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

Abstract

Laparoscopic operations offer a myriad of advantages resulting in a rapid postoperative recovery. Incisional hernia is an uncommon cause of morbidity in operative procedures performed by laparoscopic access, and the diagnosis may not be easily made. In our service we identified 2 patients with incisional hernia the site of trocar insertion. The records of these 2 cases were reviewed. We report on these 2 cases and present a review of the literature.

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

“…Such as the number of trocars used and their diameters, the duration of the procedure (the longer it takes, the higher risk is), the aponeurotic defects in trocar place (incomplete closure of fascia), the insertion technique, the method of withdrawing the trocar, midline trocars, stretching the port site for organ retrieval, the effect of a partial vacuum while port withdrawal, obesity, poor nutrition, and operation site infection. [1247–9] Laparoscopic procedures that require multiple trocars are associated with a higher frequency of hernias. It is known that using 10 mm and larger trocars results in increase risk of hernias.…”

“…[1] Despite the minimal invasiveness, some laparoscopic procedures-related complications can be directly attributed to abdominal access with laparoscopic trocars. The postoperative port-site hernia formation, which is defined as the development of a hernia at the canula insertion site, is one of them.…”

“…[12] The prevalence of herniation followed by laparoscopic surgery is reported to be 0.0002%–6%. [2–7] In contrast, the true prevalence of such complications may be higher because some patients have no symptoms and do not return to the surgeon for follow – up.…”

Alternative Port Site Selection (APSS) for Improved Cosmesis in Laparoscopic Surgery

“…Also, increased manipulation of the trocars, increased torque on the fascia, and increased surgical time have been shown to increase the occurrence of incisional hernias. 12,13 The LESS technique increases all of those risk factors. Individual non-bladed trocar sites have a very low incidence of herniation (0.14% for 12-mm trocars and <0.05% for 5-mm trocars).…”

“…Making a larger fascial incision will increase the rate to incisional herniation. 12 The hernia rate for an open Hassan approach to the midline fascia (even smaller than would be performed in a LESS procedure) has been reported at 3%. 14 The APSS laparoscopic adjustable gastric band provides a significant cosmetic improvement over a LESS laparoscopic adjustable gastric band (when not performed from the umbilicus) as there is not a large scar in the upper abdomen.…”