Incisional hernia at the insertion site of the laparoscopic trocar: case report and review of the literature

A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

INTRODUCTION:

Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site.

CASE REPORT:

A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures.

CONCLUSION:

Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

Randomized prospective trial on the occurrence of laparoscopic trocar site hernias

INTRODUCTION

Laparoscopy has become the gold standard in an increasing number of procedures. We analyze the incidence of trocar site hernias (TSH) and determine whether closure of the external fascia prevents onset of TSH and possible complications.

METHODS

We performed a simple-blind randomized trial with two groups, one in which all the orifices were closed by suturing the external fascia of the abdominal wall (group A), and another in which the orifices were left open, closing only the skin (group B). Monitoring for TSH lasted 2 years from the intervention. The trial has been registered at www.clinicaltrials.gov with the clinicaltrials.gov identifier number: NCT01240434.

RESULTS

A total of 195 patients were randomized. Thirty-three were removed from the study after conversion to open surgery, early open reoperation, or loss to follow-up. The remaining 162 patients comprised the study population, 80 in group A and 82 in group B. We found no differences between the groups regarding basic demographic data, kind of surgery, or topographic distribution of the trocars. Five TSH were diagnosed-four in group A and one in group B (P=.176)-and there was no relation between TSH and trocar size (11 or 12 mm) or location. We found 10 wound infections, 7 in group A and 3 in group B (P=.154).

CONCLUSION

Our study suggests that the onset of TSH does not depend on trocar size or location. There is no evidence that suture of the fascial defect prevents the onset of TSH. In addition, we found a trend toward a higher incidence of wound infection among patients in whom the fascia had been sutured.

Alternative port site selection (APSS) for improved cosmesis in laparoscopic surgery

The use of laparoscopy can be associated with improved cosmesis following a variety of gastrointestinal procedures versus standard open surgery. The placement of laparoscopic ports in less visible areas of the body such as the bikini line, termed alternative port site selection (APSS), may result in further improved cosmesis. Performance of laparoscopic procedures from such alternative port placement areas may be associated with increased technical challenge. This manuscript discusses APSS approaches for two common laparoscopic procedures, cholecystectomy and gastric banding. Familiarity and implementation of these techniques can allow select patients to undergo procedures with less visible scarring and is less challenging than laparoscopic single site approaches.