Port closure techniques

Shaher, Z.

doi:10.1007/s00464-006-9095-6

Cited by 92 publications

(69 citation statements)

References 40 publications

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“…With the introduction of single incision laparoscopic surgery, the incidence of port site hernia (PSH) may be expected to be less, but some authors suggest that this may be associated with an increase in the incidence [12] Usage of Deschamps ligature needle [13] and insertion of surgical plug into the muscular layer of trocar wounds [14] seem to have reduced the incidence of PSH. Morenzo-Sanz et al in their pilot study have expressed the feasibility of using a bioabsorbable hernia plug to prevent trocar site herniae [15].…”

Section: Discussionmentioning

confidence: 99%

Case Series of Umbilical and Extra-umbilical Port Site Herniae

Jayaraman¹,

Rao²

2013

Indian J Surg

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Trocar site hernia or port site hernia (PSH) is a type of incisional hernia occurring at the trocar sites after laparoscopic surgeries. This is a rare but a potentially dangerous complication, as it can lead to considerable morbidity requiring surgical intervention. Various factors have been implicated for its development and various methods are also suggested for its prevention. We present here five cases of port site herniae.Keywords Laparoscopy . Trocar site . Port site . Hernia Case ReportsCase 1 A 43-year-old fit female presented with a swelling in the left lower abdomen for about 2 years. Pain developed about 10 days ago. On examination, there was a globular, mildly tender, and irreducible swelling of about 8 cm diameter in the left iliac fossa in the subcutaneous plane, with an 8-mm irregular trocar site scar on the skin (Fig. 1). The pain aggravated on coughing with no obvious cough impulse. Old records showed that she had undergone a diagnostic laparoscopy for infertility, and a 10-mm optical port was used at the umbilicus and a 5-mm port at the left iliac fossa, and only functional cysts of the ovaries were found, for which no treatment was suggested. There was no mention about the closure of trocar sites. A clinical diagnosis of irreducible laparoscopic 5 mm port site hernia was made, which was confirmed by abdominal ultrasound. She was operated through a transverse incision made over the swelling, and the hernia sac could easily be identified, after splitting the external oblique muscle fibers. The sac was opened and it contained viable omentum. The neck of the sac was about 7 mm in diameter, which was widened more to push back the omentum into the abdominal cavity. The abdominal cavity was explored by inserting a finger through the hernia defect and no adhesions were found. The sac was excised, the defect closed with 1-0 polypropropylene, and a polypropylene mesh was placed over the internal oblique muscle and fixed with 1-0 polypropylene sutures. The external oblique muscle was approximated with 2-0 polyglactin sutures over the mesh. The skin and subcutaneous tissues were approximated with staples. The patient had uneventful recovery and remains asymptomatic without recurrence about 5 years after surgery.Case 2 A 53-year-old female presented with a large swelling in the lower abdomen (Fig. 2), which developed after laparoscopic cholecystectomy done 3 years ago by us. She had noticed this swelling about a year after surgery, and abdominal pain was of recent onset. Though reducible, while standing, the swelling was very prominent and caused back pain. She was diagnosed to have a 10-mm port site hernia, which was confirmed by ultrasonography. Incidentally, she was a cured case of non-Hodgkin's lymphoma, non-cirrhotic portal fibrosis with portal hypertension, and anemia due to hypersplenism. Our records showed that the umbilical port site was closed with a 1-0 polypropylene. Open surgery was performed for this hernia and a large defect of about 15 cm was identified which was closed with 1-0 po...

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Section: Discussionmentioning

confidence: 99%

Case Series of Umbilical and Extra-umbilical Port Site Herniae

Jayaraman¹,

Rao²

2013

Indian J Surg

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“…Another advantage of maintaining the pneumoperitoneum is that it enables surgeon inspection of abdominal cavity through smaller ports regarding adequate fascial wound closure, haemostasis and that any viscera is implicated in the suture (28).…”

Section: Port-site Fascial Closurementioning

confidence: 99%

The final stage of the laparoscopic procedure: exploring final steps

et al. 2012

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INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

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“…As for all new surgical procedures, it may cause some complications. One of the most serious complications associated with laparoscopic surgery is port site hernia [1][2][3][4]. Standard suture techniques can be laborious and often involve blind closure of the fascial defect.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, adequate closure via external sutures may be difficult especially in obese patients. Although a number of techniques have been developed to facilitate this fascial closure, most of them require special and often expensive disposable devices [1,[5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Fascial Repair of Laparoscopic Ports with Allis–Hemostat Technique

et al. 2012

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Port site hernias are one of the most serious complications associated with laparoscopic surgery. In this study, we present a simple and reliable method for port site closure in laparoscopic surgery. From 2005 to 2011, 500 patients who underwent laparoscopic surgery were enrolled for the study. They were evaluated considering age, sex, indication of laparoscopic surgery, and early and late complications of port site and were followed up at least for 1 year after the surgery. In our study, 180 males and 320 females with mean age of 36 years were enrolled. The most common indication for laparoscopic surgery was cholecystectomy in 320 patients (64 %). There were no early or late complications of port site after surgery. Our method is a new modification of the procedure presented by Spalding. Using Allis forceps and putting it under the fascia seems to be a more suitable technique which facilitates the laparoscopic port repair. We found it to be extremely safe, simple, and easy to teach.

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Port closure techniques

Abstract: Three main groups of techniques were found with favor of extracorporeal manipulations under direct visualization. Old methods are sufficient and cost-effective.

Cited by 92 publications

References 40 publications

Case Series of Umbilical and Extra-umbilical Port Site Herniae

Case Series of Umbilical and Extra-umbilical Port Site Herniae

The final stage of the laparoscopic procedure: exploring final steps

Fascial Repair of Laparoscopic Ports with Allis–Hemostat Technique

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