Using Surgicel® Plug to Prevent Trocar Site Hernia after Laparo- scopic Surgery in Obese Patients

Abstract

Background: Incisional hernia and wound dehiscence are common complications after abdominal surrgery. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. Ten-millimeter and wider ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients, so, laparoscopic surgery may still be followed by trocar site herniation. Various methods have been advocated for its prevention. The aim of this study was to try a new method to prevent trocar site hernia in obese patients. Patientsand methods: This prospective interventional non-randomized non-controlled study was conducted in the Department of General Surgery at Ain Shams University hospitals in the period from November 2013 to November 2016 on 150 obese (Body mass index (BMI)>35 kg/m2) patients (50 males and 100 females) who underwent laparoscopic surgery (70 cholecystectomies, 25 gastric bypass surgeries, 35 sleeve gastrectomies and 20 appendectomies). In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel® plug was inserted into the muscle layer of trocar wounds. Informed consent was obtained from all patients included in the study. Results: One case, out of the included 150 obese patients, after laparoscopic gastric bypass developed port site hernia with an incidence of 0.67% (1/150). In both patients, hernia was uncomplicated. No patient in the other groups has been found to develop a hernia. Conclusion: Surgicel® plug is an easy technique with very low incidence of trocar site hernia after laparoscopic procedures in obese patients.