Revision Laparoscopy for Incarcerated Hernia At a 5-mm Trocar Site Following Pediatric Laparoscopic Surgery

Abstract

We report the case of a 6-month-old female infant who developed post-operative bowel obstruction due to an incarcerated hernia through a 5-mm laparoscopic wound. The patient underwent laparoscopic Nissen fundoplication for gastroesophageal reflux. On day 6, she showed symptoms of ileus, and the diagnosis of a trocar wound hernia was made on day 13. The herniated intestine was reduced and the defective peritoneum and fascia were closed under relaparoscopic guidance, thus avoiding full-scale laparotomy. A trocar wound hernia causing early postoperative bowel obstruction is a rare complication, especially at 5-mm trocar puncture sites. Intraoperative dislodgment and reinsertion of working trocars may create fascial defects larger than the actual size of the trocar. All laparoscopic puncture wounds, even those <10 mm in size, should be closed at the fascial level in infants. Revision laparoscopy is considered preferable to manage trocar site complications in children.