Abstract
BackgroundTrocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors.MethodsA cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors.Results76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p < 0.001). Mean follow-up time was 34 months.ConclusionsTSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years.Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744
Highlights
Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery
TSIH incidence Of the 76 patients included in the study, a total of 303 trocar site incisions (TSI) were assessed (151 of 10 mmTSI and 152 of 5 mm-TSI)
The incidence of trocar site incisional hernia has been poorly documented over the years which may be due to the paucity of symptoms and to the lack of longterm postoperative follow-up since the pathology that leads to the laparoscopic surgery is usually benign and no further follow-up is deemed necessary
Summary
Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. Incisional hernia is the most common complication associated with surgical procedures, with an estimated incidence of 0–35% [1, 2]. As there are few studies with a long-term follow up and the occurrence of the incisional hernia depends on the duration of postoperative followup, this estimate may not be accurate. Despite the introduction of laparoscopic surgery, incisional hernia is still frequent and, trocar site incisional hernia (TSIH) is a common complication after laparoscopy. Dynamic abdominal sonography for hernia (DASH) has been shown to be a valid alternative to CT in the diagnosis and characterization of incisional herniation [7, 8]
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