Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery

Port-site hernia: A potentially severe complication of minimally invasive surgery

Key Clinical Message

Recently, the number of minimally invasive surgeries (MIS) is increasing; however, a specific postoperative complication of MIS such as port-site hernia needs to be recognized. A persistent postoperative ileus after MIS is rare and such symptoms need to be recognized as a probable sign of a port-site hernia.

Abstract

Recently, minimally invasive surgery (MIS) approaches for early endometrial cancer have shown non-inferior oncologic outcomes with better perioperative morbidity than open approaches. Nevertheless, port-site hernias are a rare but specific surgical complication of MIS. Knowing the clinical presentation, surgery for port-site hernias could help clinicians manage this condition.

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

Background: Laparoscopic and robot-assisted surgery is now common place, and each trocar site is a potential incisional hernia site. A number of factors increase the risk of trocar site hernia (TSH) at any given trocar site. The aim of this paper is to explore the literature and identify the patients and the trocar sites at risk, which may allow target prevention strategies to minimise TSH. Methods: A pub med literature review was undertaken using the MeSH terms of "trocar" OR "port-site" AND "hernia." No qualifying criteria were applied to this initial search. All abstracts were reviewed by the two authors to identify papers for full text review to inform this narrative review. Results: 961 abstracts were identified by the search. A reasonable quality systematic review was published in 2012, and 44 additional more recent publications were identified as informative. A number of patient factors, pre-operative, intra-operative and post-operative factors were identified as possibly or likely increasing the risk of TSH. Their careful management alone and more likely in combination may help reduce the incidence of TSH. Conclusion: Clinically symptomatic TSH is uncommon, in relation to the many trocars inserted every day for "keyhole" surgery, although it is a not uncommon hernia to repair in general surgical practice. There are patients inherently at risk of TSH, especially at the umbilical location. It is likely, that a multi-factored approach to surgery, will have a cumulative effect at reducing the overall risk of TSH at any trocar site, including choice of trocar type and size, method of insertion, events during the operation, and decisions around the need for fascial closure and how this is performed following trocar removal.