Entry Related Injuries and Port Site Hernias in Laparoscopic Procedures: A Review of 100 Cases

Abstract

OBJECTIVEThis prospective clinical trial was conducted to evaluate the incidence of intraperitoneal injuries with the use of closed Veress needle technique in primary port placement, the incidence of Port Site Hernias (PSH) and the efficacy of fascial closure in the prevention of PSH. METHODSA total of 100 patients undergoing various laparoscopic procedures were enrolled in the study, which included Cholecystectomy, Appendectomy, Adhesiolysis and diagnostic procedures. All surgeries were done on selective basis. Fascial closure was not done in any of the cases and no Endobag was used to retrieve the specimens. In the event of difficulty in retrieving the specimen, port site was extended by 2 or 3 mm to facilitate easy removal. The period of study was from October 2013 to March 2015 at The Government Chengalpattu Medical College and Hospital. The incidence of injuries to the intraperitoneal structures during the primary port insertion by the closed Veress needle technique and the incidence of PSH were observed. RESULTSThere was no incidence of bowel or vascular injuries with the use of the closed Veress needle technique or PSH in all the 100 patients (0%). The advantages of fascial closure in preventing PSH is questionable. CONCLUSIONClosed method of primary port insertion using the Veress needle is a very safe method with the appropriate technique. The efficacy of closure of fascial layer in preventing trocar site hernias is a subject of debate and needs further evaluation since our study was restricted to basic laparoscopic procedures done on elective basis and no comparative analysis was made with the open method.

Surgeons' requirements for a surgical support system to improve laparoscopic access

“…Among these, 8–17% [ 12 , 13 ] of vascular injuries and 2.5–5% of intestinal injuries are fatal [ 14 ]. This is partly due to the fact that 30–50% of bowel injuries and 13–50% of vascular injuries go unnoticed during surgery, leading to life-threatening sepsis or peritonitis (5–15% mortality rate) [ 13 , 15 , 16 ].…”