Abstract
IntroductionPort-site herniation is a rare but potentially dangerous complication after laparoscopic surgery. Closure of port sites, especially those measuring 10 mm or more, has been recommended to avoid such an event.Case presentationWe herein report the only case of a port site hernia among a series 52 consecutive cases of laparoscopy-assisted distal gastrectomy (LADG) carried out by our unit between July 2002 and March 2007. In this case the small bowel herniated and incarcerated through the port site on day 4 after LADG despite closure of the fascia. Initial manifestations experienced by the patient, possibly due to obstruction, and including mild abdominal pain and nausea, occurred on the third day postoperatively. The definitive diagnosis was made on day 4 based on symptoms related to leakage from the duodenal stump, which was considered to have developed after severe obstruction of the bowel. Re-operation for reduction of the incarcerated bowel and tube duodenostomy with peritoneal drainage were required to manage this complication.ConclusionWe present this case report and review of literature to discuss further regarding methods of fascial closure after laparoscopic surgery.
Highlights
Port-site herniation is a rare but potentially dangerous complication after laparoscopic surgery
We present this case report and review of literature to discuss further regarding methods of fascial closure after laparoscopic surgery
Bowel herniation through the fascial defect created by the entry of trocars is recognized as a rare but potentially serious complication of laparoscopic surgery [1]
Summary
Bowel herniation through the fascial defect created by the entry of trocars is recognized as a rare but potentially serious complication of laparoscopic surgery [1]. We describe the significance of complete closure of the fascial defect at the trocar site including the peritoneum in the prevention of this condition, as well as the importance of early diagnosis to avoid serious subsequent events. Wound defect at the umbilical port site was sutured completely including the peritoneum with 0 absorbable suture and fascial incisions at all other trocar insertion sites were closed with 2-0 absorbable sutures. CT showed a mass lesion at the trocar insertion site on the upper left flank, suggesting herniation through the port site (Fig. 2). The small bowel was incarcerated into the peritoneal defect in the abdominal wall created by the trocar placed in the left upper flank leading to complete obstruction of the bowel (Fig. 3). Herniation occurred at the port site indicated with an asterisk
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