Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience

Chatzimavroudis, Grigoris; Papaziogas, B.; Galanis, I.; Koutelidakis, Ioannis; Atmatzidis, Stefanos; Evangelatos, P.; Voloudakis, Nikolaos; Ananiadis, Ananias; Doundis, A.; Christoforidis, E.

doi:10.1007/s10029-017-1699-3

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…All of the previous factors were found significant on univariate analysis. However, on multivariate analysis the list of significance was shortened to advancing age (>70), BMI > 30, duration of surgery, diabetes mellitus, incision enlargement, and wound infection as detailed in Table 3 7,10,11 .…”

Section: Pt Nomentioning

confidence: 99%

Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy

Nofal

Ali

Hamdan

et al. 2020

Sci Rep

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Trocar site hernia (TSH) is an incisional hernia occurring at the trocar insertion sites after different types of laparoscopic surgeries. the aim of this study is to present characteristics of patient and surgery series with trocar site hernia after laparoscopic cholecystectomy. A 2930 consecutive patients underwent laparoscopic cholecystectomy in two major university-affiliated hospitals from April 2014 to March 2018 and the patient followed up for variable periods of time. Retrospective medical chart review to study trocar site hernia including patient, operation, instruments, and pathologic characteristics described. Six patients had trocar site hernia (incidence 0.20%), the hernias occurred mostly at the umbilical port site after using 10 mm trocar. Risk factors included mainly obesity, female gender and use of 10 mm trocars at midline sites. TSH is more described. It occurs mostly at the umbilical port site. Major risk factors include obesity, diabetes mellitus, lengthy procedure, extension of entry site, and wound infection. Closure of fascial defect is supposed to reduce the incidence despite weak evidence.Laparoscopic cholecystectomy (LC) was performed for the first time by Erich Mühe of Bo¨blingen, Germany on September 12, 1985 1 . It is now the standards surgical treatment for gallbladder stone disease (GBSD) and stood the test of time regarding reduced postoperative pain, decreased hospital stay, earlier return to work, and much more cosmetic scars. On the other hand, LC appeared progressively to have unprecedented complications such as complications related to the pneumoperitoneum and laparoscopic instruments in addition to the classical complications encountered in the open surgery such as bleeding, bile leak, and common bile duct injury.The trocar site hernia was reported for the first time in the late 1960s of the last century in a series of patients underwent laparoscopic gynecologic procedures 2 . The first case of TSH after LC was reported by Maio et al. in the USA in 1991in which they described the use of CT scan to diagnose the hernia 3 . Consequently, variable several studies were published addressing laparoscopic surgery complications including trocar site hernia. In this research, we present our observations regarding TSH after 2930 cases of LC.

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Section: Pt Nomentioning

confidence: 99%

Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy

Nofal

Ali

Hamdan

et al. 2020

Sci Rep

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“…Memon et al 8 described an incidence of 0.11% and 3.66% in port-site hernia comparing epigastric and umbilical port site to retrieve the gallbladder. Similarly, Chatzimavroudis et al 24 found a higher rate of short-and long-term complications in the umbilical port-site extraction cohort. Our meta-analysis shows no statistically significant differences among groups (epigastric vs umbilical ports) in terms of hernia incidence, postoperative infections rate, nor the operative time.…”

Section: Discussionmentioning

confidence: 74%

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

et al. 2019

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Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.

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“…Although some surgeons close all trocar site fascial defects, [17] many surgeons do not routinely close them. [9] In a 1172 case, Chatzimavroudis et al, [18] despite routine closure of fascia, found TSH ratios as 0.6% and 0.94% in the first and second years, respectively. Nassar et al [19] reported the incidence of TSH was 1.8% in patients with preoperative umbilical hernia even if the defect was closed primary.…”

Section: Discussionmentioning

confidence: 96%

Rısk Factors For Trocar Site Hernias Following Laparoscopic Cholecycstectomy

Kündeş¹

2019

Laparosc Endosc Surg Sci

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Introduction: Laparoscopic cholecystectomy (LC) remains the gold standard surgical method for cholelithiasis. The objective of this study was to evaluate risk factors for the development of a trocar site hernia following an LC. Materials and Methods:All of the patients who underwent an LC between 2014 and 2017 at the Kartal Research and Education Hospital were included in the study. Clinical data were collected retrospectively and possible causes of a trocar site hernia were analyzed. Age, gender, the method of suturing trocar sites, open or closed trocar insertion technique, body mass index (BMI), surgical site infection occurrence, associated diseases, and follow-up times were recorded.Results: A total of 340 patients were included in this study. In the group, 254 were female (74%). The mean age was 48.4±14 years (range: 19-90 years). The mean follow-up time was 31.9±12.7 days. A trocar site hernia developed in 20 (5.9%) patients, and the mean age was 62.5±12.8 years (p=0.0001). Six (35.2%) of 17 patients with a postoperative surgical site infection developed a hernia (p=0.0001). In all, 35 patients had diabetes and 6 diabetic patients (17.1%) developed a hernia (p=0.003). The mean BMI was 31.2±6.1 kg/m2 in the presence of a hernia and 27.9±4 kg/m 2 in the absence of a hernia (p=0.001). Conclusion:This study examined age, BMI, diabetes, surgical site infection, trocar insertion method, and the technique used for the closure of fascia as possible risk factors in the development of trocar site hernia. Multivariate analysis revealed that only age, diabetes, BMI, and wound site infection were significant.

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Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience

Abstract: The incidence of TSH following LC is considerably low. Obesity is an independent risk factor for TSH development, while closure of fascial incision of 10 mm below the xiphoid is not justified.

Cited by 20 publications

References 27 publications

Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy

Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

Rısk Factors For Trocar Site Hernias Following Laparoscopic Cholecycstectomy

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