Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery

Abstract

Importance: Port-site hernia is an iatrogenic complication with a documented incidence between 0.65% and 2.8%. However, the true incidence could be higher because of delayed onset, asymptomatic nature, and loss to follow-up. Port-site hernia could be further complicated by incarceration or strangulation leading to small bowel obstruction requiring emergent surgical intervention, thus imposing significant financial and emotional burden to patients.Objective: This article aims to provide a summary of the available literature concerning port-site hernia and explore preventive strategies for future clinical practice.Evidence Acquisition: This review was formulated through electronic literature searches in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The reference lists of the included studies were hand searched to identify other relevant articles to capture all available literature in this narrative review.Results: Following screening for eligibility based on relevance to the topic under consideration, 28 studies were identified. This included 5 original articles, 1 case series, and 22 review articles, including 4 systematic reviews. Included studies were critically appraised in formulating this review.Conclusions: Port-site hernia is an underrecognized yet preventable complication with careful consideration of predisposing technical and host factors, thorough attention to surgical technique, or use of a fascial closure device.Relevance: With the widespread and increasing use of laparoscopic methods to treat surgical pathologies, knowledge of this complication is imperative to encourage prevention strategies and facilitate early recognition and management should it occur.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After participating in this activity, physicians should be better able to define and differentiate the types of port-site hernia; describe technical and host factors that predispose to the development of port-site hernia; identify potential complications of port-site hernia; and apply technical and prosthetic strategies to prevent port-site hernia in the future.All authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.Contribution of authorship: D.D. performed the literature review, wrote the first draft, and made amendments to the article as per A.A. and P.N. A.A. reviewed the article. P.N. proposed the idea, wrote an outline, reviewed and edited the article, and approved the final version for publishing.

Port‐site hernia: A potentially severe complication of minimally invasive surgery

“…1,2 A previous American Association of Gynecologic Laparoscopists surgery study of 840 portsite hernia showed that approximately 85% of cases occurred at sites >10 mm; thus, the larger port should be noted as a risk factor for port-site hernias. 2 Although the size of the trochar requiring fascial closure remains controversial, several studies have suggested a >10mm size for the closure of port sites. 2 Despite fascial closure of the port site, our case developed to port-site hernia due to the ileus.…”

“…The port‐site hernia is a potentially serious complication of minimally invasive surgery (MIS) with a reported incidence of 0.5–2% 1,2 . A previous American Association of Gynecologic Laparoscopists surgery study of 840 port‐site hernia showed that approximately 85% of cases occurred at sites >10 mm; thus, the larger port should be noted as a risk factor for port‐site hernias 2 . Although the size of the trochar requiring fascial closure remains controversial, several studies have suggested a >10‐mm size for the closure of port sites 2 …”

“…2 Although the size of the trochar requiring fascial closure remains controversial, several studies have suggested a >10mm size for the closure of port sites. 2 Despite fascial closure of the port site, our case developed to port-site hernia due to the ileus. We consider that postoperative ileus may lead to increased abdominal pressure, and this may cause wound dehiscence with massive 12-mm port-site hernias.…”

“… 2 Although the size of the trochar requiring fascial closure remains controversial, several studies have suggested a >10‐mm size for the closure of port sites. 2 …”

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

“…The prevalence of TSH is unclear (2,3). Imaging such as ultrasound and CT scans appear to diagnose many more TSH than are clinically detectable, and also help clarify the diagnosis when a TSH is clinically suspected (4)(5)(6)(7).…”