Case report of an uncommon case of drain-site hernia after colorectal surgery

Drain-site hernia after laparoscopic rectal resection: A case report and review of literature

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.

[A rare case of gerniation and incarceration of the gallbladder]

The authors report a rare case of herniation and incarceration of the gallbladder at the site of abdominal drainage tube deployment in a patient undergoing treatment for aortic valve disease. An incarcerated postoperative ventral hernia was confirmed by contrast-enhanced CT of the abdomen. Emergency surgery was not indicated due to spontaneous reduction, short duration of incarceration and no peritoneal signs. This case reminds us the possibility of ventral hernias, containing the gallbladder, at the site of abdominal drainage tube deployment. According to the literature, untimely diagnosis of this event can result fatal consequences.

A case of unusual evisceration through laparoscopic port site

Drain site eviscerations have been reported as a rare complication following abdominal surgery. An 82-year-old women was diagnosed with carcinoma stomach and underwent laparoscopic subtotal gastrectomy. A few hours following removal of the duodenal stump drain, she developed small bowel evisceration through the drain site. It was successfully managed with immediate bedside release of fascial constriction followed by definitive repair later. Although herniations and eviscerations via larger drain sites have been reported, eviscerations from small laparoscopic port sites used for drains are rare. Here, we report the first case of small bowel evisceration with strangulation through a 5-mm port site.

Role of imaging in managing lateral trocar site incisional hernia after abdominoperineal resection

Trocar site incisional hernia (TSIH) is an unpleasant complication of laparoscopic surgery. A 70-year-old male with low rectal carcinoma underwent a laparoscopic abdominoperineal resection after completion of neoadjuvant radiotherapy. The postoperative recovery was smooth; however, he developed abdominal distension and pain over the previous drain site after removal on day 3. In view of diagnostic ambiguity, an imaging tool was requested as an adjunct to further management. Computed tomography of the abdomen showed small bowel obstruction secondary to herniated ileal loops passing through the right iliac fossa anterior abdominal wall defect at the previous drainage site. An exploration was made and the rectus defect was closed using a non-absorbable suture.

Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention: A case report

BACKGROUND

Trocar site hernia (TSH) is a rare but potentially dangerous complication of laparoscopic surgery, and the drain-site TSH is an even rarer type. Due to the difficulty to diagnose at early stages, TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences. Herein, we report an unusual case of drain-site TSH, followed by a brief literature review. Finally, we provide a novel, simple, and practical method of prevention.

CASE SUMMARY

A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital. She was admitted to our hospital with a 2-d history of intermittent abdominal pain, nausea, vomiting, and abdominal enlargement with an inability to pass stool and flatus. The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision, which was used as a drainage port, with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines. She was diagnosed with drain-site strangulated TSH. The emergency exploratory laparotomy confirmed the diagnosis. A herniorrhaphy followed by standard intestinal resection and anastomosis were performed. The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.

CONCLUSION

TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction, especially after the removal of the drainage tube, to avoid the serious consequences caused by delayed diagnosis. Furthermore, all abdomen layers should be carefully closed under direct vision at the trocar port site, especially where the drainage tube was placed. Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.

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.

Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort

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.