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

Abstract

INTRODUCTION:Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site.CASE REPORT:A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures.CONCLUSION:Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

Laparoscopic 5-mm port site hernia: a rare but preventable complication of laparoscopy

“…The third category includes special types of hernia which have dehiscence of the whole abdominal wall. 1 We would refer our case to the late onset 5 mm port-site hernia because there was dehiscence of fascia with a sac consisting of peritoneum with omentum herniating. There are few obvious risk factors for development of lateral 5 mm port site hernia in our patient.…”

“…Such as the intra-abdominal pressure overwhelming abdominal wall strength, number of trocars used and their diameters (10 mm or more -86% of all PSH), 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, port closure technique, presence of drain at port site, obesity, poor nutrition and operation site infection at wound site. 1,3 The factors predisposing to PSH can be divided into patient factors and operative factors. The presence of a pre-existing umbilical/paraumbilical hernia has been identified in several reports as a risk factor for PSH.…”

“…8 Almost all PSH have been found in sites greater than or equal to 10 mm with only few cases reported of 5 mm site herniation. 1 We here in report a case of the patient who developed late onset incisional hernia at the lateral 5 mm port insertion site.…”

“…The prevalence of herniation followed by laparoscopic surgery is reported to be 0.0002%-6%. 1 The incidence of an incisional hernia following an operative laparoscopic procedure increases with trocar size and is extremely unusual in ports less than 10 mm in diameter, ranging from 0%-0.09%. 2 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.…”

“…2 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. 1 Laparoscopy has become a popular tool in gynaecology. Laparoscopic operations offer advantages like early postoperative recovery and applications of this technique is still expanding.…”