Reducing the risk of trocar site hernias

Crocetti, Daniele; Sapienza, Paolo; Pedullà, Giuseppe; Toma, Giorgio De

doi:10.1308/rcsann.2014.96.7.558

Cited by 12 publications

(12 citation statements)

References 5 publications

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“…Conversely, a longer hospitalization and delayed oral feeding of patients who underwent surgery, negatively influenced the QoL at 1-month. Obviously, the laparoscopic approach, which is associated with a shorter hospitalization, faster refeeding, less postoperative pain and rapid resume to daily activities might, at least theoretically, improve 1-month QoL (32)(33)(34)(35)(36). In our study we also found that patients who had resection of the primary tumor had better QoL 6 months after surgery.…”

Section: Discussionsupporting

confidence: 53%

Quality of Life for Patients With Incurable Stage IV Colorectal Cancer: Randomized Controlled Trial Comparing Resection Versus Endoscopic Stenting

Fiori

Lamazza

Sterpetti

et al. 2019

In Vivo

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Background/Aim: A prospective randomized open label parallel trial, comparing the quality of life (QoL) after endoscopic placement of a self-expandable metal stent or primary tumor resection, in patients with stage IV colorectal cancer was performed. Patients and Methods: Thirty-three patients affected with stage IV colorectal cancer and unresectable metastases were randomly assigned into two groups: Group 1 (16 patients), that underwent selfexpandable metal stent positioning and Group 2 (17 patients), in which primary tumor resection was performed. Karnofsky performance scale and QoL assessment using the EQ-5D-5L™ questionnaire was administered before treatment and thereafter at 1, 3 and 6 months. Results: At 1 month, index values showed a statistically significant deterioration of the QoL in patients of Group 2 when compared to those of Group 1 (p=0.001; 95%CI=0.065-0.211) whereas, at 6 months, index values showed a statistically significant deterioration of the QoL in patients of Group 1 (p<0.025; 95%CI=0.017-0.238). Conclusion: QoL in patients affected with stage IV colorectal cancer has a bimodal fluctuation pattern: at 1month it was better in patients that received stent, but at 6months it was significantly better in patients submitted to surgical resection.

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Section: Discussionsupporting

confidence: 53%

Quality of Life for Patients With Incurable Stage IV Colorectal Cancer: Randomized Controlled Trial Comparing Resection Versus Endoscopic Stenting

Fiori

Lamazza

Sterpetti

et al. 2019

In Vivo

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“…1,2 These approaches require fascial closure of 12mm trocar sites, thereby reducing the risk of trocar-site hernias in obese patients. 3,4…”

mentioning

confidence: 99%

Z-entry technique reduces the risk of trocar-site hernias in obese patients

Cisano

Sapienza

Crocetti

et al. 2016

annals

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DiscussionThis is a simple, inexpensive, and safe method of harvesting tissue from the acetabular roof for biopsy, and allows early and rapid postoperative recovery. TECHNIQUEWe propose a novel 'Z-entry' technique to enter the abdominal cavity under direct vision of an optical trocar that (theoretically) can reduce the risk of trocar-site hernias in obese patients. After induction of a pneumoperitoneum through a Veress needle, a 12mm optical trocar system is inserted with a 30°laparoscope. Under direct laparoscopic vision, the trocar is inserted in subcutaneous fat in a perpendicular direction through the anterior rectus muscle sheath ( Fig 1A) and then advanced at 45°through the muscular plane (rectus abdominis muscle or flat abdominal muscles; Fig 1B). A distance of 1.5-2cm from the skin incision is obtained, and the abdominal wall is entered at 90° (Fig 1C). The anatomical structures encountered are readily recognisable by the optical trocar system. At the skin incision, the towel clips holding the abdominal wall should be dragged upwards to achieve the correct distance between the two perpendicular openings. DISCUSSIONThe distance between two openings in the muscular fascia reduces the risk of trocar-site hernias because of the angled path through the abdominal wall. We also use this technique in patients who have undergone surgery previously (a shielded trocar should be used in such cases). This technique is advised for positioning of trocars in pararectal regions and the lateral abdominal wall. A sufficient muscular plane dividing anterior and posterior sheaths is needed.

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“…The principal finding of our study was that rectal resection (43,44), without a curative intent, permits better survival rates than endoscopic stent positioning both associated with postoperative chemo-and immunotherapies. None of our patients had neoadjuvant therapies because they were admitted for signs and symptoms of chronic intestinal obstruction and needed a rapid resolution of their clinical status.…”

Section: Discussionmentioning

confidence: 77%

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

et al. 2019

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Background/Aim: Patients affected with Stage IV colorectal cancer and unresectable metastases represent a heterogeneous group. Resection of the primary tumor or stent positioning followed by chemotherapy and/or targeted therapies still represent a difficult choice for surgeons. Patients and Methods: From February 2013 to September 2019, 46 patients were enrolled into a prospective randomized open label parallel trial presenting with Stage IVA and IVB rectal cancer, unresectable metastases and symptoms of subacute large bowel obstruction. Our population was divided into two groups: Group 1 included 20 patients who underwent placement of a self-expandable metal stent and Group 2 included 26 patients in whom primary tumor resection was performed. Results: Oneyear actuarial survival rate of Group 1 was significantly lower compared to Group 2. Overall 17 patients had survival longer than 1-year (3 in Group 1 and 14 in Group 2). Cox regression analysis showed that endoscopic stent positioning and the suspension of the chemotherapy because of deterioration of liver function tests were the two most important factors negatively influencing survival. Conclusion: Patients affected with stage IVA and IVB rectal cancer and symptoms of bowel obstruction had a significant longer survival rate when submitted to surgical rectal resection followed by chemotherapy. Colorectal cancer is a commonly diagnosed cancer. More than 25% of the patients have an initial diagnosis at a Stage IV, with a 5-year overall survival ranging from 10 to 18% (1).

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Reducing the risk of trocar site hernias

Cited by 12 publications

References 5 publications

Quality of Life for Patients With Incurable Stage IV Colorectal Cancer: Randomized Controlled Trial Comparing Resection Versus Endoscopic Stenting

Quality of Life for Patients With Incurable Stage IV Colorectal Cancer: Randomized Controlled Trial Comparing Resection Versus Endoscopic Stenting

Z-entry technique reduces the risk of trocar-site hernias in obese patients

Resection or Stenting in the Treatment of Symptomatic Advanced Metastatic Rectal Cancer: A Dilemma

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