Development Of Trocar Site Hernia Research Articles

Risk factors associated with the development of trocar site hernia after laparoscopic bariatric-metabolic surgery

Risk factors associated with the development of trocar site hernia after laparoscopic bariatric-metabolic surgery

Umbilical Fascial Defects are Common and Predict Trocar Site Hernias After Laparoscopic Appendectomy.

Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH. TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected. 241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia (P < .0001). Preoperative fascial defect on CT was predictive of TSH (P < .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI: .88-.92). Other major risk factors for TSH were: age greater than 59 years (P < .031, OR = 2.48); and obesity, BMI > 30 (P < .012, OR = 2.14). The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.

Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study

BackgroundThe exact prevalence of trocar site hernias after bariatric procedures is not yet known. Recent metaanalysis data indicated concerning rates of up to 25%. We conducted a prospective cohort study to estimate the prevalence and analyze the role of fascia closure in the development of trocar hernias.MethodA total of 365 patients who were operated for obesity in our department between 2009 and 2018 were included. All patients were invited for a follow-up ultrasonography scan in order to detect abdominal wall defects. The role of intraoperative fascia closure in the development of trocar site hernias was evaluated, and a logistic regression analysis was performed to detect potential risk factors.ResultsThe overall prevalence of trocar hernias detected by ultrasonography was 34%. The prevalence of abdominal wall defects in patients who received a fascia closure was 37% compared with 34% in patients who did not receive a fascia closure (p = 0.37). The only factor that was associated with a higher risk for trocar site hernias was high excessive weight loss (p = 0.05).ConclusionTrocar site hernias are an underestimated complication of minimally invasive, multiportal bariatric surgery, and the prevalence of asymptomatic hernias is probably higher than initially expected. In this study, fascia closure did not protect against trocar hernias. However, opposing evidence from similar trials suggests closing the fascia. This clinical problem should therefore be further assessed in a prospective randomized setting.

Causes of asymptomatic trocar site hernia: How can it be prevented?

OBJECTIVE:The aim of this study is to evalute risk factors which trigger the development of trocar site hernia after elective laparoscopic cholecystectomy operation and to discuss what needs to be done to prevent it.METHODS:Patients operated with laparoscopic cholecystectomy between 2011 and 2013 were evaluated. Patients were called back for follow-up visit at 12 month after operation. Physical and ultrasonographic examinations were performed at follow-up. Factors that facilitate development of trocar site hernia were investigated.RESULTS:One hundred and ninty patients were operated during the study period. One hundred and thirty-two patients who had been examined at follow-up period were included in the study. Mean age of the patients was 50.64±11.86 (18–76) years and female/male ratio was five. Trocar site hernia was detected in four patients at umblical trocar site. One of these patients had chronic obstructive lung disease, two of them had diabetes and three of them had obesity. Advanced age and obesity were found to be statistically significant in patients having trocar site hernia (p value: 0.007, and 0.008, respectively).CONCLUSION:Development of trocar site hernia after laparoscopic surgery may be prevented by repair of trocar site in patients taken into consideration risk factors such as advanced age and obesity.

Trocar site hernias causing intestinal obstruction

Purpose: Trocar site hernia is a type of incisional hernia occuring at the trocar sites after laparoscopic surgery. After the development of trocar site hernia, the benefits of laparoscopic surgery may be disappeared, reoperation may be needed and recovery period may be elongated. In this study, we wanted to draw attention to a preventable complication of laparoscopic surgery. Materials and methods: We investigated all laparoscopic procedures performed in 42 weeks period in our surgery clinic from the patient records, retrospectively. We recorded the information about patient demographics, laparoscopic procedures, and patient comorbidities. Results: A total of 3477 patients underwent laparoscopic procedures during the study period and four hernias were identified as occurring at the trocar entry site. Two patients were operated in our clinic, one of them was operated in urology department of our hospital and the other patient was operated in another centre. All patients were symptomatic and all were operated emergently. Conclusion: Many factors affecting the development of trocar site hernia were described and many methods were suggested for prevention. The true incidence is unknown because most patients are asymptomatic. The closure of fascia defects of ≥10 mm trocar seems to be the best preventive method. Pam Med J 2015;8(3):213-218

The incidence of trocar-site hernia in minimally invasive bariatric surgery: A comparison of multi versus single-port laparoscopy

Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations. There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture. Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias. SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.

Trocar Site Hernia After Laparoscopic Cholecystectomy

The aim of this study was to elucidate the influence of pre and perioperative factors on the development of trocar site hernia after a laparoscopic cholecystectomy procedure. A total of 776 patients who underwent a laparoscopic cholecystectomy procedure in our Department of General Surgery between 1999 and 2004 were assigned as the study group. The control group included patients without trocar site hernias after a cholecystectomy. The effect of five variables, including gender, age, body mass index (BMI), operation duration, and the type of cholecystitis on the development of a trocar site hernia after a laparoscopic cholecystectomy was assessed by univariable and multivariable models. In the univariate analysis, female gender (P = 0.021), older age (P < 0.001), higher BMI at the time of surgery (P < 0.001), and an increased duration of surgery (P < 0.001) have been found to increase the likelihood of a trocar site hernia formation. However, in the multivariable model, the gender was not a significant variable to influence the development of this complication. The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.