Incisional hernias after major laparoscopic gynecologic procedures

Kadar, Nicholas; Reich, Harry; Liu, C.Y.; Manko, Gene F.; Gimpelson, Richard J.

doi:10.1016/0020-7292(94)90100-7

Cited by 42 publications

(67 citation statements)

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“…Kaddar et al observed in a study of 3560 laparoscopies that an excessive manipulation of the trocars occurred in extensive procedures, enlarging the fascial defect even more 24 . However, we want to emphasize the fact that most of the reports on post-laparoscopic IH concern surgical and gynecological procedures such as cholecystectomies, hepatic biopsies, oophorectomies, or appendicectomies, where extended surgical time is usually not necessary, nor is extreme manipulation required for dissection 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, IH at the site of introduction of the laparoscopic trocar is an inherent complication related to the extent of the surgery and time required for surgery; however, a series of measures can be taken to prevent this complication 22,24 . Preventative measures include the use, whenever possible, of trocars of smaller diameter, avoiding extreme manipulation of trocars, introducing trocars with a Z-incision technique, and preventing direct communication between the skin and the fascia 22,24 .…”

Section: Discussionmentioning

confidence: 99%

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

2003

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

2003

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“…However, the singleport hysterectomy was usually a time-consuming procedure, longer than multiport technique [11][12][13][14][15][16][17][18] . However, a larger umbilical incision could facilitate closure of the fascia and eventually decreases herniation risk 10,19 . These advantages of singleport surgery may reduce the surgical tissue trauma, providing better postoperative results compare to multiport laparoscopy.…”

Section: ■ Introductionmentioning

confidence: 99%

A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies

Tormena

Ribeiro²,

Soares³

et al. 2017

Acta Cir. Bras.

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A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies 1 AbstractPurpose: To evaluate the inflammatory responses induced by laparoscopic hysterectomies with multiport and singleport approaches.Methods: This was a pilot prospective randomized study that included 42 women candidates for hysterectomy at School of Medicine, Hospital das Clínicas, USP. The patients were randomized to two groups: MP-TLH (total laparoscopic hysterectomy with 3 abdominal incisions), and SP-TLH (total laparoscopic hysterectomy with a single umbilical incision). We evaluated the inflammatory response (via CRP, IL-6, IL-10, TNFα, VEGF and leukogram assessments), surgical time, postoperative pain, blood loss and surgical complications in both groups. Results: Both techniques were similar regarding C-reactive protein (p=.666), IL-6 (p=.833), IL-10 (p=.420), TNF-α(p=.098), VEGF (p=.092) and the leukogram (p=.712) measures. The operative time was significantly longer in the SP-TLH group than in the MP-TLH group (p=.001). The pain evaluation was similar in both groups (p=.170). Hemoglobin variation and the aspirated blood volume were similar in both groups (p=.493 and p=.347). There were no major complications. Conclusions: Multiport and singleport laparoscopic approaches are both safe methods for hysterectomy. Although SP-TLH resulted in a significantly longer operative time than MP-TLH, no differences were observed between the groups in inflammatory responses, blood loss and postoperative pain.

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“…Patient preparation should include careful counseling of the patients for the possibility of an open procedure as well as counseling on all of the risks of laparoscopic surgery (20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Patient Preparationmentioning

confidence: 99%

“…For this purpose, the Carter-Thomason Fascial Closure Device or an equivalent instrument should be utilized. Herniation into port sites can occur in as many as 3% of 12-mm port sites in lateral positions which are not closed and in 0.3% of those which have been closed by standard techniques that did not include closure of the peritoneum as well as the fascia (26).…”

Section: Exiting the Abdomenmentioning

confidence: 99%

Laparoscopic Gynecology Procedures: Avoid the Risk

Carter¹

1996

Diagnostic and Therapeutic Endoscopy

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Laparoscopic approaches to gynecological surgery have been developed by an elite group of highly skilled surgeons. As these procedures become more prevalent in the general gynecological approach to disease and the general gynecologist' s approach to treatment, the complication rate for these procedures is likely to increase. In an effort to assist in avoiding these complications, guidelines for the performance of laparoscopic gynecological procedures need to be established. This article presents approaches to the most common gynecological procedures that can assist in the prevention of complications.KEY WORDS: Laparoscopy, complications, bowel injury, Richter's hernia INTRODUCTION A short review of the literature on the laparoscopic hysterectomy (1-19) revealed the following complications: bladder injuries including lacerations, punctures, vesiclevaginal fistulas; ureteral injuries including ureterovesicle fistulas, ureteral transections, and cauterizations; bowel injuries including enterotomies, thermal injuries, and herniations into trocar sites; nerve injuries; hemorrhage both intraoperative and postoperative, some requiring transfusion; injuries to abdominal wall vessels and retroperitoneal vessels; infections including pelvic abscesses requiring drainage, cellulitis, and pneumonia, with one postoperative case of pneumonia resulting in death; anesthetic problems including cardiac arrythmias and pulmonary edema; and vascular problems including deep venous thrombosis and pulmonary embolus.Of all the laparoscopic gynecological procedures, only the complication rate of the laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic hysterectomy has been studied and recorded. In one such study by Padial et al. (13) surgery (20-27).The patient should be instructed for all advanced laparoscopic procedures and undergo a bowel cleansing procedure with the use ofan osmotic agent such as GoLITELY (25,28 (2,(36)(37)(38).This site, however, has three major disadvantages. First, the transverse colon will frequently lay directly under or even caudad to the umbilical site. The second disadvantage is that the mesentery of the bowel also frequently lies directly under the umbilical site. Finally, the aorta, vena cava, and especially the left common iliac vein are frequently in close proximity to, directly below, or caudad to the umbilical site. Therefore, when the intraumbilical incision is made (which is preferable to a subumbilical incision because of the direction of the lines of Langham at the umbilical site) the Veress needle must be inserted only millimeters through the fascia, which is elevated under tension if the Veress needle is inserted in a vertical direction. If the Veress needle is inserted in a caudad direction, the skin should be elevated and the Veress needle inserted in a direction toward the uterus in the deep pelvis. This technique will traverse fat, fascia, and peritoneum before entry.If the Veress needle technique is used, the position ofthe Veress needle must be confimed by injection of 20 ml ...

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Incisional hernias after major laparoscopic gynecologic procedures

Cited by 42 publications

References 0 publications

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

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

A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies

Laparoscopic Gynecology Procedures: Avoid the Risk

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