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Ahn C, Shibutani M, Kitayama K, Kasashima H, Miki Y, Yoshii M, Fukuoka T, Tamura T, Toyokawa T, Lee S, Maeda K. An 8-mm port site hernia after robotic-assisted ileocecal resection: a case report. Surg Case Rep 2024; 10:75. [PMID: 38564017 PMCID: PMC10987427 DOI: 10.1186/s40792-024-01878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Robotic-assisted surgery is steadily becoming more prominent. The majority of reports regarding port site hernias (PSHs) have involved laparoscopic procedures. Currently, it is common to suture the fascia at port sites that are 10 mm or larger; however, the closure of 5-mm port sites is not considered mandatory. The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) utilizes a distinctive 8-mm port. We report a case of an early-onset PSH at an 8-mm port site after robotic-assisted ileocecal resection. CASE PRESENTATION A 74-year-old male patient with a body mass index of 19.7 kg/m2 was diagnosed with cecal cancer and underwent robotic-assisted ileocecal resection. A 3-cm midline incision was made at the umbilicus for insufflation. Under laparoscopic visualization, three ports (12 mm, 8 mm, and 8 mm) were inserted in the lower abdomen. An 8-mm port was inserted in the left subcostal region, and a 5-mm port was inserted in the left lateral abdomen. The procedure was performed without significant intraoperative complications. The fascia was closed only at the umbilicus and 12-mm port site; the fascia at the 8-mm port sites was not closed. The patient was initially discharged without complications; however, on postoperative day 11, the patient was urgently hospitalized again because of PSH incarceration. After manual reduction, the fascia was sutured closed under local anesthesia. The hernial defect was small and barely allowed the insertion of a little finger. There was no evidence of compression or significant damage to the fascia. On postoperative day 27, the patient was discharged after experiencing good recovery. CONCLUSIONS Robotic-assisted colectomy could contribute to the risk of PSHs because of its surgical characteristics. Although routine closure of the fascia at 8-mm port sites is not mandatory, it may be beneficial in certain cases.
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Affiliation(s)
- Changgi Ahn
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan.
| | - Kishu Kitayama
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
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Robicsek AE, Sakhalkar OV, Frassrand SL, Gupta A, Odom JW. A rare case of incarcerated appendix in a port site hernia: A case report. Int J Surg Case Rep 2023; 111:108821. [PMID: 37734124 PMCID: PMC10518473 DOI: 10.1016/j.ijscr.2023.108821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hernias containing the vermiform appendix are very rare. The more common of these have eponyms, such as Amyand's hernia (incidence of 0.5-1 %) and de Garengeot's hernia (incidence of 0.8-1 %). Laparoscopic port site hernias containing the vermiform appendix are even more obscure with only seven previously reported cases. PRESENTATION OF CASE A 71-year-old male presented with a palpable, non-reducible right lateral periumbilical mass, diagnosed preoperatively as an irreducible hernia at a port site from prior laparoscopic surgery. He had previously undergone laparoscopic bilateral inguinal hernia repairs with the 10 mm right lateral periumbilical port site defect within the musculoaponeurotic abdominal wall. DISCUSSION There are recommendations regarding the closure of most 10-12 mm port sites, and all 15 mm port sites, given most port site hernias are associated with larger trocars. It is reasonable to conclude that if our patient's 10 mm right lateral periumbilical port site received fascial closure, the resultant hernia may have been prevented. CONCLUSION Fascial closure of port sites >5 mm poses an easy and effective way to reduce risk of port site hernias as well as other potential complications, therein reducing readmission, need for additional surgery, and improving patient quality of life.
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Affiliation(s)
| | - Om V Sakhalkar
- 1120 15th St, Augusta, GA 30912, United States of America.
| | | | - Anjuli Gupta
- 1120 15th St, Augusta, GA 30912, United States of America
| | - John W Odom
- 1120 15th St, Augusta, GA 30912, United States of America
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Tazaki T, Kohyama M, Sugiyama Y, Takahashi S, Sasaki M. A rare case of multiple port site incisional hernias repaired by laparoscopy-assisted intraperitoneal onlay mesh: A case report. Int J Surg Case Rep 2023; 106:108302. [PMID: 37148732 DOI: 10.1016/j.ijscr.2023.108302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Port site herniation is a frequent complication of abdominal surgery, yet treatment strategies for multiple port site hernias are often difficult and case reports are rare. PRESENTATION OF CASE A 72-year-old woman, with a history of multiple abdominal surgeries, underwent laparoscopic surgery for rectal prolapse four years prior. Three 12 mm ports were inserted into the umbilical region, right upper quadrant and right lower abdomen, subsequently, incisional hernias developed at all three sites. In addition, an incisional hernia developed in the lower abdomen, for a total of four incisional hernias. She was taking apixaban for atrial fibrillation, and since the standard surgical method of placing the mesh in the extraperitoneal space was judged to be high risk for postoperative bleeding and hematoma formation, we performed a laparoscopy-assisted intraperitoneal onlay mesh repair (IPOM). DISCUSSION The key points of the surgery performed are: Laparoscopic surgery was initiated with a small incision in the umbilical region, using two 5 mm ports because we reasoned that using a 12 mm port could cause a new hernia. In the lateral hernia repair, a mesh was placed in the preperitoneal space on the dorsal side of the hernia, the mesh was sutured to the peritoneum because tucking cannot be performed if nerves are present on the dorsal aspect. The medial hernia was repaired by IPOM via a small laparotomy incision. CONCLUSION For multiple incisional hernias, it is necessary to consider appropriate repair methods for each site.
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Affiliation(s)
- Tatsuya Tazaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Mohei Kohyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yoichi Sugiyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaru Sasaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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Krittiyanitsakun S, Nampoolsuksan C, Tawantanakorn T, Suwatthanarak T, Srisuworanan N, Taweerutchana V, Parakonthun T, Phalanusitthepha C, Swangsri J, Akaraviputh T, Methasate A, Chinswangwatanakul V, Trakarnsanga A. Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up. World J Clin Cases 2023; 11:357-365. [PMID: 36686347 PMCID: PMC9850963 DOI: 10.12998/wjcc.v11.i2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/06/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the infrequency of trocar site hernias (TSHs), fascial closure continues to be recommended for their prevention when using a ≥ 10-mm trocar.
AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.
METHODS Between July 2010 and December 2018, all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed. All patients underwent cross-sectional imaging for TSH assessment. Clinicopathological characteristics were recorded. Incidence rates of TSH and postoperative results were analyzed.
RESULTS Of the 254 patients included, 70 (111 ports) were in the fascial closure (closed) group and 184 (279 ports) were in the nonfascial closure (open) group. The median follow up duration was 43 mo. During follow up, three patients in the open group developed TSHs, whereas none in the closed group developed the condition (1.1% vs 0%, P = 0.561). All TSHs occurred in the right lower abdomen. Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain. The open group had a significantly shorter operative time and lower blood loss than the closed group.
CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed. However, further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.
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Affiliation(s)
- Santi Krittiyanitsakun
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chawisa Nampoolsuksan
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thikhamporn Tawantanakorn
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Tharathorn Suwatthanarak
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nicha Srisuworanan
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Voraboot Taweerutchana
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thammawat Parakonthun
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chainarong Phalanusitthepha
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thawatchai Akaraviputh
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Asada Methasate
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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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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Karampinis I, Lion E, Hetjens S, Vassilev G, Galata C, Reissfelder C, Otto M. Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study. Obes Surg 2021; 30:1820-1826. [PMID: 31950317 PMCID: PMC7242489 DOI: 10.1007/s11695-020-04400-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The exact prevalence of trocar site hernias after bariatric procedures is not yet known. Recent metaanalysis data indicated concerning rates of up to 25%. We conducted a prospective cohort study to estimate the prevalence and analyze the role of fascia closure in the development of trocar hernias. Method A total of 365 patients who were operated for obesity in our department between 2009 and 2018 were included. All patients were invited for a follow-up ultrasonography scan in order to detect abdominal wall defects. The role of intraoperative fascia closure in the development of trocar site hernias was evaluated, and a logistic regression analysis was performed to detect potential risk factors. Results The overall prevalence of trocar hernias detected by ultrasonography was 34%. The prevalence of abdominal wall defects in patients who received a fascia closure was 37% compared with 34% in patients who did not receive a fascia closure (p = 0.37). The only factor that was associated with a higher risk for trocar site hernias was high excessive weight loss (p = 0.05). Conclusion Trocar site hernias are an underestimated complication of minimally invasive, multiportal bariatric surgery, and the prevalence of asymptomatic hernias is probably higher than initially expected. In this study, fascia closure did not protect against trocar hernias. However, opposing evidence from similar trials suggests closing the fascia. This clinical problem should therefore be further assessed in a prospective randomized setting.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eliette Lion
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Galata
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Gutierrez M, Stuparich M, Behbehani S, Nahas S. Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review. Surg Endosc 2020; 34:5250-5258. [PMID: 32728766 DOI: 10.1007/s00464-020-07826-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the introduction of laparoscopic surgery, it has become more popular with many advantages over open surgery including faster recovery, shorter hospital stays, and decreased tissue trauma. Despite its benefits, laparoscopic surgery can result in its own unique complications, such as the formation of a trocar site hernia (TSH), which have been reported in approximately 0-1.0% of laparoscopic cases when using non-bladed trocars. METHODS A literature review was performed from June 1990 to June 2019. PubMed was searched using the keywords "laparoscopic surgery," "trocar site hernia," and "port site hernia." Only articles in English were identified but not limited to the USA. RESULTS The total number of patients in all articles was 18,533 with a mean follow-up period of 22.50 ± 1.76 months. The overall trocar site hernia rate was 0.104%. When comparing open vs. closed ports, there was no significant difference in the hernia incidence rate for 5-mm and 10-mm ports. When comparing bladed versus non-bladed trocars left open, there was a statistically significant difference with lower hernia incidence rates for non-bladed trocars over bladed trocars for 5-mm, 10-mm, and 12-mm ports. And when comparing trocar location from midline versus off-midline, there was a statistically significant higher TSH incidence in midline trocar locations. CONCLUSION Results suggest that TSH rate is lower when using non-bladed trocars for any size of trocar. When comparing whether fascial closure had an effect, the 5-mm and 10-mm ports had no difference in incidence rates and leaving the fascia open can reduce operative time, risk of needlestick injuries, and overall procedural cost. In addition, trocars at midline locations resulted in higher TSH incidence rates. Future research is still needed to assess for other factors that may influence hernia formation and how it can be minimized.
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Affiliation(s)
- Monica Gutierrez
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.,, Rancho Cucamonga, CA, USA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Sadikah Behbehani
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA
| | - Samar Nahas
- Department of Obstetrics and Gynecology, University of California Riverside School of Medicine, 19330 Jesse Ln Suite 100, Riverside, CA, 92508, USA.
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Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 29:1049-1057. [PMID: 30659465 DOI: 10.1007/s11695-018-03687-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
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Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany.
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Duke JM, Pillay Y. A case report of a double port site hernia and their laparoscopic repair with intra corporeal suturing of the hernia necks and an underlay mesh repair. Int J Surg Case Rep 2018; 51:86-89. [PMID: 30145499 PMCID: PMC6111058 DOI: 10.1016/j.ijscr.2018.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022] Open
Abstract
First case report of a double port site hernia. First laparoscopic repair of a double port site hernia. Intra corporeal suturing of the hernia necks prior to application of the underlay mesh. CT scan clearing showing the penetration of the right rectus muscle by the hernia.
Introduction Port site hernias (PSH) are a potential postoperative complication in laparoscopic surgery. It is difficult to estimate their true incidence given the descrepancy in published reports. Presentation of case This is a case report of a 42-year-old lady who developed two separate PSH requiring a laparoscopic repair. This is also the first reported case of multiple PSH in a single patient in the English literature. Discussion This report highlights the need for further research in establishing well defined incidence rates in order to properly discuss future surgical risks when consenting a patient for laparoscopic surgery. It is our belief that future research should be directed towards determining the risk associated with different trocar types, in the setting of various premorbid patient factors, to help surgeons decide on relevant instrument use and the most appropriate closure for port sites. Conclusion The growing incidence of PSH has brought about significant changes in the practice of laparoscopic surgery which behoves us as practicing clinicians to stay abreast of these changes so as to decrease the incidence of PSH.
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Affiliation(s)
- Jenny Marie Duke
- Rural Family Medicine Resident (PGY2), University of Alberta, Box 22 Site 18 RR#1, Sundre, Alberta, T0M 1X0, Canada.
| | - Yagan Pillay
- Department of General Surgery, University of Saskatchewan, Saskatchewan, S7N 0W8, Canada.
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Clark LH, Soliman PT, Odetto D, Munsell MF, Schmeler KM, Fleming N, Westin SN, Nick AM, Ramirez PT. Incidence of trocar site herniation following robotic gynecologic surgery. Gynecol Oncol 2013; 131:400-3. [PMID: 23988416 DOI: 10.1016/j.ygyno.2013.08.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease. METHODS A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables. RESULTS The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management. CONCLUSIONS Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites.
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Rao P, Ghosh K, Sudhan D. Port Site Hernia : A Rare Complication of Laparoscopy. Med J Armed Forces India 2008; 64:187-8. [PMID: 27408134 DOI: 10.1016/S0377-1237(08)80081-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 12/06/2007] [Indexed: 11/22/2022] Open
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Abstract
Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here, we present a 77-year-old female, diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The patient complained of left lower abdominal pain with a palpable mass. Abdominal CT showed an incarcerated small bowel hernia and the patient underwent segmental resection of the strangulated small bowel through a minimally extended port site incision.
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