Incidence and Management of Incisional Hernia Following Laparoscopic Surgery: A Retrospective Analysis from Tertiary and Multicenter Settings

Abstract

Background: Laparoscopic surgery is commonly performed for general and gynecologic procedures, but port-site incisional hernias can complicate outcomes, often presenting late and resulting in significant morbidity. Data regarding the true incidence, risk factors, and management of these hernias, especially from the Middle East and Oceania, are limited. This multicenter retrospective study was conducted to estimate the incidence of port-site incisional hernia following common laparoscopic procedures and to assess associated risk factors, management strategies, and outcomes in tertiary care centers in Dubai and Australia over a 10-year period. Methods: This retrospective multicenter study included 3,500 adults who underwent laparoscopic surgery with at least one port measuring 10 mm or larger in tertiary hospitals in Dubai and Australia between 2014 and 2024. Cases were identified using operative registers and electronic medical records. Standardized data collection forms recorded demographics, comorbidities, operative details, and 30-day wound complications. Port-site incisional hernia was defined by clinical or radiological criteria, with additional information collected on hernia site, timing, presentation, and management approach (conservative, elective, or emergency repair). Incidence was calculated as a proportion of all procedures, and logistic regression identified independent risk factors (p < 0.05). Results: Of 3,500 laparoscopic procedures, 56 patients developed a port-site incisional hernia, resulting in an incidence of 1.6%. The mean time to diagnosis was 8.4 ± 6.2 months, with the umbilical port implicated in 67.9% of cases. Most hernias presented as a painful lump and were managed by elective repair (80.4%), primarily using laparoscopic mesh techniques. Early morbidity was low, the mean postoperative stay was 2.6 ± 1.3 days, and there was no 30-day mortality. Multivariable analysis identified port size of 12 mm or greater (adjusted OR 1.89; 95% CI 1.03–3.46) and non-closure of ports 10 mm or larger (adjusted OR 2.48; 95% CI 1.29–4.76) as the only independent predictors of hernia. During a mean follow-up of 24 months, recurrence was infrequent (5.4%) and chronic port-site pain was rare. Conclusion: Port-site incisional hernia following laparoscopic surgery was infrequent (1.6%), predominantly occurred at umbilical ports, and was strongly associated with larger trocars and non-closure of fascial defects measuring 10 mm or more. Meticulous closure of large ports and the preferential use of elective laparoscopic mesh repair may reduce hernia incidence and ensure low recurrence and complication rates.