HÉRNIA INCISIONAL PÓS CIRURGIA PORTAL ÚNICO

O que era era esperado, começa a aparecer. As cirurgias de portal único parecem realmente dar mais hérnia umbilical. Vejam o artigo abaixo publicado no  J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):731-7.

Incisional hernia rate may increase after single-port cholecystectomy.
Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M.
Department of General Surgery, Selcuklu Medical School, Selcuk University , Konya, Turkey .

Abstract 
Background: The major concerns of single-port cholecystectomy are port-site hernia and cost. Essentially, a larger transumbilical incision is more likely to increase the incidence of incisional hernia. The effect of single-port cholecystectomy on hospital cost is controversial. This study evaluated single-port cholecystectomy and traditional four-port cholecystectomy with respect to perioperative outcomes, hospital cost, and postoperative complications.
Patients and Methods: Between January 2010 and March 2011, 52 patients underwent single-port cholecystectomy, and 111 patients underwent traditional laparoscopic cholecystectomy. We used equal instruments in patients undergoing operation with the same surgical technique. Demographics, diagnosis, operative data, complications, length of hospital stay, and cost were compared between the two groups. Results: The patients undergoing laparoscopic cholecystectomy were significantly older than patients undergoing single-port cholecystectomy (55.8±13.8 years versus 48.7±12.7 years, P=.002). The trocar site hernia rate was 1.8% in laparoscopic cholecystectomy, and the port-site herniarate was 5.8% in single-port cholecystectomy. This is the highest rate reported in the literature for port-site hernia following single-port cholecystectomy. Surgical techniques were not different in terms of conversion to open surgery, postoperative hospital stay, and operative time. The relative cost of single-port cholecystectomy versus laparoscopic cholecystectomy was 1.54.
Conclusions: Although single-port cholecystectomy seems to be a feasible surgical technique, it is not superior over the traditional laparoscopic cholecystectomy. Single-port cholecystectomy is equal to laparoscopic cholecystectomy with respect to conversion to open surgery, postoperative hospital stay, and operative time, but it is associated with high hospital cost and high port-site hernia rate.

Não há dúvida que há espaço para este tipo de procedimento. Os dois principais enganos são:
1. Insistir com procedimentos comuns, porém em que não acrescentam nada (só problemas e custos), tipo colecistectomia.
2. Insistir em single-site, quando o melhor é multiport (com mini, se possível).