What is the rate of incisional hernia? Analysis of initial 100 single-port robotic colorectal procedures

BACKGROUND: As single-port robotic (SP r) colorectal surgery emerges, questions regarding incisional hernia (IH) rates exist. We evaluated our first 100 consecutive SP r colorectal resections to determine postoperative hernia rates. METHODS: From a prospectively maintained database of SP r colorectal procedures, we identified the first 100 consecutive abdominal colorectal procedures. Imaging review was conducted by a blinded radiologist. Clinical examinations were performed by the operating surgeon to detect hernias. Diagnosis of IHs was analyzed as an overall group, by subset with or without postoperative imaging, and by incision position. RESULTS: (range 16.9-42.6). 66% were women. Left-sided procedures were 75% of cases, whereas right-sided procedures were 25%. Mean maximal incision size was 4.84 cm (2.5-8). IH rates by site were as follows: right lower quadrant muscle-splitting incision (n = 58), 0%; left lower quadrant muscle-splitting incision (n = 16), 0%; umbilical incision (n = 10), 20%; stoma site (n = 14), 14.3%; and Pfannenstiel incision (n = 2), 0%. Postoperative imaging was available for 40% of patients. Mean follow-up was 15.27 months. The overall hernia rate was 4%. DISCUSSION: In MIS abdominal colorectal surgery, the maximal incision size for colorectal surgery is dictated by the specimen diameter, not the port width. SP robotic surgery did not result in increased IH formation, with a hernia rate of only 4%. All hernias occurred at an umbilical incision site or were stoma associated. No hernias developed in the 76% of cases that a muscle-splitting incision or Pfannenstiel incision was employed. Umbilical incisions should be avoided whenever possible. Concerns regarding increased IH rates for SP r colorectal procedures are unfounded.