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Khoraminejad B, Sakowitz S, Porter G, Chervu N, Ali K, Mallick S, Bakhtiyar SS, Benharash P. Interhospital variation in the non-operative management of uncomplicated appendicitis in adults. Surg Open Sci 2024; 20:32-37. [PMID: 38883576 PMCID: PMC11180347 DOI: 10.1016/j.sopen.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. Methods The 2016-2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). Results Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. Conclusions We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.
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Affiliation(s)
- Baran Khoraminejad
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Boston University, Boston, MA, United States of America
| | - Sara Sakowitz
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Giselle Porter
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Konmal Ali
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Saad Mallick
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Peyman Benharash
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
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Derekoylu E, Ozkaya M, Macit M, Kalender G, Sahin KC, Gultekin MH, Demirdag C, Onal B. Evaluation of the Risk Factors for the Incisional Hernia Occurrence After Robot-Assisted Laparoscopic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38977416 DOI: 10.1089/lap.2024.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Objective: Our aim was to evaluate patient-related factors and compare the techniques used for surgical specimen removal [trocar extension (TE) and Pfannenstiel incision (PF)] in terms of incisional hernia (IH) occurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Materials and Methods: The records of 219 patients who underwent RALRP in our clinic between November 2017 and March 2021 were analyzed retrospectively. Postoperative complication data and functional (continence and potency status) and oncological outcomes were recorded. Hernia type, location, and treatments applied were also noted. Results: After exclusion, complete data were available on 192 patients undergoing RALRP between the specified dates. The TE technique for removing the surgical specimen was performed in 135 patients, and the lower abdominal transverse incision technique (PF) in 57 patients. Preoperative patient- and tumor-related characteristics (age, body mass index [BMI], American Society of Anesthesiologists (ASA) score, T stage, and prostate size) were similar in both surgical groups. IH was detected in 16 patients (14 in the TE group and 2 in the PF group) (P = .156). Thirteen patients underwent surgery for IH, and three were followed up clinically. Conclusion: In our study, no statistically significant demographic or surgical technique-related factors were found to explain the occurrence of IH in patients who underwent RALRP for prostate cancer. It was observed that IH occurred more frequently in the cases where the surgical specimen was removed with the TE technique compared with the PF incision, but this result was not statistically significant. There was also no statistically significant difference between these two groups regarding oncological and functional outcomes in the early postoperative period.
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Affiliation(s)
- Engin Derekoylu
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mustafa Ozkaya
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mustafa Macit
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Goktug Kalender
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kadir Can Sahin
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Hamza Gultekin
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cetin Demirdag
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Restaino S, Pellecchia G, Arcieri M, Del Pup L, Bogani G, Driul L, Scambia G, Vizzielli G. Port-site hernia recurrence at previous 5-mm laparoscopic access: case report and review of literature. Facts Views Vis Obgyn 2024; 16:241-247. [PMID: 38950540 DOI: 10.52054/fvvo.16.2.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Port-site hernia (PSH) of less than 10 mm is an exceptionally rare complication of minimally invasive surgery (MIS). To date, there have been no cases in the literature reporting recurrence of PSH from a 5 mm incision. We present the first case of PSH recurrence in a woman who underwent surgery for benign gynaecological pathology via a MIS approach. Her post-operative course was complicated by an episode of symptomatic hernia arising from a 5 mm accessory trocar which was surgically managed. A few months later she re-presented with the same symptoms and had a PSH recurrence of the same port-site. Two corrective surgeries employing different techniques were performed. The first episode was managed laparoscopically using interrupted stitches. On the other hand, the PSH recurrence was managed by placement of a mesh. Ultrasound played a crucial role in diagnostics, especially in the recurrent setting. Due to the complete absence of similar cases in the literature, the decision making around the management of a PSH recurrence from a 5 mm trocar site proved to be challenging. As MIS is the current standard of care, more cases are likely to occur, however despite the increasing number of surgical procedures performed via MIS, no established guidelines for managing such complications have been proposed. Trying to bridge this gap, we present the case report of the first case of PSH recurrence from a 5 mm accessory port and a review of the most significant literature available to date. We finally summarise the reported cases of PSH and the types of surgical repair conducted to highlight the absence of a standard of care.
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Paasch C, Meyer J, Hunger R, Krollmann N, Heisler S, Mantke R. Does the angle of trocar insertion affect the fascial defect caused? A porcine model. Hernia 2024; 28:585-592. [PMID: 38319439 PMCID: PMC10997682 DOI: 10.1007/s10029-023-02952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION With an incidence of 0-5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model. METHODS In October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis. RESULTS The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007). CONCLUSION When conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
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Affiliation(s)
- C Paasch
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany.
| | - J Meyer
- Department of General and Visceral Surgery, Ameos Hospital Schönebeck, Schönebeck, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - R Hunger
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - N Krollmann
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - S Heisler
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - R Mantke
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Liang JT, Liao YT, Chen TC, Huang J, Hung JS. Changing patterns and surgical outcomes of small bowel obstruction in the era of minimally invasive surgery for colorectal cancer. Int J Surg 2024; 110:1577-1585. [PMID: 38051917 PMCID: PMC10942203 DOI: 10.1097/js9.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC). METHODS Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups. RESULTS The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n =68/1544 vs. 9.7%, n =156/1604, P <0.0001). Compared with the TOS group, the MIS group had significantly different ( P <0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to ( P <0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3-12 months) onset (64.7%), while that in the TOS group ( P <0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more ( P <0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien-Dindo classification ≧3, 11.8 vs. 14.1%, P =0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower ( P =0.016) in the MIS group than in the TOS group. CONCLUSIONS The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur.
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Affiliation(s)
- Jin-Tung Liang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Yu-Tso Liao
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Tzu-Chun Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
| | - John Huang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Ji-Shiang Hung
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
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Krollmann N, Hunger R, Paasch C, Mantke R. Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients. Ann Med Surg (Lond) 2024; 86:50-55. [PMID: 38222712 PMCID: PMC10783355 DOI: 10.1097/ms9.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Background Studies have evaluated long-term occurrence of incisional hernia, cosmesis, and postoperative pain after single-incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. The authors performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period. Methods All patients that underwent SILC at the University Hospital Brandenburg an der Havel Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications, and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale). Results In total 125 patients underwent SILC. The single-incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 0.8% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6%, an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (visual analog scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar. Conclusion The present study demonstrates that SILC is a safe alternative in terms of incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow-up period and multiport laparoscopic cholecystectomy, our result is comparable.
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Affiliation(s)
- Niklas Krollmann
- Department of General Surgery, University Hospital Brandenburg an der Havel, Brandenburg, Germany
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Zhao X, Liu Y, Shi Y, Niu J. In-bag extraction of tissue through an incision in the posterior vaginal wall in laparoscopic myomectomy: a large retrospective study. BMC Womens Health 2023; 23:631. [PMID: 38012692 PMCID: PMC10683316 DOI: 10.1186/s12905-023-02780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/11/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Our purpose was to describe the outcomes of transvaginal in-bag tissue extraction tissue through an incision in the posterior vaginal wall the middle part incision of posterior vagina in laparoscopic myomectomy. METHODS This was a retrospective study of patients who received laparoscopic myomectomy and in-bag tissue extraction through an incision in the posterior vaginal wall between January 2016 and December 2022. Patient characteristics, intra- and post-operative complications, and outcomes were collected and analyzed. RESULTS A total of 511women were included in the analysis. The mean largest myoma diameter was 8.44 ± 3.56 cm; mean specimen weight was 789.23 ± 276.97 g; mean operative time was 129.01 ± 53.13minutes; and mean blood loss was 175.99 ± 210.96 mL. Within 30-days of surgery, no fever, infection, or vaginal bleeding was noted in any patient, and the vaginal incisions of all patients had healed well. There were no incisional hernias, pelvic infections, and vaginal adhesions noted at follow-up 3 months after the operation. There were 37 cases of vaginal delivery of the patients after surgery, and there were no lacerations of the posterior wall vaginal incision. CONCLUSIONS Transvaginal in-bag extraction though an incision in the posterior vaginal wall is feasible and safe for removing tissue after laparoscopic myomectomy.
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Affiliation(s)
- Xin Zhao
- Shenyang Women's and Children's Hospital, Shenyang, Liaoning Province, China
| | - Yansong Liu
- Shenyang Women's and Children's Hospital, Shenyang, Liaoning Province, China
| | - Yulin Shi
- Shenyang Women's and Children's Hospital, Shenyang, Liaoning Province, China
| | - Jumin Niu
- Shenyang Women's and Children's Hospital, Shenyang, Liaoning Province, China.
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Knochenhauer HE, Lim SL, Brown DA, Darner G, Levinson H, Havrilesky LJ, Previs RA. An obstetrician-gynecologist's review of hernias: risk factors, diagnosis, prevention, and repair. Am J Obstet Gynecol 2023; 229:214-221. [PMID: 37120051 DOI: 10.1016/j.ajog.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician-gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics.
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Affiliation(s)
| | - Stephanie L Lim
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - David A Brown
- Division of Plastic, Oral, and Maxillofacial Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | | | | | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC; LabCorp, Enterprise Oncology, Durham, NC.
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Loniewski S, Farah K, Malikov S, Fuentes S. Da Vinci robotic-assisted anterolateral lumbar arthrodesis: operative technique. Acta Neurochir (Wien) 2023; 165:2711-2716. [PMID: 37368035 DOI: 10.1007/s00701-023-05676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery. METHOD Applied to oblique lateral lumbar interbody fusion (OLIF), Da Vinci® robot (DVR) assistance can help specially in obese patients. Positioning and important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented. OLIF can be achieved efficiently through this approach with lesser blood loss, shorter hospital stays, and reduced rate of general complications. CONCLUSION The use of DVR assistance for OLIF is a promising new technique.
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Affiliation(s)
- Stanislas Loniewski
- Neurosurgery Department, CHU de Reims, 45 rue Cognacq Jay, 51100, Reims, France.
| | - Kaissar Farah
- Neurosurgery Department, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Serguei Malikov
- Vascular Surgery Department, Hôpitaux de Brabois, CHRU Nancy, rue du Morvan, 54511, Vandœuvre-lès-Nancy, France
| | - Stéphane Fuentes
- Neurosurgery Department, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
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Chen X, Xu L, Xu Z, Fan Z, Wang L, Qi Y, Lin C. Periumbilical giant abscess and intestinal leakage in late pregnancy: A rare case report and literature review. Medicine (Baltimore) 2023; 102:e34529. [PMID: 37565913 PMCID: PMC10419343 DOI: 10.1097/md.0000000000034529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Complicated Periumbilical abscess in late pregnancy is rare in clinical practice. Pubmed searches for articles published from January 1980 to September 2021. Such related reports did not retrieve article about "pregnancy" and "periumbilical abscess." CASE PRESENTATION We reported on a 34-year-old female patient who was admitted to the hospital with periumbilical pain for 3 days at 34 + 1 weeks of pregnancy. The result of imaging examination showed that there was an inflammatory mass in the middle and lower abdominal wall in the third trimester of pregnancy. The periumbilical abscess was punctured and drained first, and then the pregnant woman was assisted to give birth to a baby girl through vagina after the condition was stable.Subsequently, laparotomy + abdominal abscess resection and drainage + partial small bowel resection + ileostomy were performed. Pathology showed inflammatory mass. CONCLUSIONS Periumbilical abscess in the third trimester of pregnancy is rare clinically. For some pregnant women with previous trauma and surgical history, obstetric examination should not be restricted. For example, pregnant women with a history of abdominal surgery should expand the range of abdominal color Doppler ultrasound during the prenatal examination. When necessary, combine with computed tomography for diagnosis and treatment, avoid missed diagnosis, which will make the treatment more difficult and increase the risk. If the pregnant women has corresponding symptoms in the third trimester, vaginal delivery can be performed to terminate the pregnancy, and then the periumbilical abscess can be removed. At the same time, closely monitor the vital signs of newborn and mothers.
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Affiliation(s)
- Xiaobin Chen
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Lei Xu
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Zhaojun Xu
- Graduate School, Qinghai University, Xining, China
| | - Zuyou Fan
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Lie Wang
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
- Department of General Surgery, Dongfang Hospital of Xiamen university, School of Medicine, Xiamen University, Fuzhou, China
| | - Yafeng Qi
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
- Department of General Surgery, Dongfang Hospital of Xiamen university, School of Medicine, Xiamen University, Fuzhou, China
| | - Chen Lin
- Department of General Surgery, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of General Surgery, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
- Department of General Surgery, Dongfang Hospital of Xiamen university, School of Medicine, Xiamen University, Fuzhou, China
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 38012756 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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12
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Calini G, Abdalla S, Aziz MAAE, Behm KT, Shawki SF, Mathis KL, Larson DW. Incisional hernia rates between intracorporeal and extracorporeal anastomosis in minimally invasive ileocolic resection for Crohn's disease. Langenbecks Arch Surg 2023; 408:251. [PMID: 37382678 DOI: 10.1007/s00423-023-02976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE One-third of patients with Crohn's disease (CD) require multiple surgeries during their lifetime. So, reducing the incisional hernia rate is crucial. We aimed to define incisional hernia rates after minimally invasive ileocolic resection for CD, comparing intracorporeal anastomosis with Pfannenstiel incision (ICA-P) versus extracorporeal anastomosis with midline vertical incision (ECA-M). METHODS This retrospective cohort compares ICA-P versus ECA-M from a prospectively maintained database of consecutive minimally invasive ileocolic resections for CD performed between 2014 and 2021 in a referral center. RESULTS Of the 249 patients included: 59 were in the ICA-P group, 190 in the ECA-M group. Both groups were similar according to baseline and preoperative characteristics. Overall, 22 (8.8%) patients developed an imaging-proven incisional hernia: seven at the port-site and 15 at the extraction-site. All 15 extraction-site incisional hernias were midline vertical incisions [7.9%; p = 0.025], and 8 patients (53%) required surgical repair. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months (p = 0.037). The length of stay was lower in the intracorporeal anastomosis with Pfannenstiel incision group [ICA-P: 3.3 ± 2.5 vs. ECA-M: 4.1 ± 2.4 days; p = 0.02] with similar 30-day postoperative complication [11(18.6) vs. 59(31.1); p = 0.064] and readmission rates [7(11.9) vs. 18(9.5); p = 0.59]. CONCLUSION Patients in the ICA-P group did not encounter any incisional hernias while having shorter hospital length of stay and similar 30-day postoperative complications or readmission compared to ECA-M. Therefore, more consideration should be given to performing intracorporeal anastomosis with Pfannenstiel incision during Ileocolic resection in patients with CD to reduce hernia risk.
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Affiliation(s)
- Giacomo Calini
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Solafah Abdalla
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Sherief F Shawki
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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Tazaki T, Kohyama M, Sugiyama Y, Takahashi S, Sasaki M. A rare case of multiple port site incisional hernias repaired by laparoscopy-assisted intraperitoneal onlay mesh: A case report. Int J Surg Case Rep 2023; 106:108302. [PMID: 37148732 DOI: 10.1016/j.ijscr.2023.108302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Port site herniation is a frequent complication of abdominal surgery, yet treatment strategies for multiple port site hernias are often difficult and case reports are rare. PRESENTATION OF CASE A 72-year-old woman, with a history of multiple abdominal surgeries, underwent laparoscopic surgery for rectal prolapse four years prior. Three 12 mm ports were inserted into the umbilical region, right upper quadrant and right lower abdomen, subsequently, incisional hernias developed at all three sites. In addition, an incisional hernia developed in the lower abdomen, for a total of four incisional hernias. She was taking apixaban for atrial fibrillation, and since the standard surgical method of placing the mesh in the extraperitoneal space was judged to be high risk for postoperative bleeding and hematoma formation, we performed a laparoscopy-assisted intraperitoneal onlay mesh repair (IPOM). DISCUSSION The key points of the surgery performed are: Laparoscopic surgery was initiated with a small incision in the umbilical region, using two 5 mm ports because we reasoned that using a 12 mm port could cause a new hernia. In the lateral hernia repair, a mesh was placed in the preperitoneal space on the dorsal side of the hernia, the mesh was sutured to the peritoneum because tucking cannot be performed if nerves are present on the dorsal aspect. The medial hernia was repaired by IPOM via a small laparotomy incision. CONCLUSION For multiple incisional hernias, it is necessary to consider appropriate repair methods for each site.
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Affiliation(s)
- Tatsuya Tazaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Mohei Kohyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yoichi Sugiyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaru Sasaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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Dreifuss NH, Chang B, Schlottmann F, Cubisino A, Mangano A, Masrur MA, Bianco FM. Robotic inguinal hernia repair: is the new Da Vinci single port platform providing any benefit? Surg Endosc 2023; 37:2003-2013. [PMID: 36282359 DOI: 10.1007/s00464-022-09737-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP). METHODS A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain. RESULTS MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1 min, p = 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6 min, p < 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%, p = 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6 months for MP-TAPP and 13.3 months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups. CONCLUSION Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform.
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Affiliation(s)
- Nicolas H Dreifuss
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA.
| | - Betty Chang
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Francisco Schlottmann
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Antonio Cubisino
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Francesco M Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
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15
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Calini G, Abdalla S, Aziz MAAE, Behm KT, Shawki SF, Mathis KL, Larson DW. Incisional Hernia rates between Intracorporeal and Extracorporeal Anastomosis in Minimally Invasive Ileocolic Resection for Crohn's disease.. [DOI: 10.21203/rs.3.rs-2591968/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Purpose: One-third of patients with Crohn’s disease (CD) require multiple surgeries during their lifetime. So, reducing the incisional hernia rate is crucial. We aimed to define incisional hernia rates after minimally invasive ileocolic resection for CD, comparing intracorporeal anastomosis with Pfannenstiel incision (ICA-P) versus extracorporeal anastomosis with midline vertical incision (ECA-M).
Methods: This retrospective cohort compares ICA-P versus ECA-M from a prospectively maintained database of consecutive minimally invasive ileocolic resections for CD performed between 2014 and 2021 in a referral center.
Results: Of the 249 patients included: 59 were in the ICA-P group, 190 in the ECA-M group. Both groups were similar according to baseline and preoperative characteristics. Overall, 22 (8.8%) patients developed an imaging-proven incisional hernia: seven at the port-site and 15 at the extraction-site. All 15 extraction-site incisional hernias were midline vertical incisions [7.9%; p=0.025], and 8 patients (53%) required surgical repair. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months (p =0.037). The length of stay was lower in the intracorporeal anastomosis with Pfannenstiel incision group [ICA-P: 3.3±2.5 vs. ECA-M: 4.1±2.4 days; p=0.02] with similar 30-day postoperative complication [11(18.6) vs. 59(31.1); p=0.064] and readmission rates [7(11.9) vs. 18(9.5); p=0.59].
Conclusion: Patients in the ICA-P group did not encounter any incisional hernias while having shorter hospital length of stay and similar 30-day postoperative complications or readmission compared to ECA-M. Therefore, more consideration should be given to performing intracorporeal anastomosis with Pfannenstiel incision during Ileocolic resection in patients with CD to reduce hernia risk.
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Hata S, Nakashima S, Shinohara M, Shin T, Mimata H. A Rare Case of Hernia Incarceration Under the Closed Port-Site Fascia After Robot-Assisted Laparoscopic Radical Cystectomy: Insights and Management Strategies. Cureus 2023; 15:e34915. [PMID: 36938249 PMCID: PMC10015510 DOI: 10.7759/cureus.34915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
Most cases of port-site hernia were due to inadequate fascial closure of the port site. We experienced a rare case of hernia incarceration under the closed port-site fascia despite adequate closure of the fascia after robot-assisted laparoscopic radical cystectomy. In this case, the small intestine was incarcerated between the transversus abdominis and oblique abdominal muscles from the 12-mm trocar site for the assistant. We inserted forceps to release the incarceration, and the fascia and peritoneum of the port site were closed using a trocar site closure device under laparoscopy. We considered that all-layer suturing, including peritoneum and inner and outer oblique fascia suturing, was necessary for port-site closure, especially in patients with obesity, because hernias can occur with fascial closure alone.
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Affiliation(s)
- Shinro Hata
- Department of Urology, Faculty of Medicine, Oita University, Yufu, JPN
| | | | - Mayuka Shinohara
- Department of Urology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Toshitaka Shin
- Department of Urology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Hiromitsu Mimata
- Department of Urology, Faculty of Medicine, Oita University, Yufu, JPN
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17
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Krittiyanitsakun S, Nampoolsuksan C, Tawantanakorn T, Suwatthanarak T, Srisuworanan N, Taweerutchana V, Parakonthun T, Phalanusitthepha C, Swangsri J, Akaraviputh T, Methasate A, Chinswangwatanakul V, Trakarnsanga A. Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up. World J Clin Cases 2023; 11:357-365. [PMID: 36686347 PMCID: PMC9850963 DOI: 10.12998/wjcc.v11.i2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/06/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the infrequency of trocar site hernias (TSHs), fascial closure continues to be recommended for their prevention when using a ≥ 10-mm trocar.
AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.
METHODS Between July 2010 and December 2018, all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed. All patients underwent cross-sectional imaging for TSH assessment. Clinicopathological characteristics were recorded. Incidence rates of TSH and postoperative results were analyzed.
RESULTS Of the 254 patients included, 70 (111 ports) were in the fascial closure (closed) group and 184 (279 ports) were in the nonfascial closure (open) group. The median follow up duration was 43 mo. During follow up, three patients in the open group developed TSHs, whereas none in the closed group developed the condition (1.1% vs 0%, P = 0.561). All TSHs occurred in the right lower abdomen. Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain. The open group had a significantly shorter operative time and lower blood loss than the closed group.
CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed. However, further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.
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Affiliation(s)
- Santi Krittiyanitsakun
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chawisa Nampoolsuksan
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thikhamporn Tawantanakorn
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Tharathorn Suwatthanarak
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nicha Srisuworanan
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Voraboot Taweerutchana
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thammawat Parakonthun
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chainarong Phalanusitthepha
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thawatchai Akaraviputh
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Asada Methasate
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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18
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Jenkins E, Humphrey H, Finan C, Rogers P, McDermott FG, Smart NJ, Daniels IR, Watts AM. Long-term follow-up of bilateral gracilis reconstruction following extra-levator abdominoperineal excision. J Plast Reconstr Aesthet Surg 2023; 76:198-207. [PMID: 36527901 DOI: 10.1016/j.bjps.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Colorectal operations such as an extra-levator abdominoperineal (elAPE) excision for locally advanced or recurrent cancer create a significant perineal tissue deficit. Options for perineal reconstruction include bilateral pedicled gracilis muscle flaps (BPGMF). Fashioning the gracili into a 'weave' creates a muscular sling that supports pelvic contents and is a novel technique. Our series reports the outcomes of the BPGMF in 50 patients undergoing surgery for pelvic cancer. METHOD This is a retrospective, single-centre study of patients undergoing reconstruction of perineal defects using BPGMF. All surgeries took place between January 2008 and February 2021. The primary outcome measured was perineal wound healing. The secondary outcomes measured were complications of surgical sites and length of hospital stay (short term), flap integrity on follow-up imaging and functional outcomes (long term). RESULTS Fifty patients underwent perineal reconstruction using BPGMF (26 males). The median age was 62 years. The 30-day mortality was 2% (n = 1). The average follow-up period was 2 years. Complete perineal wound healing was 86% (42/49) at outpatient follow-up. Complication rates for the donor site and reconstructed site were 14% and 22%, respectively. Complications included infection (2% donor site, 12% perineum), haematoma (4% donor site), dehiscence (2% donor site, 4% perineum) and seroma (3% donor site, 2% perineum). CONCLUSION BPGMF offers a reliable and technically simple muscle flap to reconstruct large perineal defects. The muscle flap integrity appears maintained on follow-up imaging despite a lack of flap monitoring tools. This cohort had minimal functional impairment following BPGMF.
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Affiliation(s)
- E Jenkins
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, UK.
| | - H Humphrey
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - C Finan
- Department of Radiology, Royal Devon & Exeter Hospital, UK
| | - P Rogers
- Department of Radiology, Royal Devon & Exeter Hospital, UK
| | - F G McDermott
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - N J Smart
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - I R Daniels
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - A M Watts
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, UK
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19
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Paasch C, Mantke A, Hunger R, Mantke R. Bladed and bladeless conical trocars do not differ in terms of caused fascial defect size in a Porcine Model. Surg Endosc 2022; 36:9179-9185. [PMID: 35851813 PMCID: PMC9652221 DOI: 10.1007/s00464-022-09401-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Trocar insertion during laparoscopy may lead to complications such as bleeding, bowel puncture and fascial defects with subsequent trocar site hernias. It is under discussion whether there is a difference in the extent of the trauma and thus in the size of the fascia defect between blunt and sharp trocars. But the level of evidence is low. Hence, we performed a Porcine Model. METHODS A total of five euthanized female pigs were operated on. The average weight of the animals was 37.85 (Standard deviation SD 1.68) kg. All pigs were aged 90 ± 5 days. In alternating order five different conical 12-mm trocars (3 × bladeless, 2 × bladed) on each side 4 cm lateral of the mammary ridge were placed. One surgeon performed the insertions after conducting a pneumoperitoneum with 12 mmHg using a Verres' needle. The trocars were removed after 60 min. Subsequently, photo imaging took place. Using the GSA Image Analyser (v3.9.6) the respective abdominal wall defect size was measured. RESULTS The mean fascial defect size was 58.3 (SD 20.2) mm2. Bladed and bladeless trocars did not significant differ in terms of caused fascial defect size [bladed, 56.6 (SD 20) mm2 vs. bladeless, 59.5 (SD 20.6) mm2, p = 0.7]. Without significance the insertion of bladeless trocars led to the largest (Kii Fios™ First entry, APPLIEDMEDICAL©, 69.3 mm2) and smallest defect size (VersaOne™ (COVIDIEN©, 54.1 mm2). CONCLUSION Bladed and bladeless conical 12-mm trocars do not differ in terms of caused fascial defect size in the Porcine Model at hand. The occurrence of a trocar site hernia might be largely independent from trocar design.
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Affiliation(s)
- Christoph Paasch
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - Anne Mantke
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Richard Hunger
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Rene Mantke
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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20
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Storm AC, AbiMansour JP, Bofill-Garcia A, Mahmoud T, Rapaka B, Lescalleet KE, Dayyeh BKA. Use of an intragastric trocar to perform a novel stapling procedure for reflux disease. Endosc Int Open 2022; 10:E1508-E1513. [PMID: 36397862 PMCID: PMC9666069 DOI: 10.1055/a-1933-6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
Background and study aims A percutaneous intragastric trocar (PIT) enables intraluminal use of laparoscopic tools and helps overcome traditional limitations of endoscopy. The aim of this study was to determine the efficacy of using a PIT to perform an anti-reflux stapling procedure. Materials and methods Trocars were placed in four animals and an articulating stapler was used to perform fundoplication under endoscopic guidance. Animals were monitored for 14 days post-procedure. Functional lumen imaging of the esophagogastric junction (EGJ) was performed at baseline, immediately post-intervention, and at 14 days. Results The procedure was successful in all animals who survived to day 14 without distress or significant adverse events. Baseline EGJ distensibility was 5.0 ± 1.2 mm 2 /mmHg, 2.7 ± 0.7 mm 2 /mmHg post-procedurally, and 3.0 ± 0.8mm 2 /mmHg on day 14. Average change in distensibility pre- and post-procedure was -2.3 ± 1.8 mm 2 /mmHg (95 % confidence interval [CI] -0.5 to 5.1, P = 0.08) while change in pre- and day 14 distensibility was -2.0 ± 1.4 mm 2 /mmHg (95 % CI -0.1 to 4.2, P = 0.06). Conclusions An intragastric trocar allows for use of large-diameter laparoscopic instruments to safely and effectively perform endoluminal fundoplication with anti-reflux properties that persist for at least 14 days.
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Affiliation(s)
- Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States,Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota, United States
| | - Jad P. AbiMansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Aliana Bofill-Garcia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Babusai Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristin E. Lescalleet
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
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21
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Razak O A, Varela CL, Nassr MMA, Yang SY, Cho MS, Min BS, Han YD. CLOCAR: a Trocar That Aids in Complete Closure of Port Site Defects. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Su J, Deng C, Yin HM. Drain-site hernia after laparoscopic rectal resection: A case report and review of literature. World J Clin Cases 2022; 10:2637-2643. [PMID: 35434063 PMCID: PMC8968592 DOI: 10.12998/wjcc.v10.i8.2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drain-site hernia (DSH) has an extremely low morbidity and has rarely been reported. Small bowel obstruction is a frequent concurrent condition in most cases of DSH, which commonly occurs at the ≥ 10 mm drain-site. Here we report a rare case of DSH at the lateral 5 mm port site one month postoperatively without visceral incarceration. Simultaneously, a brief review of the literature was conducted focusing on the risk factors, diagnosis, and prevention strategies for DSH.
CASE SUMMARY A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago. A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant, and that the content consisted of the large omentum. An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously. The postoperative period was uneventful. The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.
CONCLUSION Emphasis should be placed on DSH despite the decreased use of intra-abdominal drainage. It is recommended that placement of a surgical drainage tube at the ≥ 10 mm trocar site should be avoided. Moreover, it is advisable to have a comprehensive understanding of the risk factors for DSH and complete closure of the fascial defect at the drainage site for high-risk patients.
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Affiliation(s)
- Jin Su
- Department of General Surgery, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China
| | - Cheng Deng
- Division of Science and Education, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China
| | - Hui-Ming Yin
- Department of General Surgery, the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha 410000, Hunan Province, China
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23
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Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study. Surg Endosc 2022; 36:7225-7232. [PMID: 35142904 DOI: 10.1007/s00464-022-09088-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND SPSG carries a risk of incisional hernia, particularly in patients with high body mass index. Prophylactic mesh placement with either permanent or absorbable mesh could decrease the occurrence of incisional hernia, with uncertainty on other postoperative parietal complications. METHODS This is a non-randomized monocentric single-blinded prospective study. High-risk patients (body mass index ≥ 45 kg/m2) underwent either 3 strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain. RESULTS Between November 2018 and November 2019, 255 patients were included (85 in each group). All patients reached one-year postoperative follow-up. Significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, P = 0.005). No difference was observed in mesh groups. No difference was observed regarding other parietal complications. One patient in the absorbable mesh group presented a superficial surgical site infection and required surgical drainage without mesh removal and one patient in the permanent mesh group presented a parietal hematoma and required surgical drainage with mesh removal. Twenty-six (92.8%) asymptomatic patients presented incisional hernia discovered on the one-year CT-scan. CONCLUSIONS Prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia. Routine permanent mesh placement could be proposed in high-risk patients.
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24
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Barakat HB, Elmahdy TM, El‐sherpiny WY, Moussa GI. Trocar site hernia after laparoscopic bariatric surgery: Incidence with
non‐fascial
closure. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hosam B. Barakat
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Tamer M. Elmahdy
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Waleed Y. El‐sherpiny
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Gamal I. Moussa
- Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine Tanta University Tanta Egypt
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25
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Ota K, Katagiri Y, Katakura M, Mukai T, Nakaoka K, Maemura T, Takahashi T, Morita M. Trocar-site hernia following laparoscopic salpingo-oophorectomy in a middle-aged Japanese woman: an initial case report after 40 years of experience at a single center and a brief literature review. BMC Womens Health 2022; 22:8. [PMID: 34998384 PMCID: PMC8742918 DOI: 10.1186/s12905-021-01528-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/28/2021] [Indexed: 01/17/2023] Open
Abstract
Background In gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min.
Case presentation A 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence. Conclusions The TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01528-6.
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Affiliation(s)
- Kuniaki Ota
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan. .,Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan.
| | - Yukiko Katagiri
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
| | - Masafumi Katakura
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
| | - Takafumi Mukai
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
| | - Kentaro Nakaoka
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
| | - Toshimitsu Maemura
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8751, Japan
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Ahlqvist S, Edling A, Alm M, Dackhammar JB, Nordin P, Cengiz Y. Trocar site hernia after gastric sleeve. Surg Endosc 2022; 36:4386-4391. [PMID: 34704151 PMCID: PMC9085684 DOI: 10.1007/s00464-021-08787-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias. METHODS Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. RESULTS The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH. CONCLUSIONS The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.
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Affiliation(s)
- Sandra Ahlqvist
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden ,Department of Anesthesia and Intensive Care, Region Västernorrland, 871 85 Härnösand, Sweden
| | | | - Magnus Alm
- grid.416729.f0000 0004 0624 0320Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden
| | - Johan Blixt Dackhammar
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pär Nordin
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Yücel Cengiz
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Tsai YW, Lee SY, Jiang JH, Chuang JH. Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis. BMC Surg 2021; 21:437. [PMID: 34953485 PMCID: PMC8709970 DOI: 10.1186/s12893-021-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods
The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Shin-Yi Lee
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jyun-Hong Jiang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jiin-Haur Chuang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C..
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Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery. Obstet Gynecol Surv 2021; 76:751-759. [PMID: 34942651 DOI: 10.1097/ogx.0000000000000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Port-site hernia is an iatrogenic complication with a documented incidence between 0.65% and 2.8%. However, the true incidence could be higher because of delayed onset, asymptomatic nature, and loss to follow-up. Port-site hernia could be further complicated by incarceration or strangulation leading to small bowel obstruction requiring emergent surgical intervention, thus imposing significant financial and emotional burden to patients. Objective This article aims to provide a summary of the available literature concerning port-site hernia and explore preventive strategies for future clinical practice. Evidence Acquisition This review was formulated through electronic literature searches in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The reference lists of the included studies were hand searched to identify other relevant articles to capture all available literature in this narrative review. Results Following screening for eligibility based on relevance to the topic under consideration, 28 studies were identified. This included 5 original articles, 1 case series, and 22 review articles, including 4 systematic reviews. Included studies were critically appraised in formulating this review. Conclusions Port-site hernia is an underrecognized yet preventable complication with careful consideration of predisposing technical and host factors, thorough attention to surgical technique, or use of a fascial closure device. Relevance With the widespread and increasing use of laparoscopic methods to treat surgical pathologies, knowledge of this complication is imperative to encourage prevention strategies and facilitate early recognition and management should it occur.
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Nishino K, Ikeda Y, Kitami K, Niimi K, Kajiyama H. Laparoscopic pelvic surgery after reconstructive surgery with vertical rectus abdominis muscle flap: A case report. Int J Surg Case Rep 2021; 90:106706. [PMID: 34953422 PMCID: PMC8714995 DOI: 10.1016/j.ijscr.2021.106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Patients who have experienced vertical rectus abdominis muscle (VRAM) flap reconstruction are under risk of the abdominal incisional hernia (donor site hernia), and laparotomy increases the risk. PRESENTATION OF THE CASE We present the case of a 71-year-old nulliparous woman who experienced radical vulvectomy against extramammary Paget disease and reconstructive surgery with VRAM flap 7 years ago and developed right ovarian tumor. In this case, right ovarian tumor was removed with laparoscopic surgery, instead of laparotomy, and the risk of incisional hernia was successfully minimized. DISCUSSION Incisional (donor site) hernia after reconstructive surgery using VRAM flap has been reported in between 2 and 10%. While VRAM flap can fill larger amount of skin and subcutaneous tissue to recipient site, the risk of postoperative incisional hernia of abdominal wall is substantial. CONCLUSION Reconstructive surgery of with VRAM flap is required for extramammary vulvar Paget disease expanding wide range, and develops the risk of incisional hernia. Laparoscopic surgery should be applied in patients who have experienced VRAM flap reconstruction and developed pelvic tumor for avoiding the risk of incisional hernia as long as it can be allowed on oncologic aspects such as recurrence.
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Affiliation(s)
- Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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The Voodoo that We Do: Controversies in General Surgery. Surg Clin North Am 2021; 101:939-949. [PMID: 34774273 DOI: 10.1016/j.suc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incisional hernia remains a common complication following abdominal surgery, and its incidence can be reduced with standardized wound closure techniques. Robust evidence exists to support certain fascial closure methods, such as using a small bites, 4-to-1, continuous slow absorbable suture technique for elective midline laparotomies. On the other hand, there are other common surgical practices that lack quality data to support their routine use, such as abdominal binders, negative-pressure wound therapy, and reapproximation of subcutaneous tissue.
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Hermann M, Gustafsson O, Sundqvist P, Sandblom G. Rate of incisional hernia after minimally invasive and open surgery for renal cell carcinoma: a nationwide population-based study. Scand J Urol 2021; 55:372-376. [PMID: 34286660 DOI: 10.1080/21681805.2021.1953579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. MATERIALS AND METHODS From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. RESULTS In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0-6.4%) after open surgery and 2.4% (95% CI = 1.0-3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. CONCLUSIONS Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.
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Affiliation(s)
- Maria Hermann
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Fuse M, Ozawa M, Sato S, Goto K, Suwa Y, Nakagawa K, Ishibe A, Watanabe J, Endo I. Five-millimeter Trocar Site Hernia with a Parastomal Hernia Sac: A Case Report. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:197-201. [PMID: 33937562 PMCID: PMC8084539 DOI: 10.23922/jarc.2020-078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Here, we report our experience with a 5-mm trocar site hernia (TSH) near a stoma. This is the first report describing the relationship between TSH and extraperitoneal colostomy. A 72-year-old man underwent laparoscopic abdominoperineal resection with extraperitoneal sigmoid colostomy and partial hepatectomy for rectal cancer accompanied by synchronous liver metastasis (pT3N1aM1a Stage IVA Union for International Cancer Control [UICC] 8th edition). The surgical procedures were completely performed without morbidity. After 1 year, he presented to our hospital with sudden nausea. Computed tomography (CT) revealed small bowel obstruction due to a 5-mm TSH, 1 cm from the stoma. The patient underwent laparoscopic hernia repair. The incidence of a 5-mm TSH is low. However, an abdominal wall vulnerability caused by the extensive exfoliation of the retroperitoneum due to the construction of the colostomy was observed, and the extraperitoneal colostomy influenced the onset of the 5-mm TSH. When the port and hernia sites are located in close proximity to each other, even a 5-mm trocar site may increase the incidence of TSH.
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Affiliation(s)
- Masahiro Fuse
- Department of Gastroenterological Surgery, Yokohama City University Graduate School Medicine, Yokohama, Japan
| | - Mayumi Ozawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School Medicine, Yokohama, Japan
| | - Seiya Sato
- Department of Surgery Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Koki Goto
- Department of Surgery Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Suwa
- Department of Surgery Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Nakagawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School Medicine, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School Medicine, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School Medicine, Yokohama, Japan
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What is the Real Incidence of Trocar Site Hernias? Surg Laparosc Endosc Percutan Tech 2021; 31:135. [PMID: 33734208 DOI: 10.1097/sle.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC Surg 2020; 20:330. [PMID: 33317503 PMCID: PMC7737369 DOI: 10.1186/s12893-020-01000-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023] Open
Abstract
Background Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. Methods A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. Results 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p < 0.001). Mean follow-up time was 34 months. Conclusions TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years. Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744
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Sumer F, Bag YM, Aydin MC, Evren B, Aydin ES, Sahin I, Kayaalp C. Mini-laparoscopic adrenalectomy with transgastric specimen extraction. Updates Surg 2020; 73:1487-1491. [PMID: 33119843 DOI: 10.1007/s13304-020-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022]
Abstract
We aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with transgastric specimen extraction and to assess its safety and feasibility. We used only 5-mm trocars, three ports for left adrenalectomy and four for right. Intraoperative gastroscopy was performed for specimen extraction through the mouth via an endoscopic snare. The gastrotomy was closed intracorporeally. Demographic, perioperative and pathological data were analyzed. There were 16 patients (12 females) with the mean age of 46.5 ± 11.3 years and half of them had previous abdominal surgeries. The median operative time was 150 (45-432) min with a median blood loss of 88 (0-350) ml. The median oral intake time was 2 (1-4) days and the median length of hospital stay was 2 (2-5) days. There was no mortality and extraction-related complication. Histopathological median tumor length, width and depth were 3 cm, 2.15 cm, and 1.9 cm, respectively. The median specimen length, width and depth were 6.25 cm, 4 cm, and 2.2 cm, respectively. Mini-laparoscopic adrenalectomy combined with transgastric specimen extraction is a safe and feasible surgical technique. It provides a less invasive surgery and may also have some benefits on wound-related complications and cosmesis.
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Affiliation(s)
- Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Yusuf Murat Bag
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey.
| | - Mehmet Can Aydin
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Bahri Evren
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Emine Sener Aydin
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
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Üstünyurt E, Taşgöz FN, Tiğrak S. Asymptomatic trocar site hernias: An underestimated complication of laparoscopy. Turk J Obstet Gynecol 2020; 17:202-208. [PMID: 33072425 PMCID: PMC7538828 DOI: 10.4274/tjod.galenos.2020.70952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To estimate the exact incidence of trocar site hernia (TSH) through sonographic examination and to evaluate the predisposing risk factors of TSH. Materials and Methods Three hundred patients who underwent laparoscopic surgery for benign gynecologic indications were included in this study and called back for a follow-up visit. All patients underwent an ultrasound evaluation for the detection of TSH. Risk factors for TSH formation were investigated. Results Twenty-five (8.3%) TSHs were diagnosed among 300 postoperative laparoscopies. The highest rate of TSH development among the surgeries was found in tubal ligation cases with 19%. Parity ≥3 [odds ratio (OR), 3.13; 95% confidence interval (CI): 1.21-8.09; p=0.018], and not closing fascia (OR: 6.74; 95% CI: 2.72-16.70; p<0.001) were statistically significant risk factors for the development of TSH in multivariate analysis. Conclusion The prevalence of TSH is higher than previously reported, and ultrasonographic examination is adequate for detecting subclinical types of this complication.
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Affiliation(s)
- Emin Üstünyurt
- University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Clinic of Gynecology, Bursa, Turkey
| | - Fatma Nurgül Taşgöz
- University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Clinic of Gynecology, Bursa, Turkey
| | - Sefa Tiğrak
- University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Clinic of Radiology, Bursa, Turkey
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Köckerling F, Hoffmann H, Mayer F, Zarras K, Reinpold W, Fortelny R, Weyhe D, Lammers B, Adolf D, Schug-Pass C. What are the trends in incisional hernia repair? Real-world data over 10 years from the Herniamed registry. Hernia 2020; 25:255-265. [PMID: 33074396 DOI: 10.1007/s10029-020-02319-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade. METHODS Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis. RESULTS In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique). CONCLUSION Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - H Hoffmann
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - K Zarras
- Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - W Reinpold
- Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany
| | - R Fortelny
- Department of General Surgery, Wilhelminen Hospital, Sigmund Freud University Vienna, Medical Faculty, Freudplatz 3, 1020, Vienna, Austria
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
| | - B Lammers
- Department of Surgery I, Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - C Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
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Byrne J, Kehoe JD, Kayyal MY. Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer. J Surg Case Rep 2020; 2020:rjaa376. [PMID: 33024537 PMCID: PMC7526464 DOI: 10.1093/jscr/rjaa376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022] Open
Abstract
Trocar-site hernia is an uncommon complication of laparoscopic surgery and can be classified as early-onset, late-onset or special type. Special type hernias usually occur in the early postoperative period and result in evisceration of intra-abdominal contents through all layers of the abdominal wall without an overlying hernia sac. We present a case of special type herniation of the appendix through a 5-mm trocar site in the right iliac fossa following laparoscopic repair of a perforated duodenal ulcer. In this case, herniation occurred after removal of a drain inserted through the trocar site intraoperatively and was treated with emergent open appendicectomy. A number of patient and technical factors may be associated with an increased risk of trocar-site herniation including increasing age, elevated body mass index, increasing trocar size, longer procedure duration and absence of fascial closure. These factors must be borne in mind when planning trocar placement and number to reduce the risk of herniation.
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Affiliation(s)
- Jim Byrne
- Department of General Surgery, Cork University Hospital, Cork, Ireland
| | - John D Kehoe
- Department of General Surgery, Cork University Hospital, Cork, Ireland
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Sıkar HE, Çetin K. Laparoscopic repair of lateral sided trocar site hernias. Turk J Surg 2020; 36:278-283. [PMID: 33778383 DOI: 10.47717/turkjsurg.2020.4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
Objectives Repair of trocar site hernia (TSH) has been mentioned in a limited number of studies. Trocar site hernias are mostly located in the umbilical region with a small size. Laparoscopic repair could be a choice due to the appearance of large defects and requirement of mesh repair for lateral sided TSH. We aimed to share our experience with laparoscopic repair of lateral sided trocar site hernia (LRTSH) with a long term follow up. Material and Methods Twenty-three patients who underwent LRTSH between March 2013 and July 2015 were included in our study. Four edges of the mesh were fixed with pre-tied 2/0 polypropylene suture for 9 patients initially (Group 1). Unexpected complication of chronic pain in 3 patients led us to revise our method and we avoided to position the mesh with transabdominal sutures for the rest of the patients (Group 2). Results Nineteen (82.6%) female and 4 (17.4%) male patients, with a mean age of 50.9 years underwent laparoscopic repair. Following the revision and avoiding transabdominal sutures to position the mesh, no complaint of chronic pain was observed, and the difference was statistically significant between the groups (p<0.05). Conclusion Previous laparoscopic surgery indicates the lack of obstacle in laparoscopic repair of TSH, and LRTSH can be considered as first option in treatment. Shorter mean operative time in obese patients and lack of recurrence in our series support this view. Using transabdominal sutures should be avoided to prevent chronic pain in LRTSH.
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Affiliation(s)
- Hasan Ediz Sıkar
- Dr. Lütfi Kırdar Kartal Training And Research Hospital, General Surgery, Istanbul, Turkey
| | - Kenan Çetin
- Dr. Lütfi Kırdar Kartal Training And Research Hospital, General Surgery, Istanbul, Turkey
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Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience. Surg Endosc 2020; 35:5167-5172. [PMID: 32964307 DOI: 10.1007/s00464-020-08007-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia. METHODS A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013-2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed. RESULTS A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%, p = 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12-41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%, p = 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (p = 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22-174.0, p < 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04-89.5, p = 0.007) were independent risk factors for TSH. CONCLUSION Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.
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Ghoreifi A, Whang G, Tran K, Tejura T, Liu B, Cai J, Lei X, Cen S, Aslzare M, Burg M, Desai M, Aron M, Gill I, Duddalwar V, Djaladat H. Natural History of Radiologic Incisional Hernia Following Robotic Nephrectomy. J Endourol 2020; 34:974-980. [DOI: 10.1089/end.2020.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Gilbert Whang
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Khoa Tran
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Tapas Tejura
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Benjamin Liu
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Jie Cai
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Xiaomeng Lei
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Steven Cen
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Mohammad Aslzare
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Madeleine Burg
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Monish Aron
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Inderbir Gill
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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42
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Dhanani NH, Bernardi K, Olavarria OA, Cherla D, Kao LS, Ko TC, Liang MK, Holihan JL. Port Site Hernias Following Laparoscopic Ventral Hernia Repair. World J Surg 2020; 44:4093-4097. [PMID: 32875356 DOI: 10.1007/s00268-020-05757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Port site hernias (PSH) are underreported following laparoscopic ventral hernia repair (LVHR). Most occur at the site of laterally placed 10-12-mm ports used to introduce large pieces of mesh. One alternative is to place the large port through the ventral hernia defect; however, there is potential for increased risk of surgical site infection (SSI). This study evaluates the outcomes when introducing mesh through a 10-12-mm port placed through the hernia defect. METHODS This was a retrospective case series of patients who underwent LVHR in three prospective trials from 2014-2017 at one institution. All patients had mesh introduced through a 10-12-mm port placed through the ventral hernia defect. The primary outcome was SSI. Secondary outcomes were hernia occurrences including recurrences and PSH. RESULTS A total of 315 eligible patients underwent LVHR with a median (range) follow-up of 21 (11-41) months. Many patients were obese (66.9%), recently quit tobacco use (8.8%), or had diabetes (18.9%). Most patients had an incisional hernia (61.2%), and 19.2% were recurrent. Hernias were on average 4.8 ± 3.8 cm in width. Two patients (0.6%) had an SSI. Fourteen patients had a hernia occurrence-13 (4.4%) had a recurrent hernia, and one patient (0.3%) had a PSH. CONCLUSION During LVHR, introduction of mesh through a 10-12-mm port placed through the hernia defect is associated with a low risk of SSI and low risk of hernia occurrence. While further studies are needed to confirm these results, mesh can be safely introduced through a port through the defect.
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Affiliation(s)
- Naila H Dhanani
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA.
| | - Karla Bernardi
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Oscar A Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Deepa Cherla
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Lillian S Kao
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Tien C Ko
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Mike K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
| | - Julie L Holihan
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX, 77026, USA
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43
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Gutierrez M, Stuparich M, Behbehani S, Nahas S. Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review. Surg Endosc 2020; 34:5250-5258. [PMID: 32728766 DOI: 10.1007/s00464-020-07826-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the introduction of laparoscopic surgery, it has become more popular with many advantages over open surgery including faster recovery, shorter hospital stays, and decreased tissue trauma. Despite its benefits, laparoscopic surgery can result in its own unique complications, such as the formation of a trocar site hernia (TSH), which have been reported in approximately 0-1.0% of laparoscopic cases when using non-bladed trocars. METHODS A literature review was performed from June 1990 to June 2019. PubMed was searched using the keywords "laparoscopic surgery," "trocar site hernia," and "port site hernia." Only articles in English were identified but not limited to the USA. RESULTS The total number of patients in all articles was 18,533 with a mean follow-up period of 22.50 ± 1.76 months. The overall trocar site hernia rate was 0.104%. When comparing open vs. closed ports, there was no significant difference in the hernia incidence rate for 5-mm and 10-mm ports. When comparing bladed versus non-bladed trocars left open, there was a statistically significant difference with lower hernia incidence rates for non-bladed trocars over bladed trocars for 5-mm, 10-mm, and 12-mm ports. And when comparing trocar location from midline versus off-midline, there was a statistically significant higher TSH incidence in midline trocar locations. CONCLUSION Results suggest that TSH rate is lower when using non-bladed trocars for any size of trocar. When comparing whether fascial closure had an effect, the 5-mm and 10-mm ports had no difference in incidence rates and leaving the fascia open can reduce operative time, risk of needlestick injuries, and overall procedural cost. In addition, trocars at midline locations resulted in higher TSH incidence rates. Future research is still needed to assess for other factors that may influence hernia formation and how it can be minimized.
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Affiliation(s)
- Monica Gutierrez
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.,, Rancho Cucamonga, CA, USA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Sadikah Behbehani
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Samar Nahas
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.
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44
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Damani T, James L, Fisher JC, Shah PC. Incidence of acute postoperative robotic port-site hernias: results from a high-volume multispecialty center. J Robot Surg 2020; 15:457-463. [PMID: 32710254 DOI: 10.1007/s11701-020-01128-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023]
Abstract
Fascial closure at 8-mm robotic port sites continues to be controversial. As the use of the robotic platform increases across multiple abdominal specialties, there are more case reports describing reoperation and small bowel resection for acute port-site hernias. A retrospective review of all robotic abdominal surgeries performed from 2012 to 2019 at NYU Langone Medical Center was conducted. Patients who had a reoperation in our facility within 30 days were identified, and medical records reviewed for indications for reoperation and findings. The study included 11,566 patients, of which 82 patients (0.71%) underwent a reoperation related to the index robotic surgery within 30 days. Fifteen of 11,566 patients (0.13%) had acute port-site hernias, and 3 of these 15 patients required small bowel resection. Eleven of 15 acute port-site hernias (73%) were at 8-mm robotic port site, 2 of which required a small bowel resection. More than a third of the patients had a hernia at an 8-mm port site where a surgical drain had been placed. Considering that each robotic case, regardless of specialty, has three ports at a minimum, the true incidence of acute postoperative robotic port-site hernia is 0.032% (11/34,698), with the incidence of concomitant small bowel resection being 0.006% (2/34,698). The incidence of acute port-site hernias from 8-mm robotic ports is exceedingly low across specialties. Our results do not support routine fascial closure at 8-mm robotic port sites due to an extremely low incidence. However, drain sites require special consideration.
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Affiliation(s)
- Tanuja Damani
- Division of General Surgery, Department of Surgery, NYU Robert I. Grossman School of Medicine, 530 First Ave, HCC Building, Suite 6 C, New York, NY, 10016, USA.
| | - Les James
- Division of General Surgery, Department of Surgery, NYU Robert I. Grossman School of Medicine, 530 First Ave, HCC Building, Suite 6 C, New York, NY, 10016, USA
| | - Jason C Fisher
- Division of Pediatric Surgery, Department of Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, USA
| | - Paresh C Shah
- Division of General Surgery, Department of Surgery, NYU Robert I. Grossman School of Medicine, 530 First Ave, HCC Building, Suite 6 C, New York, NY, 10016, USA
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45
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Jeon Y, Song S, Han KW, Lee DH, Baek JH. Evaluation of a Novel Trocar-Site Closure Device in Laparoscopic Surgery. JSLS 2020; 24:JSLS.2020.00033. [PMID: 32714001 PMCID: PMC7343404 DOI: 10.4293/jsls.2020.00033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: We evaluated the effectiveness and safety of EZ-CloseTM compared to those of hand suture for trocar-site closure according to obesity. Methods: Fifty-four cases of laparoscopic colorectal surgery were enrolled. For the same patient, the right port site was closed using EZ-CloseTM and left port site was closed by hand suture among cases with port-site diameter ≥10 mm. Cases switched to use of a conventional fascial closure device or with closure time 120 s were considered failures. Closure time was analyzed according to body mass index (BMI) and abdominal wall thickness (AWT). Results: The mean closure time was significantly shorter with EZ-CloseTM than with hand suture (87.9 ± 21.0 vs. 128.0 ± 59.0 s, p < 0.001). The number of failure cases was significantly lower with EZ-CloseTM than with hand suture (7 vs. 27, p < 0.001). The closure time of EZ-CloseTM was significantly shorter than that of hand suture in patients with BMI ≥ 25 and < 27 kg/m2 (n = 15, 85.9 ± 19.8 vs. 135.6 ± 67.9 s, p < 0.014) and ≥ 27 kg/m2 (n = 13, 85.1 ± 18.4 vs. 150.2 ± 70.6 s, p < 0.010). With respect to AWT, the closure time of EZ-CloseTM was significantly shorter than that of hand suture in patients with AWT ≥ 20 and < 26 mm (n = 12, 81.1 ± 11.5 vs. 142.3 ± 83.7 s, p = 0.023) and ≥ 26 mm (n = 17, 85.6 ± 22.6 vs. 160.2 ± 55.5, p < 0.001). No infection and herniation were detected in both trocar sites during the follow-up period (median 20.4 months). Conclusion: EZ-CloseTM could provide time efficiency in trocar-site closure, especially in obese patients.
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Affiliation(s)
- Youngbae Jeon
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Soohwa Song
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyoung-Won Han
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Dong-Hyuk Lee
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jeong-Heum Baek
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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46
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Pereira N, Chung ER, Irani M, Chung PH, Zarnegar R, Rosenwaks Z. Incarcerated Omental Hernia at a 5-mm Trocar Site after Laparoscopy. J Minim Invasive Gynecol 2020; 28:384-385. [PMID: 32652241 DOI: 10.1016/j.jmig.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York.
| | - Eric R Chung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York
| | - Mohamad Irani
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York
| | - Pak H Chung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital (Dr. Zarnegar), Weill Cornell Medical College, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York
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Cano-Valderrama O, Sanz-López R, Sanz-Ortega G, Anula R, Romera JL, Rojo M, Catalán V, Mugüerza J, Torres AJ. Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort. Surg Endosc 2020; 35:2907-2913. [PMID: 32556772 DOI: 10.1007/s00464-020-07729-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. METHODS A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. RESULTS 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. CONCLUSIONS Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain. .,Department of Surgery, Universidad Complutense, Madrid, Spain. .,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | - Rodrigo Sanz-López
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Gonzalo Sanz-Ortega
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Rocío Anula
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - José L Romera
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Mikel Rojo
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Vanesa Catalán
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - José Mugüerza
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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48
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Trocar-site hernia after gynecological laparoscopic surgery: a 20-year, single-center experience. Chin Med J (Engl) 2020; 132:2677-2683. [PMID: 31725450 PMCID: PMC6940105 DOI: 10.1097/cm9.0000000000000510] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Trocar-site hernia (TSH) is a serious complication after laparoscopic procedures. Although it is a rare entity, it can have life-threatening consequences. This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience. Methods: We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital (PUMCH) from August 1998 to July 2018 and further sifted through the results for cases involving TSH. All included patients were divided into different groups according to patient characteristics, and the rate of TSH was compared among groups. Moreover, the detailed information of all patients with TSH was recorded and analyzed. Statistical analyses were performed with GraphPad Prism 6. Results: The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016% (9/55,244). The rate of TSH was significant higher in elder patients (≥60 years old; 3/2686, 0.112%) than in younger patients (<60 years old, 6/52,558; 0.011%, P = 0.008). Moreover, the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery (SILS, 2/534, 0.357%) than conventional laparoscopic surgery (7/54,710, 0.013%, P = 0.003). The average age of patients with TSH was 53.4 years (range, 35.0–79.0 years). Two of the nine patients had late-onset TSH following SILS; the other seven had early-onset TSH following conventional laparoscopy. Five TSH cases occurred at right lateral port sites, and the remaining three occurred at the umbilical port site. All patients underwent repair surgery, and one required small bowel resection. Conclusion: Older age and SILS are potential associated factors for TSH development, while reducing excessive manipulation and improving suturing skills, especially at the umbilical trocar site following SILS and the right lateral trocar site, can avoid herniation.
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Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy. Sci Rep 2020; 10:2868. [PMID: 32071382 PMCID: PMC7029008 DOI: 10.1038/s41598-020-59721-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
Trocar site hernia (TSH) is an incisional hernia occurring at the trocar insertion sites after different types of laparoscopic surgeries. The aim of this study is to present characteristics of patient and surgery series with trocar site hernia after laparoscopic cholecystectomy. A 2930 consecutive patients underwent laparoscopic cholecystectomy in two major university- affiliated hospitals from April 2014 to March 2018 and the patient followed up for variable periods of time. Retrospective medical chart review to study trocar site hernia including patient, operation, instruments, and pathologic characteristics described. Six patients had trocar site hernia (incidence 0.20%), the hernias occurred mostly at the umbilical port site after using 10 mm trocar. Risk factors included mainly obesity, female gender and use of 10 mm trocars at midline sites. TSH is more described. It occurs mostly at the umbilical port site. Major risk factors include obesity, diabetes mellitus, lengthy procedure, extension of entry site, and wound infection. Closure of fascial defect is supposed to reduce the incidence despite weak evidence.
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50
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Kawai H, Misawa T, Sasaya K, Aoyama Y. Dual-hemostat port closure technique with customized surgical suture after laparoscopic cholecystectomy: Single-center experience. Asian J Endosc Surg 2020; 13:83-88. [PMID: 30688041 DOI: 10.1111/ases.12690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dual-hemostat techniques for port closure have previously been reported, but their safety and efficacy have not been evaluated. Here, we describe the dual-hemostat port closure technique employed at our institution, which uses a customized surgical suture for safe and certain port closure, and we assess the incidence rate of trocar-site hernia (TSH) after laparoscopic cholecystectomy. METHODS From March 1999 to March 2017 at our institution, 316 patients underwent elective laparoscopic cholecystectomy performed by a single experienced surgeon. We routinely used a dual-hemostat technique with a customized surgical suture to achieve safe and certain port closure. We assessed the incidence rate of TSH after laparoscopic cholecystectomy (defined as a reoperation for a TSH or clinical hernia at the port site) based on follow-up data from patient questionnaires and clinical examinations. RESULTS After 67 patients were excluded because of death, unknown address, or conversion to open cholecystectomy, 249 eligible patients received questionnaires, of which 173 were returned (response rate, 69.5%). From these responses, TSH was suspected in three patients, but only one underwent reoperation for TSH after laparoscopic cholecystectomy. Thus, the incidence rate of TSH after laparoscopic cholecystectomy was 0.6% (1/173). CONCLUSIONS Our single-center experience demonstrated that our port closure technique using a dual-hemostat technique with customized surgical suture provides an appropriate option for laparoscopic cholecystectomy, especially given its ease and low incidence of TSH.
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Affiliation(s)
- Hironari Kawai
- Department of Surgery, Aoyama Hospital, Funabashi, Japan
| | - Takeyuki Misawa
- Department of Surgery, Aoyama Hospital, Funabashi, Japan.,Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kazuto Sasaya
- Department of Surgery, Aoyama Hospital, Funabashi, Japan
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