Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication

Bowrey, David J.; Blom, Dennis; Crookes, Peter F.; Bremner, Cedric G.; Johansson, Jan; Lord, Reginald V.; Hagen, Jeffrey A.; DeMeester, Steven R.; DeMeester, Tom R.; Peters, Jeffrey H.

doi:10.1007/s004640080146

Cited by 136 publications

(93 citation statements)

References 23 publications

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“…The same survey revealed that 86.3% of herniae occurred in sites where the trocar diameter was 10 mm or more, and umbilical herniae were found in 75.70% as compared to lateral hernias in 23.70% [2]. In another retrospective study of 320 cases, the prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3% [3]. All herniae occurred at the midline supraumbilical port [3].…”

Section: Discussionmentioning

confidence: 94%

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A case report of incisional hernia through a 5-mm lateral port site following laparoscopic right ovarian cystectomy

2009

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We report a case of postoperative bowel obstruction with early onset hernia presenting through a 5-mm port. A 43-year-old woman having undergone laparoscopic ovarian cystectomy 2 days before presented with features of intestinal obstruction in the form of persistent abdominal pain, vomiting, and inability to pass stool or flatus. Computed tomography scan of her abdomen showed collapsed large bowel and a loop of small bowel protruding through the lateral 5-mm sheath defect. A secondary laparoscopic procedure allowed both confirming diagnosis and surgical repair of the hernia. Our case describes this rare complication through a 5-mm lateral port, with complete bowel obstruction, in the absence of any of the recognized risk factors following a straightforward short surgical procedure, performed as an open laparoscopy with the sample retrieved through the 10-mm trocar. Body mass index was normal, with no significant health problems preoperatively.

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Section: Discussionmentioning

confidence: 94%

“…In another retrospective study of 320 cases, the prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3% [3]. All herniae occurred at the midline supraumbilical port [3].…”

Section: Discussionmentioning

confidence: 95%

A case report of incisional hernia through a 5-mm lateral port site following laparoscopic right ovarian cystectomy

2009

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“…However, incisional hernia can form post-operatively, a situation whereby contents of the abdominal cavity protrude through a weakness in the abdominal wall as a result of improper trocar site wound closure (commonly at the linea alba near the umbilicus [3][4][5]). Such cases have a prevalence of approximately 1-5% [6][7][8][9][10][11], meaning that, in the U.S alone, up to 100,000 cases of port site incisional hernia occur each year. This outlines a clear need for a more robust solution to the current methodology of wound closure in laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Uniaxial and biaxial mechanical properties of porcine linea alba

Cooney

Moerman

Takaza

et al. 2015

Journal of the Mechanical Behavior of Biomedical Materials

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Trocar site hernia (or incisional hernia) is a severe complication post laparoscopic surgery that is commonly associated with the linea alba. However, the few studies on the mechanical properties of the linea alba in the literature appear contradictory, possible due to challenges with the physical dimensions of samples and variations in protocol. This study focuses on the tensile mechanical characterisation of the porcine linea alba, as determined by uniaxial and equi-load biaxial testing using image-based strain measurement methods. Results show that the linea alba demonstrated a non-linear elastic, anisotropic behaviour which is often observed in biological soft tissues. The transverse direction (parallel to fibres) was found to be approximately 8 times stiffer than the longitudinal (cross-fibre) direction under both uniaxial and equi-load biaxial loading. The equi-load biaxial tensile tests revealed that contraction could occur in the transverse direction despite increasing load, probably due to the anisotropy of the tissue. Optical surface marker tracking and digital image correlation methods were found to greatly improve the accuracy of stretch measurement, resulting in a 75% change in the apparent stiffness compared to using strain derived from machine cross-head displacement. Additionally, a finite element model of the experiments using a combination of an Ogden and fibre exponential power law model for the linea alba was implemented to quantify the effect of clamping and tissue dimensions (which are suboptimal for tensile testing) on the results. The preliminary model results were used to apply a correction factor to the uniaxial experimental data prior to inverse optimisation to derive best fit material parameters for the fibre reinforced Ogden model. Application of the model to the equi-load biaxial case showed some differences compared to the experimental data, suggesting a more complex anisotropic model may be necessary to capture biaxial behaviour. These results provide an improved assessment of the mechanical properties of the porcine linea alba for wound closure and other studies.

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“…

We enjoyed the recent report by D. J. Bowrey et al [1] about risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. As a consequence of their observations, they state that they have developed a new method of open trocar placement by use of a paramedian skin incision and separate fascial incisions with retraction of the rectus abdominus muscle laterally.

However, we have been using this technique, which we described in 1999 in this journal [2], since 1992 in laparoscopic fundoplications and in other laparoscopic procedures (more than 3000 procedures).

…”

mentioning

confidence: 96%

“…We enjoyed the recent report by D. J. Bowrey et al [1] about risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. As a consequence of their observations, they state that they have developed a new method of open trocar placement by use of a paramedian skin incision and separate fascial incisions with retraction of the rectus abdominus muscle laterally.…”

mentioning

confidence: 96%

Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication

Laffularde¹,

Gys²

2002

Surg Endosc

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We enjoyed the recent report by D. J. Bowrey et al. [1] about risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. As a consequence of their observations, they state that they have developed a new method of open trocar placement by use of a paramedian skin incision and separate fascial incisions with retraction of the rectus abdominus muscle laterally.However, we have been using this technique, which we described in 1999 in this journal [2], since 1992 in laparoscopic fundoplications and in other laparoscopic procedures (more than 3000 procedures). We indeed encourage its widespread use since we have not encountered any vascular or bowel injury with trocar placement and have experienced no postoperative hernia formation at this trocar site.

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Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication

Cited by 136 publications

References 23 publications

A case report of incisional hernia through a 5-mm lateral port site following laparoscopic right ovarian cystectomy

A case report of incisional hernia through a 5-mm lateral port site following laparoscopic right ovarian cystectomy

Uniaxial and biaxial mechanical properties of porcine linea alba

Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication

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