Wound Complications in 1145 Consecutive Transumbilical Single-Incision Laparoscopic Procedures

Objective: To evaluate the wound complication rate in patients undergoing transumbilical single-incision laparoscopic (SIL) surgery. Background: SIL surgery claims to be less invasive than conventional laparoscopy. Small SIL series have raised concerns toward a higher wound complication rate related to the transumbilical incision. Methods: In a 44-month period, 1145 consecutive SIL procedures were included. The outcomes were assessed according to the intention-to-treat analysis principle. All procedures were followed for a minimum of 6 months postoperatively, and wound complications were recorded as bleeding, infection (superficial/deep), or hernia. Patients were classified as having a wound complication or not. For all comparisons, significance level was set at P < 0.05. Results: Pure transumbilical SIL surgery was completed in 92.84%, and additional trocars were used in 7.16%. After a median follow-up of 22.1 (range, 7.67-41.11) months, 29 wound complications (2.53%) had occurred [bleeding 0%/infection 1.05% (superficial 0.9%/deep 0.17%)/early-onset hernia 0.09%/late-onset hernia 1.40%, respectively]. Factors associated with complications were higher patient body mass index (28.16 4.73 vs 26.40 +/- 4.68 kg/m(2); P = 0.029), longer skin incisions (3.77 +/- 1.62 vs 2.96 +/- 1.06 cm; P = 0.012), and multiport SIL versus single-port SIL (8.47% vs 2.38%; P = 0.019) in complicated versus uncomplicated procedures. Furthermore, a learning curve effect was noted after 500 procedures (P = 0.015). Conclusions: With transumbilical SIL surgery, the incidence of wound complications is acceptable low and is further reduced once the learning curve has been passed.