4. ULTRASOUND STUDY OF TROCAR HERNIA IN POST-OPERATED PATIENTS OF BARIATRIC SURGERY: MEDIUM AND LONG-TERM FOLLOW-UP

Abstract

Abstract Introduction Patients undergoing bariatric surgery have comorbidities and risk factors that increase the likelihood of incisional hernias. Bladeless trocars are safe and not very harmful, so we opted not to close them due to the difficulty they present in these patients. Methods Observational, descriptive, longitudinal, and retrospective study in patients who underwent bariatric surgery by laparoscopy with 12mm trocars without a blade or fascial closure between January 2015 and July 2016. Data on risk factors, pain scale, and ultrasound of ports by an expert radiologist in 2018 and 2022. Results A total of 45 patients, with a mean age of 49.9 years and an initial BMI of 45.5 kg/m², were included in the study. The majority (88.9%) underwent gastric bypass, while the rest underwent vertical gastrectomy. In 2018, 45 abdominal wall ultrasounds were conducted, revealing 7 trocar hernias out of 225 explored ports (3.1%). All hernias were located in the epigastric port and were asymptomatic. In 2022, 32 ultrasound scans were performed with findings of 7 hernias (4.4%), 3 new and 4 known, with 2 symptomatic patients at the site of the hernia with mild symptoms not consulted. Conclusion The incidence of trocar hernia in the medium and long term following bariatric surgery with 12mm ports, without blade or fascial closure, is notably low, with all cases located in the midline (p<0.00001). These findings lead us to question the necessity of closing transmuscular accesses and assess the closure or lateralization of the midline trocar.