Trocar Site Hernia after Laparoscopic Colectomy: A Case Report and Literature Review

Abstract

Background. Trocar Site Hernia (TSH) is defined as an incisional hernia which occurs after minimally invasive surgery on the trocar incision site.In 2004 Tonouchi classified trocar site hernias into 3 types: Early onset type; Late onset type; Special type. Case Report. We report the case of a 76-year old woman that underwent an emergency explorative laparotomy on the 10th p.o. day after a laparoscopic left hemicolectomy. Surgery showed a small bowel herniation through the 12 mm trocar incision site; the intestinal loop appeared necrotic and had to be resected, and the hernia orifice was repaired. We carried out a review of literature about this topic. Discussion. The clinical onset of a trocar site hernia is usually early, occurring within the 30th post operative day and it is caused by the omentum or small bowel entrapment into the trocar orifice. The clinical presentation is insidious, with progression to an acute abdomen, and an emergency surgical approach is often required. Conclusions. TSH is a severe complication of operative laparoscopy especially with large-bore trocar ports. The incidence of TSH resulting from our review ranges from 0.007% to 22% with an average of 1.85%. Prevention of TSH appears to be more effective when trocar insertion through the abdominal wall is tangential, the closure of both the fascia and the peritoneum is performed if the incision is greater than 7 mm, the suture of extra umbilical port site is performed under laparoscopic vision.

Strangulated small-bowel loop herniation at the 5 mm trocar entry site after laparoscopic ovarian cyst excision operation

“…11 The development of TH often occurs early in the postoperative period, especially in the first 30 days, and usually requires urgent surgical interventions. 12 In a study, 16% of TH repair operations were performed under emergency conditions and this ratio was found to be higher than the operation rate in emergency conditions after laparotomy operations (10.5%). 13 This shows that the width of the incision line may be inversely proportional to the likelihood of developing complicated hernias.…”

Transabdominal versus transvaginal specimen extraction in mini‐laparoscopic surgery

“…Unfortunately, specimen retrieval devices usually require a 10‐ or 12‐mm trocar to be inserted into the abdomen. Therefore, the enlargement of the skin and fascial incisions to allow the use of the required ports leads to an increase in port site complications, such as incisional herniation . Therefore, the use of a colpotomy for the surgical specimen delivery could decrease the incidence of complications associated with port sites.…”

Five-Millimetre Trocar Site Herniation as a Late Complication After Six Years Following Laparoscopic Appendectomy in Nine-year-old Boy

“…Trocar site hernia (TSH) is defined as an incisional hernia, which occurs after minimal invasive surgery on the trocar incision site and is a wellknown post-operative complication associated with adult laparoscopic surgery; some authors also define this condition as a port site hernia [1]. The overall incidence of TSH is 0-5.2% and occurs most often (96%) in trocar sites that are located umbilicus region (82%) [2].…”

“…The incidence of incisional hernias increases with trocar size, when the trocar site fascia was not sutured and in preschool children [2][3][4]. In 2004, TSH was classified into three types for better management, early onset, late onset and special type [1].…”