Journal of Minimally Invasive Surgery 2021; 24(3): 145-151
Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closurewound closure
Yeseul Kim1, Sunghoon Choi1, Sungyub Jeong2, Sunghwan Lee1, Incheon Kang1, Jaeyoung Jang1
1Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, Seongnam, Korea
2Department of Surgery, Armed Force Capital Hospital, Seongnam, Korea
Correspondence to: Sunghoon Choi
Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea
Tel: +82-31-780-1824
Fax: +82-31-780-5259
Received: May 17, 2021; Revised: September 12, 2021; Accepted: September 13, 2021; Published online: September 15, 2021.
© The Korean Society of Endoscopic and Laparoscopic Surgeons.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures.
Methods: A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon).
Results: The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia.
Conclusion: Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.
Keywords: Incisional hernia, Laparoscopy, Cholecystectomy, Minimally invasive surgery

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