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Restaino S, Pellecchia G, Arcieri M, Del Pup L, Bogani G, Driul L, Scambia G, Vizzielli G. Port-site hernia recurrence at previous 5-mm laparoscopic access: case report and review of literature. Facts Views Vis Obgyn 2024; 16:241-247. [PMID: 38950540 DOI: 10.52054/fvvo.16.2.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Port-site hernia (PSH) of less than 10 mm is an exceptionally rare complication of minimally invasive surgery (MIS). To date, there have been no cases in the literature reporting recurrence of PSH from a 5 mm incision. We present the first case of PSH recurrence in a woman who underwent surgery for benign gynaecological pathology via a MIS approach. Her post-operative course was complicated by an episode of symptomatic hernia arising from a 5 mm accessory trocar which was surgically managed. A few months later she re-presented with the same symptoms and had a PSH recurrence of the same port-site. Two corrective surgeries employing different techniques were performed. The first episode was managed laparoscopically using interrupted stitches. On the other hand, the PSH recurrence was managed by placement of a mesh. Ultrasound played a crucial role in diagnostics, especially in the recurrent setting. Due to the complete absence of similar cases in the literature, the decision making around the management of a PSH recurrence from a 5 mm trocar site proved to be challenging. As MIS is the current standard of care, more cases are likely to occur, however despite the increasing number of surgical procedures performed via MIS, no established guidelines for managing such complications have been proposed. Trying to bridge this gap, we present the case report of the first case of PSH recurrence from a 5 mm accessory port and a review of the most significant literature available to date. We finally summarise the reported cases of PSH and the types of surgical repair conducted to highlight the absence of a standard of care.
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Şermet M. Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study. Cureus 2023; 15:e49538. [PMID: 38156148 PMCID: PMC10753265 DOI: 10.7759/cureus.49538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.
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Affiliation(s)
- Medeni Şermet
- General Surgery, İstanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
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3
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You X, Wang Y, Zheng Y, Yang F, Wang Q, Min L, Wang K, Wang N. Efficacy of transumbilical laparoendoscopic single-site surgery versus multi-port laparoscopic surgery for endometrial cancer: a retrospective comparison study. Front Oncol 2023; 13:1181235. [PMID: 37700843 PMCID: PMC10495218 DOI: 10.3389/fonc.2023.1181235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Background Although single-port laparoscopy surgery has been evaluated for several years, it has not been widely adopted by gynecologic oncologists. The objective was to compare the perioperative outcomes and survival of endometrial cancer (EC) patients undergoing transumbilical laparoendoscopic single-site surgery (TU-LESS) with multi-port laparoscopic surgery (MLS). Materials and methods This is a retrospective comparative monocentric study including patients treated between December 2017 and October 2021. The perioperative outcomes and survival of EC patients who had surgery via TU-LESS or MLS were compared, by propensity matching. Results A total of 156 patients were included (TU-LESS vs. MLS: 78 vs. 78). The conversion rate of TU-LESS and MLS was 5.13% and 2.56%, respectively (P=0.681). The operation time was comparable between the two groups [207.5min (180-251) vs. 197.5min (168.8-225), P=0.095]. There was no significant difference between the two groups in exhaustion time, perioperative complications, or postoperative complications. While, the TU-LESS group had a shorter out-of-bed activity time [36 hours (24-48) vs. 48 hours (48-72), P<0.001] and a lower visual analog pain scale 36 hours after surgery [1 (1-2) vs. 2 (1-2), P<0.001] than the MLS group. The length of hospital stay was similar in the two groups [5(4-6) vs. 5(4-5), P=0.599]. Following surgery, 38.5% of the TU-LESS patients and 41% of the MLS patients got adjuvant therapy (P=0.744). The median follow-up time for TU-LESS and MLS cohorts was 45 months (range: 20-66) and 43 months (range: 18-66), respectively. One TU-LESS patient and one MLS patient died following recurrence. The 4-year overall survival was similar in both groups (98.3% vs. 98.5%, P=0.875). Conclusion TU-LESS is a feasible and safe option with comparable perioperative outcomes and survival of MLS in endometrial cancer. With the growing acceptance of sentinel lymph node biopsy, TU-LESS of endometrial cancer may be a viable option for patients and surgeons.
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Affiliation(s)
- Xiaolin You
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanyun Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Zheng
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Yang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiao Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Min
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kana Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Vineet K, Rai S, Mishra V. Port Site Obstructed Hernia in a Morbidly Obese Patient: A Case Report. Cureus 2023; 15:e42264. [PMID: 37605666 PMCID: PMC10440123 DOI: 10.7759/cureus.42264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Indications for laparoscopic surgeries are increasing in the current era in view of the advantages they offer in terms of less perioperative morbidities, early mobilization, and better cosmesis. These benefits are perceived even more in obese women. However, there are special challenges in this population, associated with their body habitus, poor visibility, and perioperative anesthesia risks. Difficulty in port closure is one such problem encountered in these women causing inadequate rectus suturing and leading to port site hernia. We report a case of a 59-year-old morbidly obese lady who underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for carcinoma endometrium. The intraoperative course was uneventful. In the postoperative period, she developed acute obstruction due to port site herniation of the small bowel, which was not suspected till postoperative day five. This was due to an inaccurate assessment of her abdomen because of her body habitus. A CT scan was done in view of the non-resolving obstruction, which revealed herniation of a small bowel loop through the umbilical port. Immediate correction was resorted to under local anesthesia. Rectus sheath closure was done in the same sitting. The patient had a quick recovery after that and was discharged three days later. Rectus sheath closure should be done for all ports 10 mm or greater in diameter. There should be a low threshold to get cross-sectional imaging in postoperative obese women with non-resolving gastrointestinal symptoms.
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Affiliation(s)
- Kumar Vineet
- Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Shweta Rai
- Gynecologic Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Vibha Mishra
- Gynecologic Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
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Bangeas P, Hatzikomnitsa P, Karatzia D, Mauromatidis S, Papadopoulos V. Trocar-site hernia repair after laparoscopic surgery: a case report study. J Surg Case Rep 2023; 2023:rjad015. [PMID: 36908686 PMCID: PMC10001673 DOI: 10.1093/jscr/rjad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 03/12/2023] Open
Abstract
Tracer site hernias (TSHs) are extremely uncommon. There have been only a few cases reported in the literature. Here we report a case of TSH after umbilicus laparoscopic hernia repair procedure. Diagnosis was based on patient symptoms and computed tomography. Patient underwent exploratory laparoscopy followed by laparoscopic hernia repair with mesh. We also provide a mini review of the literature in order to highlight that although rare, this pathology should be included in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Petros Bangeas
- 1st University Surgical Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, PC, Greece
| | - Paraskevi Hatzikomnitsa
- 1st University Surgical Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, PC, Greece
| | - Despoina Karatzia
- 1st University Surgical Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, PC, Greece
| | - Savvas Mauromatidis
- 1st University Surgical Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, PC, Greece
| | - Vasileios Papadopoulos
- 1st University Surgical Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, PC, Greece
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Dai X, Zhang Y, Wang F, Luo Y, Gong Y. Effects of Umbilical Preparation Before Trans-umbilical Laparo-endoscopic Single-site Surgery on Umbilical Wounds Healing: a Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2022; 32:632-636. [PMID: 36314980 DOI: 10.1097/sle.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The umbilicus is the only anatomic entrance and incision site for trans-umbilical laparoendoscopic single-site surgery (TU-LESS). Data on incisional surgical site infections (ISSI) and incision healing in TU-LESS are lacking. Therefore, we aimed to observe umbilical incision healing and possible hernia after TU-LESS and explore the efficacy of preoperative umbilicus preparation on ISSI. SUBJECTS AND METHODS Consecutive patients aged 18 to 65 years, who were scheduled to undergo TU-LESS at a teaching hospital between March 2020 and November 2021, were enrolled in this prospective study. All patients were randomized to the study group with preoperative umbilicus preparation 30 minutes before patients were sent to the operating room and to the control group without preparation. The umbilical dimple was disinfected twice using povidone-iodine in both groups before the skin incision. The primary outcome was ISSI within 30 days of surgery. Umbilical hernia at 3 months after surgery and perioperative data such as operation time, complications, and incision healing were recorded and compared. RESULTS A total of 400 patients were recruited for this study. TU-LESS was performed in all patients without major complications. ISSI occurred in 5 patients in the study group (2.5%) and 3 patients in the control group (1.5%), with no significant differences between both groups ( P =0.479). No umbilical hernia occurred in any patient during the 3 months follow-up. Six patients in the study group (3.1%) and 1 in the control group (0.5%) experienced excessive scarring, a relatively high incidence in the study group, though the difference was not statistically significant ( P =0.067). CONCLUSIONS TU-LESS-related umbilical hernias are rare with existing suturing methods. Umbilicus preparation before TU-LESS could not decrease ISSI; however, it increased the nursing workload, which should be avoided.
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Affiliation(s)
- Xuelin Dai
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Sakurai S, Suzuki Y, Nagai K, Ishidera Y, Nakagawa K, Miyagi E. Strangulated internal hernia caused by an iatrogenic peritoneal band after total laparoscopic hysterectomy—A caveat to consider retroperitoneum closure. Clin Case Rep 2022; 10:e6550. [PMCID: PMC9638085 DOI: 10.1002/ccr3.6550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shizuka Sakurai
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Yukio Suzuki
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology Columbia University Vagelos College of Physicians and Surgeons New York New York USA
| | - Koichi Nagai
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Yumi Ishidera
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Kazuya Nakagawa
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
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8
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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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9
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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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10
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Ahlqvist S, Edling A, Alm M, Dackhammar JB, Nordin P, Cengiz Y. Trocar site hernia after gastric sleeve. Surg Endosc 2022; 36:4386-4391. [PMID: 34704151 PMCID: PMC9085684 DOI: 10.1007/s00464-021-08787-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias. METHODS Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. RESULTS The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH. CONCLUSIONS The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.
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Affiliation(s)
- Sandra Ahlqvist
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden ,Department of Anesthesia and Intensive Care, Region Västernorrland, 871 85 Härnösand, Sweden
| | | | - Magnus Alm
- grid.416729.f0000 0004 0624 0320Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden
| | - Johan Blixt Dackhammar
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pär Nordin
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Yücel Cengiz
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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11
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Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery. Obstet Gynecol Surv 2021; 76:751-759. [PMID: 34942651 DOI: 10.1097/ogx.0000000000000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Port-site hernia is an iatrogenic complication with a documented incidence between 0.65% and 2.8%. However, the true incidence could be higher because of delayed onset, asymptomatic nature, and loss to follow-up. Port-site hernia could be further complicated by incarceration or strangulation leading to small bowel obstruction requiring emergent surgical intervention, thus imposing significant financial and emotional burden to patients. Objective This article aims to provide a summary of the available literature concerning port-site hernia and explore preventive strategies for future clinical practice. Evidence Acquisition This review was formulated through electronic literature searches in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The reference lists of the included studies were hand searched to identify other relevant articles to capture all available literature in this narrative review. Results Following screening for eligibility based on relevance to the topic under consideration, 28 studies were identified. This included 5 original articles, 1 case series, and 22 review articles, including 4 systematic reviews. Included studies were critically appraised in formulating this review. Conclusions Port-site hernia is an underrecognized yet preventable complication with careful consideration of predisposing technical and host factors, thorough attention to surgical technique, or use of a fascial closure device. Relevance With the widespread and increasing use of laparoscopic methods to treat surgical pathologies, knowledge of this complication is imperative to encourage prevention strategies and facilitate early recognition and management should it occur.
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12
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Kimura M, Eguchi Y, Kuwabara Y, Mitsui A, Nagasaki T, Nakaya S, Sugita S, Sawai S. A simple and reliable procedure for laparoscopic port-site closure. Langenbecks Arch Surg 2021; 406:1233-1237. [PMID: 33598848 DOI: 10.1007/s00423-021-02121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/04/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE One of the complications in laparoscopic surgery is port-site hernia. It is a rare but potentially dangerous complication. Especially when using ports with a size 10 mm or more, it is required to securely close the port site. However, this procedure is often difficult especially for obese patients. METHODS We herein devised a new closure method by using a device developed for port site. These techniques are methods that can close the port site by a combination of putting in and out of thread and port rotation without removing a port. The port-site closure with these techniques was done for 53 port sites of 41 patients. RESULTS The port site was closed horizontally or vertically, depending on the shape of the port site for two patients. Modified Z-suture was done for other 37 patients. To date, we have not noted any complications from this new method, including port-site hernia. CONCLUSION With our technique, we could save operation time and reduce stress of us especially for obese patients. We would like to increase the number of patients and verify the safety and usefulness in further study.
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Affiliation(s)
- Masahiro Kimura
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan.
| | - Yuki Eguchi
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan
| | | | - Akira Mitsui
- Department of Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Takaya Nagasaki
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Seiji Nakaya
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Saburo Sugita
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Satomi Sawai
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547, Japan
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13
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Successful laparoscopic management of ovarian cyst torsion in the third trimester. Chin Med J (Engl) 2020; 134:375-377. [PMID: 33156009 PMCID: PMC7846451 DOI: 10.1097/cm9.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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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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15
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Uketa S, Shimizu Y, Ogawa K, Utsunomiya N, Kanamaru S. Port-site incisional hernia from an 8-mm robotic trocar following robot-assisted radical cystectomy: Report of a rare case. IJU Case Rep 2020; 3:97-99. [PMID: 32743482 PMCID: PMC7292067 DOI: 10.1002/iju5.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/22/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Port-site incisional hernia is a rare but well-known complication following a laparoscopic procedure and it may cause severe adverse outcomes, such as intestinal necrosis. Here, we report a rare case of hernia that occurred from an 8-mm trocar after robot-assisted radical cystectomy. CASE PRESENTATION An 80-year-old woman was diagnosed with cT2bN1M0 bladder cancer. She underwent robot-assisted radical cystectomy. Nine days after surgery, she complained of severe abdominal pain. Computed tomography showed herniation of small intestine. Emergency explorative laparotomy revealed herniation of small intestine from an 8-mm trocar site. A section of the small bowel was necrotic and was resected. CONCLUSION It is debatable whether we should routinely close the fascia of an 8-mm trocar site. The patient was an elderly woman with multiple major abdominal surgery histories and hernia risk factors. For these patients, fascial closure of the 8-mm trocar site may be indicated.
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Affiliation(s)
- Shoko Uketa
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | - Yousuke Shimizu
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | - Kosuke Ogawa
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | | | - Sojun Kanamaru
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
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