Port site hernia in laparoscopic surgery: Mechanism, prevention and management

Pulle, Mohan Venkatesh; Siddhartha, Rahul; Dey, Ashish; Mittal, Tarun; Malik, Vinod

doi:10.1016/j.cmrp.2015.05.008

Cited by 11 publications

(29 citation statements)

References 20 publications

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“…Although prior studies have reported the rare incidence of TSHs after surgery, this complication can be avoided with proper intraoperative management. The predisposing factors for developing hernias may comprise both patient-related instrument-related factors[ 3 , 14 ]. To improve the surgical outcomes and lessen the incidence of TSHs, modifications to the laparoscopic trocar tip have been attempted.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, routine closure of these fascial defects remains controversial. Owing to the potentially harmful consequences, some studies have recommended closing the defect when using a 10-mm trocar[ 3 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, certain complications can occur following laparoscopy, including trocar site hernias (TSHs), the incidence of which varies from 0.1% to 2%[ 1 , 2 ]. Clinical presentation of patients can range from asymptomatic to bowel strangulation in case of delayed diagnosis[ 3 ]. Despite the multifactorial etiology of this condition, older age, obesity, and wound infection have been identified to be the predisposing factors[ 4 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Krittiyanitsakun¹,

Nampoolsuksan²,

Tawantanakorn³

et al. 2023

World J Clin Cases

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BACKGROUND Despite the infrequency of trocar site hernias (TSHs), fascial closure continues to be recommended for their prevention when using a ≥ 10-mm trocar. AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries. METHODS Between July 2010 and December 2018, all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed. All patients underwent cross-sectional imaging for TSH assessment. Clinicopathological characteristics were recorded. Incidence rates of TSH and postoperative results were analyzed. RESULTS Of the 254 patients included, 70 (111 ports) were in the fascial closure (closed) group and 184 (279 ports) were in the nonfascial closure (open) group. The median follow up duration was 43 mo. During follow up, three patients in the open group developed TSHs, whereas none in the closed group developed the condition (1.1% vs 0%, P = 0.561). All TSHs occurred in the right lower abdomen. Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain. The open group had a significantly shorter operative time and lower blood loss than the closed group. CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed. However, further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Krittiyanitsakun¹,

Nampoolsuksan²,

Tawantanakorn³

et al. 2023

World J Clin Cases

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“…However, in cases of patients with BMI greater than 30kg/m2 or when the abdominal wall is thicker than 30mm, identification, grasping, suturing, and threading of the fascia is difficult [12] . Given these challenges, there have been several techniques proposed for suturing the port-site wound: Lasheen needle [13], Deschamps needle [14], VersaStepTM trocar system, use of two Sretractors, use of a skin hook and Langenbach retractor, non-bladed, radially dilating and concial blunt devices, Carter-Thomason devices [14], tangential insertion of ports, endoscopic placement of fascial suture under direct vision, and insertion of a surgical plug into the muscular layer. In recent years, a system has been developed that can easily suture port-sites during laparoscopic surgery [4].…”

Section: Discussionmentioning

confidence: 99%

Verification of Fascial Fissure Direction at the Port-site: the Search for a Reliable Closure Method

Kimura

Harata

Tsuboi

et al. 2022

JAMMR

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Background: One of the complications of endoscopic surgery is port-site hernia. The risk of port-site hernia is minimized by proper port-site closure, which relies on appropriate characterization of the fascia, particularly the direction of fascial fissures. Methods: The following 4 procedures were examined to identify the fascial fissure direction: mobility of the port, observation from the lumen of the port, palpation for fascia, and visual confirmation. The match rate of each procedure with visual confirmation was verified. Results: 51 port-sites without fasciotomy were examined. The direction of the fissure was from 12 to 6 o’clock in 11 cases and 3 to 9 o’clock in 40 cases. The match rate between mobility and the fissure was 45.1%. The match rate of observation from the lumen was 96.1%. Comparing the suturing time, the average time was significantly shortened to 327 seconds in the second half compared to 494 seconds in the first half of our study period with the VersaOneTM fascial closure system. Conclusion: Treatment of port-site hernia can be done by suture or mesh repair, although ideally it is best to prevent the hernia in the first place. The fissure direction was almost always identifiable via observation from the lumen of the port. Closure of the port-site using modified Z-sutures allowed for full fascial closure, particularly in cases of patients with obesity.

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“…There is no consensus as to the definition of DR, but a separation of >2 cm is generally considered to be a rectus diastasis. 4 It is well known that age, body mass index (BMI), multiparity, sarcopenia, and gender difference are typical of the risk factors for DR. 10 The studies of DR have predominantly been focused on pregnant or multipara females, but recently, the incidence of DR is increasing due to the increase in the population of elderly, the obesity, the sarcopenic obesity.…”

Section: Discussionmentioning

confidence: 99%

Umbilical Port Site Hernia and Diastasis Recti

Park

Sul

2020

J Minim Invasive Surg

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The port site hernia (PSH) is a specific type of incisional hernia related to the trocar sites of laparoscopic surgery. Diastasis recti of the abdominis muscle (DR) is the separation of the rectus muscle by a certain distance. The present study aims to present our experience with umbilical PSH and concomitant DR and to raise awareness of DR as one of the risk factors of umbilical PSH. Methods:Eighteen patients with umbilical PSH after laparoscopic abdominal surgery, was retrospectively reviewed. Preoperative CT was analyzed to measure the Inter-recti distance (IRD) for all patients. Other factors, such as trocar size, wound infection, obesity (BMI), port extension, suture materials, and pre-existing co-morbidities, were recorded and analyzed.Results: Extension of the port incision was associated with umbilical PSH. Ten out of eighteen umbilical PSH patients (56%) had DR before they had first laparoscopic surgery. Nine (50%) patients showed sarcopenia. Moreover, four out of five recurrences had DR. More than two recurrences were all associated with DR. Conclusion:Port extension and sarcopenia were risk factors of umbilical PSH. Also, DR might be a possible risk factor of umbilical PSH occurrence and recurrence. Surgeons should be aware of the presence of DR before the planning of the laparoscopic surgery by diagnostic imaging. If DR is associated with umbilical PSH, we need to consider the correction of both pathologies at the same time.

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Port site hernia in laparoscopic surgery: Mechanism, prevention and management

Cited by 11 publications

References 20 publications

Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Verification of Fascial Fissure Direction at the Port-site: the Search for a Reliable Closure Method

Umbilical Port Site Hernia and Diastasis Recti

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