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Cianfarani A, Mongelli F, Iaquinandi F, Xhepa G, Pini R, Gaffuri P, La Regina D. Trocar-site incisional hernia after 8-mm robotic trocar placement: A prospective study. World J Surg 2024; 48:1656-1661. [PMID: 38743387 DOI: 10.1002/wjs.12214] [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: 11/08/2023] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The current literature supports the closure of trocar sites ≥10-mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5-mm trocars. To date, evidence regarding the closure of 8-mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8-mm trocars. METHODS We prospectively collected data on all patients undergoing robotic-assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8-mm trocars was not closed. The enrolled patients underwent a follow-up visit during which we conducted clinical and sonographic evaluations of all 8-mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port-site hernia. RESULTS We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1 ± 14.0 years, and mean BMI was 27.0 ± 3.9 kg/m2. The follow-up visits were carried out after a median follow-up of 14.5 (9.0-23.2) months. Only one case developed an asymptomatic 1 × 1 cm supra-umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8-mm trocars and skin sutures of 9.8 ± 0.5 out of 10 points. CONCLUSIONS The occurrence of a trocar-site hernia after 8-mm robotic access is extremely low. Hence, the fascia closure may not be necessary.
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Affiliation(s)
- Agnese Cianfarani
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Fabiano Iaquinandi
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Genti Xhepa
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Kwon CS, Vaseeharan A, Sauer MV. Trocar site hernia after laparoscopy: Early recognition prevents catastrophic sequelae. J Emerg Med 2022; 63:791-794. [PMID: 36522813 DOI: 10.1016/j.jemermed.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/16/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Trocar site hernia is a rare but potentially serious complication of laparoscopic surgery that may lead to bowel incarceration and strangulation. Prompt diagnosis by emergency physicians facilitates timely intervention that prevents bowel necrosis. We report a case of trocar site hernia presenting to the emergency department (ED) with abdominal pain that was correctly diagnosed and promptly managed. CASE REPORT A 25-year-old woman, gravida 2, abortion 2, underwent outpatient surgery and laparoscopic removal of a ruptured right-sided tubal pregnancy without any intraoperative difficulties. However, 48 h later, she presented to the ED complaining of acute abdominal pain and nausea. Computed tomography revealed a loop of small bowel herniating through a 12-mm right lower quadrant trocar site defect in the fascia. She was taken back to the operating room, where the computed tomography findings were confirmed and the entrapped bowel was successfully reduced and the fascial defect repaired. The patient was discharged home feeling much improved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trocar site hernia is a rare but potentially dangerous complication that can present with acute symptoms or be asymptomatic if late in onset. Intestinal necrosis begins as soon as 6 h after constriction of blood flow to entrapped bowel, so timely intervention is critically important. Therefore, trocar site hernias should be considered in patients presenting with abdominal complaints after laparoscopic surgery and included in the differential diagnosis of bowel obstruction.
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Affiliation(s)
- Caroline S Kwon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | - Mark V Sauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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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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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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Valcarenghi J, Hernigou J, Apicella G, Clegg E, Rousie M, Chasse E. Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study. Acta Chir Belg 2021; 121:320-326. [PMID: 32375576 DOI: 10.1080/00015458.2020.1765673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). BACKGROUND Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. METHODS Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. RESULTS A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. CONCLUSIONS Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.
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Affiliation(s)
| | - Jacques Hernigou
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Giulia Apicella
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emilie Clegg
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Maxime Rousie
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emmanuel Chasse
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
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Comparison of short- and long-term postoperative occurrences after robotic single-incision cholecystectomy versus multiport laparoscopic cholecystectomy. Surg Endosc 2021; 36:2357-2364. [PMID: 33938991 DOI: 10.1007/s00464-021-08513-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Long-term outcomes of SIRC are not well established. Furthermore, SIRC is only now being considered more frequently for patients with independent risk factors for PSH, such as obesity. As such, the paucity of data on longer-term post-surgical outcomes of SIRC is particularly notable as it pertains to obese patients. METHODS All patients undergoing cholecystectomy performed by two surgeons at our institution from 2008-2018 were reviewed. Our inclusion criteria were patients who underwent SIRC or multiport laparoscopic cholecystectomy (MPLC) and had at least one month of postoperative follow-up. Patients who underwent additional procedures at the time of cholecystectomy were excluded. Our outcomes of interest were the 30-day POC rate and the long-term PSH rate. Analysis was conducted on an intention-to-treat basis, using logistic regression analysis for POC and time-to-event analysis for PSH. RESULTS We examined 584 patients who underwent either SIRC (51%) or MPLC (49%). Of the 296 patients who underwent SIRC, 15 (5%) developed a POC and 23 (8%) developed a PSH. Of the 288 patients who underwent MPLC, 11 (4%) developed a POC, and 28 (10%) developed a PSH. Procedure group and obesity was not associated with the risk of POC (p = 0.29, p = 0.21, respectively). Procedure group was not associated with an increased risk of PSH (p = 0.29). Obese patients, however, were 1.94 times more likely to develop PSH compared to non-obese patients overall (p = 0.02). CONCLUSIONS There is no statistically significant difference in POC and PSH rate following SIRC when compared with MPLC in patients in the same BMI group. Male gender and prior abdominal surgery are risk factors for POC, while advancing age and obesity are risk factors for PSH.
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7
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Abu Gazala M, Brodie R, Yuval JB, Kornblau G, Neustadter D, Mintz Y. Sutureless energy-based wound closure: a step in the quest for trocar site hernia prevention. MINIM INVASIV THER 2021; 31:567-572. [PMID: 33459096 DOI: 10.1080/13645706.2021.1871630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Easy and safe methods of fascia closure are needed in order to reduce the risk for trocar site hernias without affecting procedure time significantly. Here we present a method for port site closure using heat induced collagen denaturation. MATERIAL AND METHODS Controlled heat-induced collagen denaturation was applied to laparoscopic trocar sites in living porcine animal models. These were compared to control trocar sites which were left open. Port sites were evaluated visually at days 14 and 28 after the procedure, and both visually and pathologically at post-procedural day 42. RESULTS A total of 12 port sites were evaluated in three pigs. No incisional hernias were noted at any of the trocar sites in both groups. Histological evaluation revealed that one of the six control ports appeared to have a complete transfascial defect, whereas none of the study group trocars showed this finding. Furthermore, the study port sites showed a more robust scarring pattern. CONCLUSIONS Heat-induced collagen denaturation in this preliminary study was found to be safe and allowed better scarring of the healing port sites. We believe that this technology may offer a safe and efficient closure of laparoscopic trocar sites. More studies are needed to further evaluate the true effectiveness of this technology.Abbreviations: TSH: trocar site hernia; IACUC: institutional animal care and use committee.
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Affiliation(s)
- Mahmoud Abu Gazala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ronit Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan B Yuval
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Yoav Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Takemoto Y, Ikeda M, Karakuchi N, Shimomura M, Inoue M, Ohmori I, Miyamoto K, Toyota K, Sadamoto S, Takahashi T. A safe and reliable technique for fascial closure without special devices after laparoscopic surgery. Asian J Endosc Surg 2021; 14:149-153. [PMID: 32677273 DOI: 10.1111/ases.12809] [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: 02/18/2020] [Revised: 04/02/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To prevent port-site hernia, we established a simple and low-cost closure method that uses a venous catheter needle and suture, without any other special devices. MATERIALS AND SURGICAL TECHNIQUE We used the inner needle of a 16-G venous catheter and a 2-0 absorbable bladed suture. To evaluate the efficacy of this technique, the procedure time was noted and compared among three operators (an experienced surgeon and two inexperienced surgeons). DISCUSSION The median suturing time was 60.5 seconds (range, 26-130 seconds) per incision. Even an unexperienced surgeon can close the fascia safely and quickly after some experience with the procedure.
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Affiliation(s)
- Yuki Takemoto
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Masahiro Ikeda
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Nozomi Karakuchi
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Manabu Shimomura
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Masashi Inoue
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Ichiro Ohmori
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Kazuaki Miyamoto
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Kazuhiro Toyota
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Seiji Sadamoto
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Tadateru Takahashi
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
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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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Noh JJ, Kim TH, Kim CJ, Kim TJ. Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period. Sci Rep 2020; 10:17388. [PMID: 33060799 PMCID: PMC7562698 DOI: 10.1038/s41598-020-74471-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
The present study was conducted to report the perioperative outcomes of single-port access (SPA) laparoscopic gynecologic surgeries with focus on the incidence of postoperative incisional hernia from our cumulative data of 2498 patients. A retrospective review was performed on the women who had received SPA surgeries from 2008 to 2018. Patient characteristics and perioperative outcomes including the incidence of postoperative incisional hernia were analyzed. There were 2498 Korean patients who received SPA surgeries for various gynecologic diseases. The median age of the patients was 40.3 ± 9.2 years, and the mean body mass index (BMI) was 22.6 ± 3.2 kg/m2. A total of 3 postoperative incisional hernia occurred during the study period. Two patients whose fascial layers were closed in running sutures developed hernias 6 and 8 months after their operations. One patient whose fascial layers were closed in interrupted sutures developed hernia 11 months after her operation. The incidence of postoperative incisional hernia following SPA surgery is low in Asian women whose BMI is relatively lower than other patient populations. Interrupted suture technique may reduce postoperative incisional hernia by providing a distinct visualization of fascial layers during closure. Detailed descriptions of our surgical techniques of closing the port incision are provided.
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Affiliation(s)
- Joseph J Noh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University School of Medicine, Taejon, South Korea
| | - Chul-Jung Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University School of Medicine, Taejon, South Korea
| | - Tae-Joong Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, South Korea.
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11
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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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12
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Ariyoshi Y, Suto T, Umemura A, Fujiwara H, Yanari S, Uesugi N, Sugai T, Sasaki A. Two-stage laparoscopic surgery for incarcerated umbilical Littre's hernia in severely obese patient: a case report. Surg Case Rep 2020; 6:245. [PMID: 33000336 PMCID: PMC7527395 DOI: 10.1186/s40792-020-01008-3] [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: 05/25/2020] [Accepted: 09/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Littre's hernia containing Meckel's diverticulum is an extremely rare disease. We report an adult case of two-stage laparoscopic surgery for incarceration of Meckel's diverticulum in an umbilical hernia. Case presentation The case involved a 23-year-old, severely obese man with BMI 36.5 kg/m2. After experiencing effusion from the umbilicus for 2 months, and was referred from a local dermatologist. We diagnosed an infected urachal remnant, and antibiotic therapy was performed first. Surgery was planned for after the infection disappeared. During follow-up, effusion from the umbilicus took on an intestinal fluid-like character, so we diagnosed small intestinal cutaneous fistula and performed surgery. Under laparoscopy, we found a Meckel's diverticulum incarcerated in an umbilical hernia. The diverticulum was resected first, and the incarceration was released. The umbilicus was infected, so we planned repair of the umbilical hernia in a second surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 5. One month after the initial operation, we confirmed that there were no signs of infection, and performed umbilical hernia repair using the laparoscopic intraperitoneal onlay mesh (IPOM) repair. Postoperative progress was uneventful and he was discharged on postoperative day 4. No recurrence or infection was observed until 8 months postoperatively. Conclusions We performed dissection of the diverticulum and umbilical hernia repair for the incarcerated umbilical Littre's hernia under laparoscopy in a severely obese patient. The risk of mesh infection seems to be avoidable using a two-stage surgery, and the risk of recurrence can be reduced using the IPOM repair compared with simple suture closure.
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Affiliation(s)
- Yu Ariyoshi
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Shingo Yanari
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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13
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Amiki M, Seki Y, Kasama K, Pachimatla S, Kitagawa M, Umezawa A, Kurokawa Y. Reduced-Port Sleeve Gastrectomy for Morbidly Obese Japanese Patients: a Retrospective Case-Matched Study. Obes Surg 2020; 29:3291-3298. [PMID: 31187457 DOI: 10.1007/s11695-019-03987-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reduced-port laparoscopic surgery remains controversial due to technical challenges that can lead to suboptimal outcomes, and data pertaining to operative and clinical outcomes of reduced-port sleeve gastrectomy (RPSG) vs. conventional laparoscopic sleeve gastrectomy (CLSG) are lacking. AIMS This retrospective case-matched study aimed to compare midterm (2-year) outcomes of RPSG and of CLSG. METHODS Patients included in the study had undergone laparoscopic bariatric surgery at our center between 2010 and 2017. Thirty-one consecutive female patients who underwent RPSG were compared to a sex-, age-, body mass index-matched group of 31 patients who underwent CLSG. Outcomes were evaluated and compared between groups. RESULTS Estimated blood loss volume, incidences of intraoperative and postoperative complications, and length of postoperative hospital stay did not differ significantly between the 2 groups. Operation time was significantly greater in the RPSG group than in the CLSG group (148.7 ± 22.6 vs. 120.2 ± 25.9 min, respectively; p < 0.001). Excess weight loss at 1 year was 105.9% and 109.7%, respectively (p = 0.94) and at 2 years was 101.1% and 105.3%, respectively (p = 0.64). One RPSG patient required placement of additional trocars because of bleeding from short gastric vessels, but conversion to open surgery was not required. CONCLUSIONS RPSG is feasible in carefully selected bariatric patients and results in midterm outcomes comparable to those observed after CLSG. Good cosmesis is a potential benefit of RPSG.
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Affiliation(s)
- Manabu Amiki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Srinivasulu Pachimatla
- Ramdev Rao Memorial General Hospital, Sivananda Rehabilitation Home, National Highway No. 65 Metro Pillar No. 34, Kukutpally Hyderabad, Telangana, 500072, India
| | - Michiko Kitagawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Akiko Umezawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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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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15
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Lateral Transperitoneal Adrenalectomy Versus Posterior Retroperitoneoscopic Adrenalectomy for Benign Adrenal Gland Disease: Randomized Controlled Trial at a Single Tertiary Medical Center. Ann Surg 2020; 269:842-848. [PMID: 29189215 DOI: 10.1097/sla.0000000000002603] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to compare the surgical outcomes of lateral transperitoneal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) for benign adrenal tumor. BACKGROUND Although LTA is the standard treatment for benign adrenal gland tumor, PRA has recently gained popularity. Studies comparing the surgical outcomes of the 2 approaches have reported conflicting findings and thus it remains unclear which approach is superior. METHODS This trial was conducted between September 2012 and February 2016. Patients were randomized to either LTA or PRA groups in a 1:1 ratio using web-based randomization. The primary outcome was operative time, and the secondary outcomes were blood loss, intraoperative hemodynamic stability, postoperative pain, recovery of bowel movement, and complication rates. This trial was registered with ClincalTrials.gov, number NCT01676025. RESULTS A total of 83 patients were randomly assigned to the LTA group (n = 42) or the PRA group (n = 41). Median follow-up was 31.3 months. The mean operative times of LTA and PRA were comparable (59.7 ± 18.6 vs 67.6 ± 28.7 minutes, P = 0.139). Logistic regression analysis showed that male sex [odds ratio (OR) = 4.20] and pheochromocytoma (OR = 5.06) were associated with an operative time ≥60 minutes. There were no differences in the secondary outcomes between the groups. One patient in the PRA group required open conversion. CONCLUSION Both LTA and PRA were performed safely with similar operative outcomes, and thus are comparable options for the treatment of benign adrenal gland tumor.
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16
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Chelala E, El Hajj Moussa W, Rizk S, Assaker N. Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases. Obes Surg 2019; 30:1515-1526. [PMID: 31858397 DOI: 10.1007/s11695-019-04356-8] [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: 10/25/2022]
Abstract
BACKGROUND This paper aims to retrospectively evaluate the feasibility, safety, and standardization for both consecutive primary and revisional SILS bariatric surgeries, and to analyze incisional hernia's prevalence, technical improvements, and limiting factors. METHODS A retrospective database review was undertaken involving, in Part I (Belgium), 290 consecutive SILS, including 80.68% primary bariatric surgeries, and 19.32% revisional gastric bypass, followed in Part II (Lebanon), by 40 selective primary SILS. Training for and standardization of the trans-umbilical technique was done for the operating room team, and was executed in part II. RESULTS The procedure of single incision was successfully completed in all of the 330 cases part I & part II. There was a need for additional salvage for one or two trocars in respectively 3.1% and 2.75% of the cases. There were no deaths or conversions in either group. Early complications included one medically healed fistula after revisional GB, and two secondary gastric and intestinal perforation requiring reoperations. Late surgical complications were: "3 patients (1.03%) in Part I and 2 (5%) in Part II suffered occlusions, requiring laparoscopic mesenteric defect's closure on an internal herniation." Twelve patients (4.1%) from part I and 5 (12.5%) in part II suffered an incisional hernia. CONCLUSION Selective SILS, when standardized, tends to be superior to consecutive SILS in terms of overall morbidity, operative time, and need for additional salvage trocars. Cost effectiveness and higher midterm rate of umbilical port site incisional hernia should be weighed against the beneficial cosmetic effect for the patient.
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Affiliation(s)
- Elie Chelala
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon. .,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,General Surgery Department, University Hospital of Tivoli, La Louvière, Belgium.
| | - Wissam El Hajj Moussa
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Simon Rizk
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nidal Assaker
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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Micelli E, Russo E, Mannella P, Iodice V, Cappellini G, Falchi N, Pancetti F, Simoncini T, Giannini A. Severe bowel incarceration in an eight-millimeter left-lateral trocar site after robot-assisted laparoscopic colposacropexy: A case report. Case Rep Womens Health 2019; 24:e00151. [PMID: 31709157 PMCID: PMC6833345 DOI: 10.1016/j.crwh.2019.e00151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022] Open
Abstract
Over the last twenty years, robotic surgery has become an increasingly important form of surgical intervention. However, it can have complications. Trocar site hernia (TSH), also known as port site hernia (PSH), is an uncommon complication, but in the case of bowel incarceration or strangulation it can cause significant morbidity. The lateral trocar sites usually do not need fascial closure, given their low susceptibility to hernia development. In this paper, we present a rare case of an incarcerated TSH from an 8 mm left lateral port after robotic colposacropexy. The patient was a 74-year-old woman with fourth-degree vaginal vault prolapse. She underwent robot-assisted colposacropexy and adnexectomy and was eventually discharged 3 days after surgery, with flatus. A few hours later, the woman developed generalized malaise and acute abdominal pain in the lower left quadrant, with no flatus or bowel movements. CT imaging revealed a small bowel dilatation with a transition point along the left lateral 8 mm trocar site. Laparotomy confirmed an incarcerated ischemic small bowel loop. This required a surgical 40 cm small bowel resection. Although uncommon, TSH is an important clinical entity to recognize after minimally invasive surgery. While it is known that a trocar site port of 10 mm or more does require fascial closure, it is not known whether the same is true of lateral 8 mm sites. Further studies are needed to reconsider the importance of lateral trocar site port fascial closure after robot-assisted surgery.
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Affiliation(s)
- Elisabetta Micelli
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Eleonora Russo
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Veronica Iodice
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Giulia Cappellini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Nadia Falchi
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Federica Pancetti
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Wells A, Germanos GJ, Salemi JL, Mikhail E. Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey. JSLS 2019; 23:JSLS.2019.00013. [PMID: 31148913 PMCID: PMC6532834 DOI: 10.4293/jsls.2019.00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives: Although trocar site hernias (TSHs) occur in only 1.5% to 1.8% of all laparoscopic procedures, TSHs can present serious postoperative complications. The purpose of this study was to survey surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) to elicit their experiences with TSHs, including fascial closure preferences. Methods: After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based software. The survey link was emailed to all SLS members. Descriptive analyses included frequencies, percentages, and χ2 or Fisher's exact tests to assess statistical associations. Results: There were 659 SLS members who completed the survey: 323 general surgeons, 242 gynecologists, 45 colorectal surgeons, 25 bariatric surgeons, and 24 urologists. Nearly 7 in 10 respondents (68.4%) reported at least 1 patient developing a TSH within the previous decade. Compared with other specialties, bariatric surgeons had the smallest proportion of respondents reporting fascial closure for 10- to 12-mm trocars (68%) and the largest proportion indicating no fascial closure for trocars of any size (28%) (P < .01). Among all respondents, 86.6%, 15.3%, and 2.4% close 10- to 12-mm, 8-mm, and 5-mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported no fascial closure for any size. Conclusion: Port size remains one of the main risk factors for TSH development, with most respondents closing only 10- to 12-mm ports regardless of surgical volume or practice setting. The general trend for port closure for bariatric surgeons is significantly different from that of other surgeons.
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Affiliation(s)
- Ali Wells
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - George J Germanos
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Emad Mikhail
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
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Chorti A, AbuFarha S, Michalopoulos A, Papavramidis TS. Richter's hernia in a 5-mm trocar site. SAGE Open Med Case Rep 2019; 7:2050313X18823413. [PMID: 30719305 PMCID: PMC6349989 DOI: 10.1177/2050313x18823413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022] Open
Abstract
We present an unusual case of a trocar site incision hernia at a 5-mm trocar port occurring approximately 2 weeks post-operatively after a laparoscopic cholecystectomy. The patient, in her mid-60s, reported diffuse abdominal pain, constipation, nausea and vomiting. An abdominal X-ray demonstrated dilated small bowel loops with gas-fluid levels. Abdominal computed tomography revealed the small bowel herniation through the 5-mm port site. Laparotomy confirmed a Richter’s hernia of the small bowel in the fascia defect. This case highlights the necessity to examine and investigate any complaint post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying disease or risk factors, a rare complication could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure. High clinical suspicion is essential in order to avoid further deterioration of the patient condition and optimal treatment.
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Affiliation(s)
- Angeliki Chorti
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samer AbuFarha
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodosios S Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Li M, Cao B, Gong R, Sun D, Zhang P, Jiang X, Sheng Y. Randomized trial of umbilical incisional hernia in high-risk patients: extraction of gallbladder through subxiphoid port vs. umbilical port after laparoscopic cholecystectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:342-349. [PMID: 30302147 PMCID: PMC6174159 DOI: 10.5114/wiitm.2018.76001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/27/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Trocar site incisional hernia (TSIH) is one of the most common complications of laparoscopic surgery. Using the umbilical port as a common hole for removing the gallbladder in laparoscopic cholecystectomy is more likely to lead to TSIH than other ports. Thus, extracting the gallbladder through other ports may reduce the incidence of TSIH. AIM To ascertain whether extraction of the gallbladder through the subxiphoid port is more beneficial for reducing umbilical incisional hernia than the umbilical port. MATERIAL AND METHODS From April 2014 to March 2017, a randomized clinical trial was conducted among patients with high risk of incisional hernia and accepted for three-port laparoscopic cholecystectomy (TLC) in our department. 182 patients with indications of cholecystectomy were allocated randomly to group A (subxiphoid port) and group B (umbilical port). Data collection was carried out on operative time, postoperative pain, hospital stay, wound infection and TSIH in the early postoperative course, and at 1, 10, and 24 months after surgery. RESULTS The incidence of TSIH in group A was lower than that in group B (4.9% vs. 14.6%; odds ratio = 8.02; 95% CI: 2.15-47.6; p < 0.001). The mean operative time of group A was significantly shorter than that of group B (35 ±15.16 min vs. 42 ±14.58 min, p < 0.01). There was no significant difference in wound infection rate between group A and group B (p = 0.068). The data of hospital stay (p = 0.428) and postoperative pain (p = 0.349) of all analyzed patients were similar in the two groups. CONCLUSIONS Extraction of the gallbladder through the subxiphoid port can reduce umbilical incisional hernia in high-risk patients effectively.
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Affiliation(s)
- Min Li
- Department of General Surgery, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Baoqiang Cao
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Renhua Gong
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Dengqun Sun
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Peisong Zhang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Xudong Jiang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Yanfei Sheng
- Department of Emergency Department, Anhui Armed Police General Hospital, Hefei, China
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21
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Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience. Hernia 2017; 21:925-932. [PMID: 29071498 DOI: 10.1007/s10029-017-1699-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard of treatment for patients with symptomatic cholelithiasis. Compared to open cholecystectomy, LC is associated with significantly lower postoperative complications. Trocar site hernia (TSH) is an uncommon, but potentially dangerous, complication of LC. The aim of this study was to evaluate the incidence of TSH following LC. METHODS The records of all patients who underwent elective LC between January 2004 and December 2013 were retrospectively reviewed. The open technique with a vertical incision infraumbilically was used to establish pneumoperitoneum. Two or three other skin incisions were made and trocars were inserted. In all cases, only the fascia at the site of infra-umbilical incision was closed. Following hospital discharge, all patients were regularly re-examined 1, 4 and 52 weeks postoperatively and were contacted by phone during November-December 2015. Based on the findings from clinical and telephone follow-ups, the incidence of TSH was recorded. Using univariate/multivariate analysis, we investigated several variables to identify risk factors for TSH development. RESULTS During the study period, 1172 patients were eligible and included in the final analysis. Seven patients (0.6%) presented TSH at 1-year follow-up. At the end of the study and with a mean follow-up of 65.86 ± 25.19 months, 11 patients (0.94%) presented TSH. Interestingly, all TSHs were developed at the infra-umbilical site. Multivariate analysis identified obesity as an independent risk factor for TSH. CONCLUSION The incidence of TSH following LC is considerably low. Obesity is an independent risk factor for TSH development, while closure of fascial incision of 10 mm below the xiphoid is not justified.
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22
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Cybulska P, Schiavone MB, Sawyer B, Gardner GJ, Zivanovic O, Brown CL, Jewell EL, Sonoda Y, Barakat RR, Abu-Rustum NR, Leitao MM. Trocar site hernia development in patients undergoing robotically assisted or standard laparoscopic staging surgery for endometrial cancer. Gynecol Oncol 2017; 147:371-374. [PMID: 28947174 DOI: 10.1016/j.ygyno.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare the incidence and potential risk factors of trocar site hernia formation in women undergoing robotically assisted versus standard laparoscopic staging (RBT vs. LSC, respectively) for endometrial cancer. METHODS We retrospectively identified all patients who underwent MIS staging for endometrial cancer at our institution from 01/09-12/12. Data collection involved the review of all operative notes, postoperative follow-up visit notes, and postoperative imaging reports. Appropriate statistical tests were used. RESULTS We identified 760 eligible patients (LSC, 193; RBT, 567). The overall median age was 61years (range, 33-90). The median BMI was 28.5kg/m2 for LSC (range, 16.6-67.6) and 29.5kg/m2 for RBT (range, 17.9-66) patients (p=0.8). A trocar site hernia developed in 16 patients (2.1%)-5 (2.6%) of 193 LSC and 11 (1.9%) of 567 RBT patients (p=0.6). Median time to hernia diagnosis was 13months (range, 5-20.5) and 18months (range, 3-49), respectively (p=0.5). All hernias in the LSC cohort developed at the camera trocar site. In the RBT cohort, 10 developed at the camera trocar site and 1 at a lateral trocar site. Only BMI was associated with the development of hernias. A hernia was diagnosed in 7 (6.9%) of 101 patients with a BMI ≥40kg/m2 compared with 9 (1.4%) of 659 with a BMI <40kg/m2 (p=0.001). CONCLUSION MIS for endometrial cancer is associated with a low rate of trocar site hernia formation, with similar rates associated with RBT and standard LSC. Higher BMI is associated with the development of postoperative trocar site hernias.
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Affiliation(s)
- Paulina Cybulska
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria B Schiavone
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon Sawyer
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Richard R Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Abstract
BACKGROUND The impact of laparoscopy on the prevalence of incisional hernias remains unclear. The aim of this study is to determine (1) surgeon perceptions of port-site hernias (PSHs), (2) the true incidence of PSH. MATERIALS AND METHODS A survey on PSH was given to determine the surgeon-reported rate of PSH. A literature review was performed for studies with a primary outcome of PSH. Studies were evaluated using checklists, and scores were used to compare risk of bias. Risk of bias was graphed against PSH incidence. RESULTS From 38 surgeons surveyed, the surgeon perceived rate of PSH was a median (range) of 0.5% (0% to 5%) for ports ≤5 mm, 5% (0.1% to 20%) for ports extended, and 5% (0.1% to 40%) for ports ≥10 mm. Thirty studies showed a PSH rate from 0% to 39.3%. Higher quality studies reported higher rates of PSH. CONCLUSIONS Surgeons underestimate the incidence of PSH, but high-quality literature suggests that it may be nearly 40%.
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Cooney GM, Lake SP, Thompson DM, Castile RM, Winter DC, Simms CK. The suture pullout characteristics of human and porcine linea alba. J Mech Behav Biomed Mater 2017; 68:103-114. [PMID: 28157595 DOI: 10.1016/j.jmbbm.2017.01.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/12/2023]
Abstract
There is a substantial prevalence of post-operative incisional hernia for both laparoscopic and laparotomy procedures, but there have been few attempts at quantifying abdominal wound closure methodology in the literature. One method to ascertain a more robust method of wound closure is the identification of the influence of suture placement parameters on suture pullout force. Current surgical practice involves a recommended bite depth and bite separation of 10mm, but the evidence base for this is not clear. In this paper, the suture pullout characteristics of both porcine and human linea alba were investigated to ascertain a suture placement protocol for surgical wound closure. Uniaxial suture pullout force testing on fresh frozen porcine and human linea alba samples was performed using standard materials testing machines. The influence of the number of suture loops, the bite depth and the bite separation of the sutures and the orientation of the sutures with respect to the principal fibre direction in the linea alba were assessed. Results showed a clearly identifiable relationship between pullout force of the suture, bite separation and bite depth, with low suture separation and high suture depth as optimal parameters for increasing pullout force. Resistance to pullout could be improved by as much as 290% when optimizing test conditions. Both human and porcine tissue were observed to exhibit very similar pullout force characteristics, corroborating the use of a porcine model for investigations into wound closure methodology. Orientation of suture application was also found to significantly affect the magnitude of suture pullout, with suturing applied longitudinally across a transverse defect resulting in higher pullout forces for small suture bite separations. Although further assessment in an environment more representative of in vivo conditions is required, these findings indicate that increasing the bite depth and reducing the bite separation with respect to the current surgical recommendations may reduce the risk of post-operative incisional hernia.
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Affiliation(s)
- Gerard M Cooney
- Trinity Centre for Bioengineering, Department of Mechanical and Manufacturing Engineering, Parsons Building, Trinity College, College Green, Dublin 2, Ireland.
| | - Spencer P Lake
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, United States.
| | - Dominic M Thompson
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St. Louis, St. Louis, MO, United States.
| | - Ryan M Castile
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, United States.
| | - Des C Winter
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Ciaran K Simms
- Trinity Centre for Bioengineering, Department of Mechanical and Manufacturing Engineering, Parsons Building, Trinity College, College Green, Dublin 2, Ireland.
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Ermolov AS, Koroshvili VT, Blagovestnov DA, Yartsev PA, Shlyakhovsky IA. [Postoperative abdominal hernia: a modern view on incidence and etiopathogenesis]. Khirurgiia (Mosk) 2017:76-82. [PMID: 28514387 DOI: 10.17116/hirurgia2017576-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A S Ermolov
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - V T Koroshvili
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - D A Blagovestnov
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - P A Yartsev
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
| | - I A Shlyakhovsky
- Chair of Emergency and General Surgery of the Russian Medical Academy of Postgraduate Education, Moscow; Sklifosovsky Research Institute for Emergency Care, Moscow
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Lasheen AE, Salem A, Abd Elaal S, Elsheweal AE, Osman G, Alkilany M, Ibrahim A. Percutaneous trans-abdominal external looped needle with two holes in the trocar sheath for port-site closures in difficult obese cases. Asian J Endosc Surg 2016; 9:295-299. [PMID: 27452810 DOI: 10.1111/ases.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Port closure is essential after successful laparoscopic surgery to prevent incisional hernia. However, good fascial closure still represents a problem, especially in obese patients and when the port wound is oblique. We report a novel technique for port-site closures in such cases. METHODS This study involved 67 obese patients who underwent laparoscopic surgery. We used a novel technique for port-site closure that employed a looped needle passed through two holes in the port sheath. RESULTS The method was used in 67 patients (45 laparoscopic cholecystectomies, 22 laparoscopic hernia repairs), with a mean BMI of 35.7 kg/m2 . No intraoperative incidents or port-site hernias were reported during follow-up (mean, 22 months). CONCLUSION Our procedure is safe, easy, and effective for fascial port site closures, especially in cases of difficult obese patients and oblique port wounds.
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Affiliation(s)
- Ahmed E Lasheen
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
| | - Ayman Salem
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Salah Abd Elaal
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Abd Elhafez Elsheweal
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Gamal Osman
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Mohammed Alkilany
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Amr Ibrahim
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
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Cooney GM, Lake SP, Thompson DM, Castile RM, Winter DC, Simms CK. Uniaxial and biaxial tensile stress–stretch response of human linea alba. J Mech Behav Biomed Mater 2016; 63:134-140. [DOI: 10.1016/j.jmbbm.2016.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 12/18/2022]
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Bailon-Cuadrado M, Rodriguez-Lopez M, Blanco-Alvarez JI, Rodriguez-Vielba PL. Incarcerated umbilical Littre's hernia at the trocar site of a previous laparoscopic surgical procedure. Ann R Coll Surg Engl 2016; 98:e82-3. [PMID: 27087344 DOI: 10.1308/rcsann.2016.0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Prevalence of Littre's hernia (protrusion of a Meckel´s diverticulum through an opening in the abdominal wall) is very low, and Littre's hernias found in an umbilical site are uncommon. Even rarer are cases of an incarcerated hernia resulting in a surgical emergency. Trocar-site hernias are a relatively common complication after laparoscopic cholecystectomy that develop in association with insertion of wide trocars (usually at the umbilical port). CASE HISTORY A 63-year-old female with a history of obesity, diabetes mellitus, hypertension, laparoscopic cholecystectomy and open hysterectomy arrived at hospital complaining of acute umbilical pain but with no other symptoms or fever. A painful mass observed was believed to be an incarcerated umbilical hernia at a trocar site used in previous laparoscopic surgery. Emergency surgery was undertaken: the opening of the hernia sac revealed a Meckel's diverticulum within it. The Meckel's diverticulum was resected using a stapler, followed by herniorrhaphy and hernioplasty. Postoperative recovery was uneventful. CONCLUSION An incarcerated umbilical Littre's hernia at a laparoscopic trocar site has not been reported before. To avoid this complication, we agree with the numerous authors who recommend closure of trocar sites of width ≥10mm.
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Influencing factors for port-site hernias after single-incision laparoscopy. Hernia 2016; 20:729-33. [PMID: 27417943 DOI: 10.1007/s10029-016-1512-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 06/09/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been demonstrated to be a feasible alternative to multiport laparoscopy, but concerns over port-site incisional hernias have not been well addressed. A retrospective study was performed to determine the rate of port-site hernias as well as influencing risk factors for developing this complication. METHODS A review of all consecutive patients who underwent SILS over 4 years was conducted using electronic medical records in a multi-specialty integrated healthcare system. Statistical evaluation included descriptive analysis of demographics in addition to bivariate and multivariate analyses of potential risk factors, which were age, gender, BMI, procedure, existing insertion-site hernia, wound infection, tobacco use, steroid use, and diabetes. RESULTS 787 patients who underwent SILS without conversion to open were reviewed. There were 454 cholecystectomies, 189 appendectomies, 72 colectomies, 21 fundoplications, 15 transabdominal inguinal herniorrhaphies, and 36 other surgeries. Cases included 532 (67.6 %) women, and among all patients mean age was 44.65 (±19.05) years and mean BMI of 28.04 (±6). Of these, 50 (6.35 %) patients were documented as developing port-site incisional hernias by a health care provider or by incidental imaging. Of the risk factors analyzed, insertion-site hernia, age, and BMI were significant. Multivariate analysis indicated that both preexisting hernia and BMI were significant risk factors (p value = 0.00212; p value = 0.0307). Morbidly obese patients had the highest incidence of incisional hernias at 18.18 % (p value = 0.02). CONCLUSIONS When selecting patients for SILS, surgeons should consider the presence of an umbilical hernia, increased age and obesity as risk factors for developing a port-site hernia.
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Caglià P, Tracia A, Buffone A, Amodeo L, Tracia L, Amodeo C, Veroux M. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg 2016; 33 Suppl 1:S97-S102. [PMID: 27255126 DOI: 10.1016/j.ijsu.2016.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients. MATERIALS AND METHODS A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients. RESULTS Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients. CONCLUSIONS Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
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Affiliation(s)
- Pietro Caglià
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Angelo Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Antonino Buffone
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luca Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luciano Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Corrado Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
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Port-site transversus abdominis fascia closure reduced the incidence of incisional hernia following retroperitoneal laparoscopic nephrectomy. Hernia 2016; 20:735-40. [DOI: 10.1007/s10029-016-1508-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/09/2016] [Indexed: 01/22/2023]
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Agaba EA, Rainville H, Ikedilo O, Vemulapali P. Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS 2016; 18:204-10. [PMID: 24960483 PMCID: PMC4035630 DOI: 10.4293/108680813x13693422518317] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined. Methods: All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh. Results: A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up. Conclusion: Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.
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Affiliation(s)
- Emmanuel Atta Agaba
- Department of Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, New York, NY, USA; Department of Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx NY 10467, USA.
| | - Harvey Rainville
- Department of Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, New York, NY, USA
| | - Ojinika Ikedilo
- Department of Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, New York, NY, USA
| | - Pratibha Vemulapali
- Department of Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, New York, NY, USA
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Bulian DR, Knuth J, Ströhlein MA, Sauerwald A, Heiss MM. [Transvaginal/transumbilical hybrid NOTES appendicectomy : Comparison of techniques in uncomplicated and complicated appendicitis]. Chirurg 2016; 86:366-72. [PMID: 24969344 DOI: 10.1007/s00104-014-2774-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Appendicectomy (AE), the most frequent emergency surgical procedure, can be performed as a transvaginal hybrid natural orifice translumenal endoscopic surgery (NOTES) technique (TVAE). The question of feasibility also arises in cases of advanced inflammation with perforation. MATERIAL AND METHODS Since May 2012 all female patients with suspected acute appendicitis were offered a TVAE as an alternative to the standard procedure. Preoperative, intraoperative and postoperative parameters were registered prospectively. RESULTS Until October 2013 a total of 13 TVAEs had been performed. The median age of the patients was 41 years (range 20-76 years), median BMI was 23.1 (range 18.1-28.3 kg/m(2)) and the American Society of Anesthesiologists score (ASA) distribution (I/II/≥ III) was 8/5/0. Histology revealed three cases of perforated, one hemorrhagic necrotizing and seven phlegmonous appendicitis. Furthermore, there were two findings without inflammation, namely one neurogenic appendicopathy and one neuroendocrine tumor. For the three patients with perforated appendicitis, there was a trend for higher age (67.0 years versus 33.5 years, p=0.063) and a higher C-reactive protein (CRP) level on admission (134.4 mg/l versus 26.4 mg/l, p=0.043). Also, procedural time and hospital stay were longer (64 min versus 47 min, p=0.033 and 14 days versus 3 days, p=0.004, respectively). The former was mostly due to more extensive intraoperative flushing (volume 3000 ml versus 500 ml, p=0.013 and duration 13 min versus 2 min, p=0.011). None of the cases required conversion but two of the three postoperative complications occurred in patients with perforation, which also resulted in the longer hospital stay. CONCLUSION Technically, TVAE seems feasible also in cases of perforated appendicitis. However, in these cases procedural time is prolonged due to more extensive flushing. Whether or not the longer hospital stay can be attributed to the perforation or if TVAE results in a higher rate of complications in cases of perforated appendicitis needs further evaluation.
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Affiliation(s)
- D R Bulian
- Klinik für Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität Witten/Herdecke; Campus Merheim; Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland,
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Wu S, Lv C, Tian Y, Fan Y, Yu H, Kong J, Li Y, Yu X, Yao D, Chen Y, Han J. Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center. Surg Endosc 2015; 30:3375-85. [DOI: 10.1007/s00464-015-4618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/05/2015] [Indexed: 02/08/2023]
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Rebibo L, Dhahri A, Chivot C, Cyril C, Yzet T, Regimbeau JM. Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique. Surg Obes Relat Dis 2015; 11:791-6. [DOI: 10.1016/j.soard.2014.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/06/2014] [Accepted: 11/30/2014] [Indexed: 01/13/2023]
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European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 2015; 19:1-24. [DOI: 10.1007/s10029-014-1342-5] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
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Caglià P, Tracia A, Borzì L, Amodeo L, Tracia L, Veroux M, Amodeo C. Incisional hernia in the elderly: Risk factors and clinical considerations. Int J Surg 2014; 12 Suppl 2:S164-S169. [DOI: 10.1016/j.ijsu.2014.08.357] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/03/2023]
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Jan H, Al-Khatib A, Araklitis G, Davison A, Narvekar N. A 5-mm Port-Site Hernia Following a Laparoscopic Myomectomy Resulting in Bowel Obstruction. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haider Jan
- King's College Hospital NHS Foundation Trust, Denmark Hill London, Greater London, United Kingdom
- Epsom Hospital, Epsom, Surrey, United Kingdom
| | - AlHamza Al-Khatib
- King's College Hospital NHS Foundation Trust, Denmark Hill London, Greater London, United Kingdom
| | - George Araklitis
- King's College Hospital NHS Foundation Trust, Denmark Hill London, Greater London, United Kingdom
| | - Amelia Davison
- King's College Hospital NHS Foundation Trust, Denmark Hill London, Greater London, United Kingdom
| | - Nitish Narvekar
- King's College Hospital NHS Foundation Trust, Denmark Hill London, Greater London, United Kingdom
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High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass. Surg Endosc 2014; 28:2890-8. [DOI: 10.1007/s00464-014-3543-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/08/2014] [Indexed: 01/10/2023]
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40
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Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 2014; 218:960-8. [PMID: 24680572 DOI: 10.1016/j.jamcollsurg.2014.01.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients. STUDY DESIGN A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery. RESULTS A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups. CONCLUSIONS Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients.
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Affiliation(s)
- Laura Armañanzas
- Department of Surgery, General University Hospital Elche, Elche, Spain.
| | - Jaime Ruiz-Tovar
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Antonio Arroyo
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | | | | | - María Diez
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Isabel Galindo
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Rafael Calpena
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
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Sucher R, Resch T, Mohr E, Perathoner A, Biebl M, Pratschke J, Mittermair R. Single-incision laparoscopic sleeve gastrectomy versus multiport laparoscopic sleeve gastrectomy: analysis of 80 cases in a single center. J Laparoendosc Adv Surg Tech A 2014; 24:83-8. [PMID: 24432970 DOI: 10.1089/lap.2013.0250] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Through efficacy and improved safety, multiport laparoscopic sleeve gastrectomy (LAPS-G) has emerged as an important and broadly available treatment option for people with severe and complex obesity. Because a single-incision laparoscopic sleeve gastrectomy (SILS-G) would be less invasive, we applied this novel surgical technique for a selected number of patients enrolled into our minimally invasive bariatric program. SUBJECTS AND METHODS A retrospective review of prospectively collected data from 80 morbidly obese patients who qualified for SILS-G or LAPS-G was performed from January 2011 to May 2012. RESULTS SILS-G and LAPS-G were performed in 40 patients, respectively. All patients were female. Mean age was 41 (range, 19-73) years (SILS-G, 37 [19-62] years; LAPS-G, 43 [24-73] years; P=not significant). Preoperative body mass index was 40.8 (35.1-45.0) kg/m(2) in the SILS-G group and 43.8 (35.0-47.8) kg/m(2) in the LAPS-G group (P=not significant). Total operative time was significantly lower in the SILS-G group (85±21 minutes) compared with the LAPS-G group (97±26 minutes) (P<.05). Median percentage excess weight loss was comparable in both groups (SILS-G, 57.2%; LAPS-G, 53.7%) at 6.6 months after surgery. Mean hospital stay was 5 days (SILS-G, 5 [4-24] days; LAPS-G, 6 [4-14] days; P=not significant). Complication rates were low in both groups: leakage, 2.5% in SILS-G and 0% in LAPS-G; bleeding, 2.5% in SILS-G and 2.5% in LAPS-G; and trocar-site hernia, 0% in both groups. Patients operated on with single-incision laparoscopy had a significantly better cosmetic outcome as assessed by a scar satisfaction assessment questionnaire (P<.01). CONCLUSIONS SILS-G is a feasible and safe operative procedure that leads to a significant reduction of total operative time compared with a multiport access procedure. Further potential benefits associated with single-incision laparoscopic surgery remain to be investigated objectively.
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Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University , Innsbruck, Austria
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Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdú H, López Negre JL, Urgellés J, Estalella L, Parés D. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2013; 207:1-6. [PMID: 24112669 DOI: 10.1016/j.amjsurg.2013.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/25/2013] [Accepted: 05/16/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Trocar site incisional hernia (TSIH) is a common complication after laparoscopic cholecystectomy. The aim of this study was to evaluate the prevalence of TSIH and analyze the influence of several risk factors for this complication in a prospective series. METHODS From 2007 to 2008, a prospective observational study with 3 years of follow-up was performed including all consecutive patients with cholelithiasis who underwent elective laparoscopic cholecystectomy. A multivariate analysis was performed to identify risk factors for TSIH. RESULTS Overall, 241 patients were included. During a median follow-up period of 46.8 months, 57 patients (25.9%) were diagnosed with umbilical TSIH by physical exam or ultrasound. The multivariate analysis revealed that incision enlargement (odds ratio [OR], 14.17; 95% confidence interval [CI], 3.61 to 55.51; P < .001), wound infection (OR, 5.62; 95% CI, 2.35 to 13.42; P < .001), diabetes mellitus (OR, 2.79; 95% CI, 1.05 to 7.37; P = .0038), and obesity (OR, 2.71; 95% CI, 1.28 to 5.75; P = .009) contributed to the risk for developing a TSIH. CONCLUSIONS Umbilical TSIH is highly prevalent. This study identified several factors that could be useful to introduce preventive measures in high-risk patients.
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Affiliation(s)
- Jordi Comajuncosas
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Judit Hermoso
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Pere Gris
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Jaime Jimeno
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Rolando Orbeal
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Helena Vallverdú
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Jose Luis López Negre
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Joan Urgellés
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Laia Estalella
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - David Parés
- Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, C/ Camí Vell de la Colònia 25, 08830 Sant Boi de Llobregat (Barcelona), Spain.
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Huang BS, Seow KM, Tsui KH, Su WH, Lu CH, Wang PH. Small trocar site hernia after laparoscopy. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Boone JD, Fauci JM, Barr ES, Estes JM, Bevis KS. Incidence of port site hernias and/or dehiscence in robotic-assisted procedures in gynecologic oncology patients. Gynecol Oncol 2013; 131:123-6. [PMID: 23845692 DOI: 10.1016/j.ygyno.2013.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/25/2013] [Accepted: 06/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The incidence of port site hernia and/or dehiscence using bladeless trocars is 0-1.2%. Robotic surgery uses additional port sites and increases manipulation of instruments, raising the concern for more complications. We sought to characterize the incidence of port site complications following robotic surgery when fascia was not routinely closed. METHODS Robotically-assisted (RA) procedures performed for suspected gynecologic malignancy between 1/2006 and 12/2011 were retrospectively reviewed. Bladeless 12 mm and 8mm robotic trocars were used. Fascial closure was not routinely performed except after specimen removal through the port site. The decision to close the fascia remained at the discretion of the surgeon. RESULTS Data from 842 procedures were included. Mean patient age was 55.6 years. Mean Body Mass Index was 33.6 kg/m(2). RA-total laparoscopic hysterectomy (TLH)± unilateral or bilateral salpingo-oophorectomy (BSO)± lymphadenectomy (LND) accounted for 91.6% of procedures. Final pathology confirmed malignancy in 58.6% of cases, primarily endometrial cancer. In 35 cases, the specimen was removed through the port site; fascia was closed in 54.3% of them and no port site hernias or dehiscences occurred. Only one patient underwent a RA-TLH/BSO/LND for endometrial adenocarcinoma and had a port site dehiscence of the 8mm trocar site. No port site hernias occurred. CONCLUSION Port site hernias and dehiscences are rare in RA gynecologic oncology procedures. When bladeless dilating trocars are used, routine closure of even up to a 12 mm port site is unnecessary, even in cases requiring removal of the specimen through the trocar sites.
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Affiliation(s)
- Jonathan D Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, AL, USA.
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[Hernia surgery in urology. Part 2: parastomal, trocar and incisional hernias - fundamentals of clinical diagnostics and treatment]. Urologe A 2013; 52:871-81; quiz 882-3. [PMID: 23695159 DOI: 10.1007/s00120-013-3200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.
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Abstract
Laparoscopic sleeve gastrectomy has gained popularity and acceptance among bariatric surgeons, mainly as a result of its low morbidity and mortality. Single-incision laparoscopic surgery (SILS), the most recent development in minimally invasive surgery, allows operations to be carried out through only a single incision using special ports. To further minimize the trauma of access incisions, we applied the SIL sleeve gastrectomy on a selected number of patients enrolled into our minimally invasive bariatric program. Between June 2010 and May 2012, 40 consecutive female patients underwent SIL sleeve gastrectomy. All data (demographic, morphologic, operative, and follow-up data) were prospectively collected in a computerized data bank. All patients were female. Mean age was 37 years (range, 19 to 62 years), preoperative body mass index was 40.8 kg/m2 (range, 35.1 to 45.0 kg/m2), and excess weight loss was 57.2 per cent at 6.6 months after surgery. Total operative time was 85 ± 21 minutes and mean hospital stay was 5 days (range, 4 to 24 days). Of the patients, two (5%) sustained postoperative complications such as leakage from the suture line and hemorrhage one in each case. There was no trocar site hernia. SIL sleeve gastrectomy seems to be an effective surgical option for the treatment of morbid obesity. During the first 6 months after the operation, weight loss was excellent. These results are at present comparable to those of multiport sleeve gastrectomy. SIL sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of this procedure.
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Affiliation(s)
- Reinhard Mittermair
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Pratschke
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Robert Sucher
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
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Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M. Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 2013; 22:731-7. [PMID: 23039699 DOI: 10.1089/lap.2012.0129] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The major concerns of single-port cholecystectomy are port-site hernia and cost. Essentially, a larger transumbilical incision is more likely to increase the incidence of incisional hernia. The effect of single-port cholecystectomy on hospital cost is controversial. This study evaluated single-port cholecystectomy and traditional four-port cholecystectomy with respect to perioperative outcomes, hospital cost, and postoperative complications. PATIENTS AND METHODS Between January 2010 and March 2011, 52 patients underwent single-port cholecystectomy, and 111 patients underwent traditional laparoscopic cholecystectomy. We used equal instruments in patients undergoing operation with the same surgical technique. Demographics, diagnosis, operative data, complications, length of hospital stay, and cost were compared between the two groups. RESULTS The patients undergoing laparoscopic cholecystectomy were significantly older than patients undergoing single-port cholecystectomy (55.8±13.8 years versus 48.7±12.7 years, P=.002). The trocar site hernia rate was 1.8% in laparoscopic cholecystectomy, and the port-site hernia rate was 5.8% in single-port cholecystectomy. This is the highest rate reported in the literature for port-site hernia following single-port cholecystectomy. Surgical techniques were not different in terms of conversion to open surgery, postoperative hospital stay, and operative time. The relative cost of single-port cholecystectomy versus laparoscopic cholecystectomy was 1.54. CONCLUSIONS Although single-port cholecystectomy seems to be a feasible surgical technique, it is not superior over the traditional laparoscopic cholecystectomy. Single-port cholecystectomy is equal to laparoscopic cholecystectomy with respect to conversion to open surgery, postoperative hospital stay, and operative time, but it is associated with high hospital cost and high port-site hernia rate.
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Affiliation(s)
- Husnu Alptekin
- Department of General Surgery, Selcuklu Medical School, Selcuk University , Konya, Turkey.
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Lee DY, Rehmani SS, Guend H, Park K, Ross RE, Alkhalifa M, McGinty JJ, Teixeira JA. The incidence of trocar-site hernia in minimally invasive bariatric surgery: a comparison of multi versus single-port laparoscopy. Surg Endosc 2012; 27:1287-91. [PMID: 23232997 DOI: 10.1007/s00464-012-2597-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/17/2012] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations. METHODS There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture. RESULTS Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias. CONCLUSIONS SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.
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Affiliation(s)
- David Y Lee
- St. Luke's-Roosevelt Hospital Center, Institute for Bariatric and Minimally Invasive Surgery, 1111 Amsterdam Avenue, Babcock 4W, New York, NY 10025, USA.
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Zemet R, Mazeh H, Grinbaum R, Abu-Wasel B, Beglaibter N. Incarcerated hernia in 11-mm nonbladed trocar site following laparoscopic appendectomy. JSLS 2012; 16:178-81. [PMID: 22906352 PMCID: PMC3407445 DOI: 10.4293/108680812x13291597716780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This report emphasizes the importance of performing meticulous closure on all trocar sites 10-mm and greater. Background: Nonbladed trocars are considered less traumatic to the abdominal wall due to the lack of fascial incision. It has been suggested that closure of the abdominal fascia may be unnecessary when such nonbladed trocars are used. Case Report: We report on 2 patients who were diagnosed with trocar-site hernias 2 days after laparoscopic appendectomy performed using 11-mm nonbladed trocars. Conclusion: Although rare, trocar-site hernias after laparoscopic surgery with nonbladed trocars remain a cause of postoperative morbidity and require prompt intervention. Therefore, this report underscores the significance of performing meticulous closure of all trocar sites that are ≥10mm.
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Affiliation(s)
- Roni Zemet
- Hadassah-Hebrew University Medical Center, Mount Scopus, Department of Surgery, Jerusalem, Israel
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50
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Erdas E, Dazzi C, Secchi F, Aresu S, Pitzalis A, Barbarossa M, Garau A, Murgia A, Contu P, Licheri S, Pomata M, Farina G. Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: a long-term follow-up study. Hernia 2012; 16:431-7. [PMID: 22714582 DOI: 10.1007/s10029-012-0929-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 05/25/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this retrospective study was to assess the incidence of trocar site hernias (TSH) following laparoscopic cholecystectomy (LC) through a long-term follow-up and to elucidate the significance of several technical and patient-related factors. METHODS A total of 313 patients submitted to LC between 2000 and 2004 were included in our study. The pneumoperitoneum was always performed by means of Hasson's technique at the umbilical site and the operative trocars were positioned using either the American technique or the French technique. Closure of the fascial defect was performed only at the umbilical site. The effects of several variables, including age, gender, size of gallstones, co-existing umbilical hernia, complexity of operation, diabetes, obesity, malnutrition, smoking, and heavy manual work on the development of TSH were assessed by univariate and multivariate models. RESULTS Thirteen cases of TSH (4.1 %) were detected over a mean follow-up period of 89.8 months (range: 60-128). Of these, 11 (84.6 %) developed at the umbilicus and 2 at the 10 mm subxiphoid site (15.4 %). At univariate and multivariate analysis, gallstones ≥ 2 cm (p = 0.030; OR = 9.95, p = 0.01) and obesity (p = 0.002; OR = 22.93, p < 0.01) were found to increase the likelihood of TSH development. CONCLUSIONS After long-term follow-up, the incidence of TSH following LC was higher than expected. The insertion of large trocars at the umbilical site plays a key role in the development of TSH. Other conditions such as obesity and large gallstones can be additional risk factors since the umbilical defect must often be widened in these cases.
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Affiliation(s)
- E Erdas
- 1st Institute of General Surgery, San Giovanni di Dio Hospital, University of Cagliari, via Ospedale, 46, 09124, Cagliari, Italy.
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