34.7 months.

Interestingly, none of the patients who were obese, had a history of abdominal surgery, or had a pre-existing hernia at the belly button developed a hernia at the incision site. Moreover, none of the women who became pregnant after the surgery developed a hernia at the incision site.

However, they did find a link between having a pre-existing hernia at the belly button and early complications like infection or blood clot at the incision site.

Overall, the rate of developing a hernia at the incision site was 1.4%, which is similar to the rate seen with traditional laparoscopy. They concluded that the larger incision used in LESS surgery could actually be beneficial, as it made it easier to handle existing hernias, close the incision in obese patients, and remove tissue samples, thus reducing the need for additional surgery.

FAQs

  1. What is the rate of trocar site hernia in patients who underwent LESS surgery for cholecystectomy or sigmoidectomy?
  2. Did any of the obese patients, those with a history of abdominal surgery, or those with a preoperative umbilical hernia develop a trocar site hernia after the LESS surgery?
  3. What advantages does a peri-umbilical incision offer in LESS surgery compared to conventional laparoscopy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to carefully follow postoperative instructions to reduce the risk of complications, including avoiding heavy lifting and strenuous activities, keeping the surgical site clean and dry, and taking prescribed medications as directed. It is also important to attend follow-up appointments with your healthcare provider to monitor your recovery progress and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended sigmoidectomy include those with conditions such as diverticulitis, colorectal cancer, inflammatory bowel disease, and severe constipation. These patients may have failed other treatments or have a high risk of complications if left untreated. Additionally, patients who have a history of recurrent diverticulitis or complications such as perforation or abscess formation may also be recommended for sigmoidectomy.

Timeline

-Before sigmoidectomy:

  1. Patient undergoes pre-operative evaluation and consultation with surgeon to discuss the procedure and potential risks.
  2. Patient may undergo imaging studies such as CT scan or colonoscopy to assess the condition of the sigmoid colon.
  3. Patient may be placed on a clear liquid diet and given bowel preparation medication to cleanse the colon before surgery.
  4. Patient undergoes sigmoidectomy surgery, which involves removing a portion of the sigmoid colon.
  5. Patient is monitored in the recovery room and then transferred to a hospital room for post-operative care.

-After sigmoidectomy:

  1. Patient is closely monitored for any complications such as infection, bleeding, or bowel obstruction.
  2. Patient may experience pain at the incision site and be given pain medication as needed.
  3. Patient is gradually allowed to resume eating and drinking, starting with clear liquids and progressing to solid foods.
  4. Patient may be instructed to perform breathing exercises and gentle movement to prevent complications such as pneumonia or blood clots.
  5. Patient is discharged from the hospital once they are stable and able to care for themselves at home.
  6. Patient follows up with the surgeon for post-operative visits to monitor healing and discuss any concerns or complications.

What to Ask Your Doctor

  1. What is the specific reason for recommending sigmoidectomy surgery?
  2. What are the potential risks and complications associated with sigmoidectomy surgery?
  3. How long is the recovery period expected to be after sigmoidectomy surgery?
  4. How will the surgery be performed (laparoscopically, open surgery, etc.)?
  5. What is the success rate of sigmoidectomy surgery for my condition?
  6. Are there any alternative treatment options for my condition besides surgery?
  7. How many sigmoidectomy surgeries have you performed, and what is your success rate?
  8. Will I need to make any lifestyle changes after sigmoidectomy surgery?
  9. What should I expect in terms of pain management after the surgery?
  10. Are there any long-term effects or complications I should be aware of after sigmoidectomy surgery?

Reference

Authors: Smirnoff A, de Poncheville L, Allix-Béguec C, Lefant PY, Drapier E. Journal: Hernia. 2016 Feb;20(1):15-20. doi: 10.1007/s10029-015-1434-x. Epub 2015 Oct 27. PMID: 26508501