Five-Millimeter Trocar Site Small Bowel Eviscerations after Gynecologic Laparoscopic Surgery

Moreaux, Grégoire; Estrade-Huchon, Sonia; Bader, G.; Guyot, Bernard; Heitz, D; Huchon, Cyrille

doi:10.1016/j.jmig.2009.05.014

Cited by 42 publications

(21 citation statements)

References 12 publications

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“…In addition, a recently published randomized study investigating the effect of prophylactic topical rifamycin showed a reduction in the incidence of incisional hernia among patients in the study group, 27 thus validating the observation of Callery et al Other reports suggest that the placement of a drain through a port site may be a risk factor for PSH. 24,30 …”

Section: Discussionmentioning

confidence: 99%

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

Agaba

Rainville

Ikedilo

et al. 2014

JSLS

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Background and Objectives:Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.Methods:All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.Results:A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up.Conclusion:Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.

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Section: Discussionmentioning

confidence: 99%

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

Agaba

Rainville

Ikedilo

et al. 2014

JSLS

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“…3 Overall, worldwide, only 5 cases of strangulation requiring emergency bowel resection have been reported following herniation through a 5-mm port site. [5][6][7][8] Multiple risk factors such as trocar diameter, 9 insertion of drains, 5 obesity, 10,11 prolonged manipulation, reinsertion of the ports and increased duration of surgery, 11,12 preexisting hernias, 10 and medical comorbidities 12,13 have been implicated in the development of port-site hernias, but there are very few prospective studies and no randomized studies conducted to identify these hernias. There is no difference between closed-entry and openentry laparoscopic techniques, when fascial closure is undertaken, in the incidence of port site umbilical hernias.…”

Section: Discussionmentioning

confidence: 99%

A 5-mm Port-Site Hernia Following a Laparoscopic Myomectomy Resulting in Bowel Obstruction

JanHaider

Al-KhatibAlHamza

AraklitisGeorge

et al. 2014

Journal of Gynecologic Surgery

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Background: Royal College of Obstetricians and Gynaecologists guidelines advise closure of 7-mm or larger lateral ports and 10-mm or larger midline ports. Herniation through 5-mm port sites has been shown, particularly when drains have been left in situ, and this case demonstrates the serious risk of bowel strangulation. Case: A 41-year-old woman underwent laparoscopic myomectomy for a 15-cm pedunculated fibroid. Four ports, 2 · 10-mm and 2 · 5-mm ENDOPATHÒ XCELÒ Bladeless trocars were used for access and 1:20 vasopressin was used for hemostasis. The fibroid was then morcelated with a PKSÔ Plasma-SORDÔ Bipolar Morcellator. The rectus sheath for the 10-mm umbilical and right lateral ports were closed with Vicryl,Ô using a J needle, and the skin was closed with MONOCRYL.Ô The surgical time was 194 minutes, and surgery was complicated by recurrent reinsertion of a trocar because of the patient's high body mass index. No drains were used and the patient was discharged 2 days later. She was readmitted to the hospital 10 days later with intractable vomiting and abdominal pain. A plain X-ray revealed the presence of air under her diaphragm and computed tomography of her abdomen revealed a loop of small bowel present within the abdominal wall at the 5-mm left lateral port site. An emergency laparotomy confirmed that she had an incarcerated, strangulated small bowel within the port site and a straightforward resection anastomosis was performed. Results: The patient was discharged 9 days later and made a full recovery. Conclusions: Elective closure of the rectus irrespective of port size should be considered in cases of prolonged manipulation through the port or repeated reinsertion of a trocar, both of which may lead to an extension of an initial incision. ( J GYNECOL SURG 30:247)

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“…No patients in this large study or our study required bowel resection. The need for bowel resection due to incarcerated hernia has been reported [8,11]. In the 2 previously mentioned case reports of herniation at 8-mm robotic trocar sites, bowel resection was necessary in 1 case [10,11].…”

Section: Discussionmentioning

confidence: 99%

Incidence of trocar site herniation following robotic gynecologic surgery

Clark

Soliman

Odetto³

et al. 2013

Gynecologic Oncology

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Objective Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease. Methods A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables. Results The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management. Conclusions Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites.

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Five-Millimeter Trocar Site Small Bowel Eviscerations after Gynecologic Laparoscopic Surgery

Cited by 42 publications

References 12 publications

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

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

A 5-mm Port-Site Hernia Following a Laparoscopic Myomectomy Resulting in Bowel Obstruction

Incidence of trocar site herniation following robotic gynecologic surgery

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