Respect for the Laparoscopic Port Site: Lessons in Diagnosis, Management, and Prevention of Port-Site Hernias Following Laparoscopic Colorectal Surgery

Bevan, K.; Venkatasubramaniam, Arcot; Mohamed, Faheez; Moran, Brendan; Cecil, Tom

doi:10.1089/lap.2009.0419

Cited by 13 publications

(6 citation statements)

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“…Il s'agit de plaies du pédicule épigastrique inférieur [31], plaies nerveuses [32,33], plaies vésicales ainsi que le risque d'hernie sur orifice de trocart selon le diamètre utilisé [34].…”

Section: Discussionunclassified

Facteurs influençant la durée opératoire de la kystectomie ovarienne par accès endoscopique unique

Poizac

Ménager

Tourette

et al. 2015

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Section: Discussionunclassified

Facteurs influençant la durée opératoire de la kystectomie ovarienne par accès endoscopique unique

Poizac

Ménager

Tourette

et al. 2015

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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“…Intermittent or complete bowel obstruction may occur later. Clinical suspicion and liberal use of CT scanning can help the diagnosis in the early postoperative period [4], as CT can even indicate about the viability of the bowel [5]. Ultrasound examination is useful in nonemergent situations.…”

Section: Discussionmentioning

confidence: 99%

Case Series of Umbilical and Extra-umbilical Port Site Herniae

Jayaraman¹,

Rao²

2013

Indian J Surg

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Trocar site hernia or port site hernia (PSH) is a type of incisional hernia occurring at the trocar sites after laparoscopic surgeries. This is a rare but a potentially dangerous complication, as it can lead to considerable morbidity requiring surgical intervention. Various factors have been implicated for its development and various methods are also suggested for its prevention. We present here five cases of port site herniae.Keywords Laparoscopy . Trocar site . Port site . Hernia Case ReportsCase 1 A 43-year-old fit female presented with a swelling in the left lower abdomen for about 2 years. Pain developed about 10 days ago. On examination, there was a globular, mildly tender, and irreducible swelling of about 8 cm diameter in the left iliac fossa in the subcutaneous plane, with an 8-mm irregular trocar site scar on the skin (Fig. 1). The pain aggravated on coughing with no obvious cough impulse. Old records showed that she had undergone a diagnostic laparoscopy for infertility, and a 10-mm optical port was used at the umbilicus and a 5-mm port at the left iliac fossa, and only functional cysts of the ovaries were found, for which no treatment was suggested. There was no mention about the closure of trocar sites. A clinical diagnosis of irreducible laparoscopic 5 mm port site hernia was made, which was confirmed by abdominal ultrasound. She was operated through a transverse incision made over the swelling, and the hernia sac could easily be identified, after splitting the external oblique muscle fibers. The sac was opened and it contained viable omentum. The neck of the sac was about 7 mm in diameter, which was widened more to push back the omentum into the abdominal cavity. The abdominal cavity was explored by inserting a finger through the hernia defect and no adhesions were found. The sac was excised, the defect closed with 1-0 polypropropylene, and a polypropylene mesh was placed over the internal oblique muscle and fixed with 1-0 polypropylene sutures. The external oblique muscle was approximated with 2-0 polyglactin sutures over the mesh. The skin and subcutaneous tissues were approximated with staples. The patient had uneventful recovery and remains asymptomatic without recurrence about 5 years after surgery.Case 2 A 53-year-old female presented with a large swelling in the lower abdomen (Fig. 2), which developed after laparoscopic cholecystectomy done 3 years ago by us. She had noticed this swelling about a year after surgery, and abdominal pain was of recent onset. Though reducible, while standing, the swelling was very prominent and caused back pain. She was diagnosed to have a 10-mm port site hernia, which was confirmed by ultrasonography. Incidentally, she was a cured case of non-Hodgkin's lymphoma, non-cirrhotic portal fibrosis with portal hypertension, and anemia due to hypersplenism. Our records showed that the umbilical port site was closed with a 1-0 polypropylene. Open surgery was performed for this hernia and a large defect of about 15 cm was identified which was closed with 1-0 po...

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“…Le deuxième avantage est la diminution des risques liés à l'utilisation de trocarts additionnels. En effet, il n'existe pas de risque lié à l'utilisation de trocarts latéraux (plaies du pédicule épigastrique inférieur [16,17], plaies nerveuses [18,19], centraux (plaie vésicale [20] ainsi que le risque d'hernie sur orifice de trocart selon le diamètre utilisé [21]. Les autres avantages théoriques sont à démontrer.…”

Section: Discussionunclassified

Traitement de la grossesse extra-utérine par accès endoscopique unique avec le système SILS® : expérience initiale

Lamourdedieu

Rua

Lazard

et al. 2011

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Respect for the Laparoscopic Port Site: Lessons in Diagnosis, Management, and Prevention of Port-Site Hernias Following Laparoscopic Colorectal Surgery

Abstract: Awareness of the need to close the fascia in all ports over 5 mm, and the techniques available to do so, may reduce the incidence and decrease the morbidity associated with this potentially fatal complication associated with laparoscopic colorectal surgery.

Cited by 13 publications

References 10 publications

Facteurs influençant la durée opératoire de la kystectomie ovarienne par accès endoscopique unique

Facteurs influençant la durée opératoire de la kystectomie ovarienne par accès endoscopique unique

Case Series of Umbilical and Extra-umbilical Port Site Herniae

Traitement de la grossesse extra-utérine par accès endoscopique unique avec le système SILS® : expérience initiale

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