Trokarhernien Eine seltene, potenziell gefährliche Komplikation nach laparoskopischen Eingriffen

Abstract

With increasing numbers of laparoscopic procedures more postoperative trocar site hernias can be expected. This complication of minimally invasive surgery is rare but potentially dangerous. According to the literature, the overall incidence of trocar site hernias is expected to be around 1%. Among trocar site hernias, Richter's hernias are the most frequent, accounting for two-thirds of all small intestinal hernias. The following risk factors for the development of trocar site hernias have been identified: the trocar diameter, the trocar design, preexisting fascial defects, and some operation- and patient-related factors. Peritoneal and fascial closure should be done when blunt trocars of >10 mm have been employed. Based on the literature and our own experience, some preventive recommendations are given to further reduce the risk of hernia formation at trocar sites.

Port-site incisional hernia - A case series of 54 patients

“…According to the literature, the overall incidence of port-site hernia is estimated to be around 1% [15], [16], [17], whereas fascial defects occur in 3–20% after conventional surgery depending on observational periods [6]. On the other hand, there are only a few studies with small sample sizes available on this specific topic of port-site incisional hernia [18] leading to rare information regarding to its prevention and treatment.…”

“…Several risk factors have been described for the development of PIH like the trocar diameter, the trocar design, pre-existing fascial defects as well as some operation- and patient-related factors [6], [15], [19], [20]. For example the risk of port-site hernia is greater in obese patients due to their larger preperitoneal space and elevated intraabdominal pressure [21].…”

“…Since various factors have been implicated for the development of port-site hernia [6], various methods are also suggested for its prevention [7], [8], [9]. But until today, it is not finally clarified how to close laparoscopic port-sites defects [10], [11].…”

Laparoscopic Cholecystectomy Combined Using Miniaturised Instruments in Transgastric Gall Bladder Removal: Performed on 63 Patients

“…So we can reduce the rate of incisional hernia. Of course, the abdominal organ removal (as the gall bladder and its lithiasis) often requires enlarging the fascia incision with a high rate of incisional hernia, bruise, and infection [9–11]. This abdominal wall trauma, even limited, prevents the patients from resuming normal physical activity very quickly especially for patients who practise sport, manual workers, or for example, if they have to look after a dependant relative.…”

“…The removal of an inflamed gall bladder with or without very large gallstones usually requires enlarging one of the abdominal incisions. It will be closed of course, scrupulously [7, 8], but there is always a risk of complication (infection, bruising, incisional hernia [9–11]) and that is the same problem with the single port access surgery as it is also difficult to get back to normal physical activity quickly, without risk of trocar-site incisional hernia (especially for patients who practise sport, manual workers or if, for example, they have to look after a dependant relative).…”