Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy

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.Laparoscopic cholecystectomy (LC) was performed for the first time by Erich Mühe of Bo¨blingen, Germany on September 12, 1985 1 . It is now the standards surgical treatment for gallbladder stone disease (GBSD) and stood the test of time regarding reduced postoperative pain, decreased hospital stay, earlier return to work, and much more cosmetic scars. On the other hand, LC appeared progressively to have unprecedented complications such as complications related to the pneumoperitoneum and laparoscopic instruments in addition to the classical complications encountered in the open surgery such as bleeding, bile leak, and common bile duct injury.The trocar site hernia was reported for the first time in the late 1960s of the last century in a series of patients underwent laparoscopic gynecologic procedures 2 . The first case of TSH after LC was reported by Maio et al. in the USA in 1991in which they described the use of CT scan to diagnose the hernia 3 . Consequently, variable several studies were published addressing laparoscopic surgery complications including trocar site hernia. In this research, we present our observations regarding TSH after 2930 cases of LC.

Evaluation of a Novel Trocar-Site Closure Device in Laparoscopic Surgery

“…7,14 -15 Trocar-site hernia is associated with obesity, duration of surgery, age, diabetes mellitus, incision enlargement, and wound infection; thus, proper fascial closure is even more essential in patients with those risk factors. 16 In the current study, the mean closure time of EZ-Close TM was 87.9 Ϯ 21.0 s. This result is comparable to that of previously published studies evaluating conventional suturing devices. According to an in vitro study in cadaver models, the mean closure time of the conventional Carter-Thomason system was 133.6 Ϯ 54.6 s. 17 Another study reported that the Carter-Thomason needle technique took an average of 8 min to close two 10-mm port sites, although the time of complete skin closure was counted.…”

“… 7 , 14 – 15 Trocar-site hernia is associated with obesity, duration of surgery, age, diabetes mellitus, incision enlargement, and wound infection; thus, proper fascial closure is even more essential in patients with those risk factors. 16 …”

Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer

“…Patient factors associated with herniation include older age and elevated body mass index with increased intra-abdominal pressure and reduced fascial strength suggested as contributory factors. Although diabetes mellitus has been suggested as a potential risk factor, there is little evidence regarding the impact of patient comorbidity on hernia development [ 6 , 7 ]. Technical factors, which may affect the incidence of trocar-site hernia, include trocar size and position, fascial closure and procedure duration.…”

Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report

“…Therefore, the decision was made to perform a laparoscopic mesh-based repair approach for accurate measurement of the hernial defect size and reduce the risk of surgical site infection. It is also well known that trocar-site hernia was associated with obesity, wound infection, and the use of > 10-mm trocar [14]. Compared with the open access technique, direct trocar insertion was considered superior in terms of port-site hernia, infection, and pain [7,15].…”