A rare case of interparietal incisional hernia from 8 mm trocar site after robot-assisted laparoscopic prostatectomy

Laparoscopic Repair of a Large Incarcerated Intraparietal Inguinal Hernia Mimicking Acute Appendicitis: A Case Report

Inguinal hernia is common. However, only a few cases have been reported in the literature of inguinal interparietal hernia, in which the herniated sac exits the intraperitoneal cavity through the deep inguinal ring and then protrudes into one of the anatomical planes of the anterior abdominal wall. Only one of the reported inguinal interparietal hernia cases was managed laparoscopically. We report the case of a right inguinal interparietal hernia in a young, healthy adult with a herniated cecum, terminal ileum, and appendix. He presented with right iliac fossa pain. On investigation, he was found to have an interparietal hernia in the inguinal region. Diagnostic laparoscopy showed a clear herniated cecum through the internal inguinal ring into the anterior abdominal wall. The patient was treated with regular laparoscopic hernioplasty and was discharged on the second postoperative day with no complications. Although the diagnosis might be difficult for interparietal hernias, laparoscopic diagnosis and management provide precise assessment and less invasive management.

Unusual presentation of 'internal hernia' after robot-assisted radical cystectomy

Here is presented the first case of internal hernia developing from the space between ureter and muscle fascia after robot-assisted radical cystectomy with uretero-cutaneostomy diversion. An 82-year-old man underwent robot-assisted radical cystectomy with uretero-cutaneostomy diversion for high-grade urothelial carcinoma (pT2). On the Postoperative Day 7, the patient presented abdominal pain and nausea. Abdominal computed tomography showed that a part of the small intestine was protruding between the right ureter and the transverse fascia, and was strangulated, causing an obstruction of the intestine. Patient underwent an emergency laparotomy that revealed prolapse and strangulation of the small intestine through the space between the right ureter and the transversalis fascia. The ischemic intestinal tract and ureter were resected. A new right uretero-cutaneostomy diversion anastomosis with use of ureteral stent single J was created. The man was discharged 28 days after surgery, and his clinical course was uneventful through follow-up.

[Prostate cancer: surgical complications]

Radical prostatectomy (RP), performed as an open, laparoscopic or robotic procedure, remains the "gold standard" for patients with localised prostate cancer who can be cured with surgery and have a life expectancy of at least 10 years. Today, RP is also used as a first-line treatment for locally advanced prostate cancer, possibly in a multimodal setting with adjuvant radiation/hormonal therapy. The increasing experience of surgeons, better knowledge of anatomy and refinements of surgical techniques have greatly improved oncological and functional outcomes. In our article we would like to give an overview of the complications associated with this surgical procedure.

Incidence of acute postoperative robotic port-site hernias: results from a high-volume multispecialty center

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.

Port-site incisional hernia from an 8-mm robotic trocar following robot-assisted radical cystectomy: Report of a rare case

INTRODUCTION

Port-site incisional hernia is a rare but well-known complication following a laparoscopic procedure and it may cause severe adverse outcomes, such as intestinal necrosis. Here, we report a rare case of hernia that occurred from an 8-mm trocar after robot-assisted radical cystectomy.

CASE PRESENTATION

An 80-year-old woman was diagnosed with cT2bN1M0 bladder cancer. She underwent robot-assisted radical cystectomy. Nine days after surgery, she complained of severe abdominal pain. Computed tomography showed herniation of small intestine. Emergency explorative laparotomy revealed herniation of small intestine from an 8-mm trocar site. A section of the small bowel was necrotic and was resected.

CONCLUSION

It is debatable whether we should routinely close the fascia of an 8-mm trocar site. The patient was an elderly woman with multiple major abdominal surgery histories and hernia risk factors. For these patients, fascial closure of the 8-mm trocar site may be indicated.

A rare case of acute presentation of trocar site hernia from robot-assisted laparoscopic partial nephrectomy

Trocar site hernia is not a common acute complication encountered after robot-assisted surgery, especially in the urological cohort of patients. A few case reports of small bowel obstruction secondary to incarceration by trocar site hernia have been described in gynaecological surgery and prostatectomies. As the clinical presentation is non-specific, late diagnosis has significant implication on morbidity and mortality. Here, we present a rare case of a patient with recent robot-assisted laparoscopic partial nephrectomy for a renal cell carcinoma presented with features of impending bowel obstruction secondary to incarcerated small bowel in the trocar site. We also reviewed the literature focusing on clinical features of trocar site hernia and preventive measures.