5 mm port site hernia causing small bowel obstruction

Abstract

We present a case of acute postoperative small bowel obstruction following laparoscopic ovarian cystectomy. The patient returned to theatre for second look laparoscopy where a 5-mm port-site hernia containing small bowel was found at the site of a previous drain. The hernia was reduced and the defect closed with sutures. This should make surgeons rethink the assumption that herniae do not occur through 5-mm ports. The use of drains, methods of achieving port closure, ways of investigating postoperative ileus, and the treatment of port-site herniae are discussed.

A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

“…Such as the number of trocars used and their diameters, the duration of the procedure (the longer it takes, the higher risk is), the aponeurotic defects in trocar place (incomplete closure of fascia), the insertion technique, the method of withdrawing the trocar, midline trocars, stretching the port site for organ retrieval, the effect of a partial vacuum while port withdrawal, obesity, poor nutrition, and operation site infection. [ 1 2 4 7 – 9 ] Laparoscopic procedures that require multiple trocars are associated with a higher frequency of hernias. It is known that using 10 mm and larger trocars results in increase risk of hernias.…”

A Case Report of Incisional Hernia Through a 5mm Suprapubic Port Site Following Laparoscopic Appendicectomy

“…Such as the number of trocars used and their diameters, the duration of the procedure (the longer it takes, the higher risk is), the aponeurotic defects in trocar place (incomplete closure of fascia), the insertion technique, the method of withdrawing the trocar, midline trocars, stretching the port site for organ retrieval, the effect of a partial vacuum while port withdrawal, obesity, poor nutrition, and operation site infection. [1,2,4,[7][8][9] Laparoscopic procedures that require multiple trocars are associated with a higher frequency of hernias. It is known that using 10 mm and larger trocars results in increased risk of hernias.…”

“…[1,2] The prevalence of herniation followed by laparoscopic surgery is reported to be 0.0002%-6%. [2][3][4][5][6][7] In contrast, the true prevalence of such complications may be higher because some patients have no symptoms and do not return to the surgeon for follow -up. [5] Almost all trocar site hernias have been found in sites greater than or equal to 10 mm with only few cases reported of 5 mm site herniation.…”

Methods for specimen removal from the peritoneal cavity after laparoscopic excision

“…This can be a serious complication requiring laparotomy in the majority of patients and intestinal resection in about 20% . Even with 5‐mm lateral port sites, the risk of hernia exists as result of stretch and tear of the fascia secondary to the instrument manipulation or the passage of the tissue through the port site . It is true that the risk of a hernia at the umbilicus is lower compared with ancillary ports, unless the umbilical wound is enlarged .…”