No Need of Fascia Closure to Reduce Trocar Site Hernia Rate in Laparoscopic Surgery: A Prospective Study of 200 Non-Obese Patients

Abstract

BackgroundLaparoscopy is widely practiced and offers realistic benefits over conventional surgery. Port closure is important after a laparoscopic procedure to prevent port site incisional hernia. Larger port size and increasing numbers of ports needed to perform more complex laparoscopic procedures are likely to increase the incidence of port site hernias (PSHs). PSHs tend to develop more frequently at umbilical and midline port sites due to the thinness of the umbilical skin and weaknesses in the linea alba. More than 90% of PSHs occur through 10 mm and large ports can occur through 5 mm ports also. The aim was to study the outcomes and complications in laparoscopic surgery without fascial sheath closure of port site. We compared the results with another group in which fascial closure was done by a standard method.MethodsThis was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala, from August 2013 to 2015 in a single unit by a single surgeon. A total of 200 patients were selected randomly for the different laparoscopic procedures. Patients were divided into group A (only skin closure was done without fascia closure) and group B (fascial closure of the port in addition to skin closure). In both groups, we used blunt trocar for the 10 mm port. Skin of the 5 mm port was closed simply. The results in two groups were compared in terms of complications like PSH, bleeding, and wound infection.ResultsThe outcomes in two groups were compared with and without fascia closure of 10 mm trocar port site. Patients operated for lap cholecystectomy were 170 (85%), 10 (5%) for lap appendicectomy, and 20 (10%) for lap hernia. The study compared the results in two groups mainly for PSH formation. The P value was insignificant and Fischer’s exact test result came as 1.00. There were no significant differences between the two groups in terms of PSH, bleeding and infection in non-obese cases.ConclusionIn both groups, blunt trocar was introduced into the abdomen. We concluded that this is safe, without visceral injury, and no bleeding was seen in both the groups. We had not encountered any case with PSH formation in follow-up of 6 - 8 months. There was no infection over the port site.

A Study of Post Laparoscopic Port Related Complications

“…Moreover, in present study improvised techniques to avoid port-site hernia such as use of standard closure (via skin wound), direct visualization closure method and use of suture passer needle were used which itself help in reducing the port site hernia rate. [28] Similar to our study, Singal et al [28] in their study also showed that use of improvised techniques can minimize the incidence of port-site incisional hernia to 0%.…”

The Safety and Efficacy of Clipless versus Conventional Laparoscopic Cholecystectomy – our Experience in an Indian Rural Center

“…This suggests that the use of suture for ligation is cost-effective and economical for ligation. q DISCUSSIONS L aparoscopy is widely practiced and it offers realistic benefits over conventional surgery (5). It was first performed by Carl Langenbuch in 1882, and in 1983 Kurt Semm used an automatic insufflation device for assessing intra-abdominal pressures (6).…”

Frequency of umbilicus site port hernia after laparoscopic procedure.

“…There was no significant difference in the presence of complications in the two groups. 12 As more surgical expertise is needed with single incision laparoscopic procedures, port site complications and wound complication risk cannot be studied properly. The risk of complications decreases as the experience of the surgeon increases.…”