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Abstract

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

The Stoppa procedure in inguinal hernia repair: to drain or not to drain

“…Recent publications about the GPRVS have revealed that there still are authors who routinely use drainage with this procedure 15,17 ; however, some others do not use drainage 12,16 , and some eventually use drainage 13,20 . When we looked for potential complications reported in these publications that might have arisen from fluid collections (seroma, hematoma, and infection), we found the following complication rate: 1) routine drainage: 3% 15 and 9% 17 ; 2) use of suction drain according to intraoperative parameters: 10.2% 20 and 24.6%…”

“…From these data, it appears that the use of a suction drain would bring some benefit. However, considering that Coda et al 13 reported a 24.6% rate of hematoma and seroma, even with the use of suction drainage in 83% of the patients in their study, it appeared that there was some controversy about the benefit of the drainage in GPRVS. To the best of our knowledge, this issue has not been studied before.…”

“…Sometimes this drainage procedure is responsible for longer hospitalization that may be as long as 9.7 days 11 . Since the description of GPRVS procedure, many surgeons have reported good outcomes; however, whether drainage is mandatory or how many suction drains should be placed in the preperitoneal space at the time of intervention is still controversial 8,9,[12][13][14][15][16][17][18][19] . The purpose of this study was to analyze the actual benefit of drainage in the GPRVS procedure and to answer the question of whether drainage is better than no drainage.…”

Incisional Hernias

“…The incidence of IH after laparoscopic surgery is low, averaging less than 1% [73]. The diameter of the port site seems to be the major factor.…”

Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

“…This is comparable with other reported series. 6,11–13 Of the patients in our series with PSHs, none had any obstructive symptoms. This is not unusual because other studies have shown that most patients have minimal symptoms, particularly those with the delayed-onset type.…”