Incidence Of Trocar Site Hernia Research Articles

Trocar site incisional hernias

Objective: to analyse the incidence of trocar site hernias among patients admitted to the surgical clinic on an emergency basis with a diagnosis of an incarcerated hernia. Materials and methods. The retrospective and prospective study; the follow-up period is 10 years. A statistical analysis of patients with incarcerated hernias had been performed. A total of 1,448 subjects was selected for the study. Of these, 825 (57.0%) patients were diagnosed with incarcerated hernias of various localizations. The diagnosis of incarceration among 623 (43.0%) subjects proved to be false, and the hernias of these patients were classified as “reducible” and “irreducible” hernias. Results. An analysis of the operations revealed 34 patients with trocar site hernias, representing 2.34% of the total number of patients admitted to hospital with hernias and 4.93% of those operated on an emergency basis. Conclusion. The rare, partial incarceration of the omentum and small intestine, the so-called Richter’s hernia, after using 5-mm-diameter trocars was revealed in 4 people operated on previously (3 to 5 years). Moreover, the hernial orifice (abdominal wall defect) at the time of our operation turned out to be significantly larger than after puncture with a 5-mm trocar. A direct correlation was found between the incidence of trocar site hernia and the degree of obesity, body mass index.

OC-072 COMPARATIVE STUDY OF THE TROCAR SITE INCISIONAL HERNIA INCIDENCE ACCORDING TO SLOW VS RAPID ABSORPTION SUTURES

Abstract Aim Abdominal wall closure guidelines recommend the utilization of slow absorption sutures. However, fast absorption sutures are still used for laparoscopic trocar site closure, mainly due to ease of handling and availability. We planned a retrospective cohort study, analysing the incidence of trocar site hernia (TSH) depending on the suture used for the fascial closure. Materials & Methods A retrospective cohort study is carried out including a sample of 200 patients operated in our centre by any elective laparoscopic procedure, by Hasson access technique at the umbilical trocar site. Patients were distributed in 2 groups, according to the suture used: Group-1 Polyglactin, Group-2 Polydioxanone. In both groups the needle that was employed had a J-shape. Patients that had open or robotic surgery, reinterventions, and previous diagnosis of umbilical hernia were excluded. Results 100 patients were included in Group-1, and 100 patients in Group-2. The average age was 57.34 and 63.39 years respectively. The incidence of TSH in Group-1 was 20% with an average follow up of 22.3 months, compared to an 15% TSH incidence in Group-2, with an average follow-up of 20.3 months. These differences were not statistically significant. 80% of TSH were diagnosed in the first 24 months after the surgery. Conclusions Likewise the existing evidence in open surgery wall closure, the use of slow absorption sutures in trocar site closure probably reduces the TSH incidence, without repercussion in comorbidity, however, in our study, the sample was not enough to prove statistical significance. These results should be contrasted with further randomized Control Trials.

Trocar site hernia after laparoscopic bariatric surgery: Incidence with non‐fascial closure

Objective The aim of this study was to determine the incidence of trocar site hernia (TSH) after minimally invasive bariatric surgery in the setting of non-fascial closure and to assess the possible predisposing factors. Methodology Two hundred four patients who underwent laparoscopic bariatric surgery between May 2015 and December 2019 were retrospectively reviewed and were asked for a follow-up visit. All patients were examined clinically and underwent an abdominal ultrasound (US) for detection of any TSH. Results Trocar site hernia was detected in three patients (1.4%), all of them occurred after laparoscopic sleeve gastrectomy (LSG). The three TSH developed at the 12-mm port site. The mean time of TSH occurrence was 13 months postoperatively. Two cases were asymptomatic and discovered on US evaluation while the third was symptomatic. The mean time of follow-up was 40 months, range (13–67 month). In our study, age, sex, preoperative BMI and comorbidities had no significant statistical relation with TSH; however, postoperative wound infections and smoking were statistically significant predisposing risk factors for TSH. Conclusions Trocar wound sites skin closures without fascial closure were associated with a low rate of TSH (1.4%) and all cases were related to 12 mm trocar size.

P060 TROCAR SITE HERNIA AFTER GASTRIC SLEEVE

Abstract Aim Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position upon a ring was found to be a reliable method for the detection of TSH in obese. Our aim was to examine the incidence of TSH after gastric sleeve. Material and Methods 79 patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. Results The incidence of trocar site hernia was 17 out of 79 (21,5 %), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no clear correlation between symptomatic TSH and TSH on CT. Conclusions The incidence of TSH is high in this group of patients. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of trocar site hernia can be serious, the proportion of symptomatic TSH is unknown.

Trocar site hernia after gastric sleeve

BackgroundLaparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.MethodsSeventy-nine patients subjected to laparoscopic gastric sleeve in 2011–2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.ResultsThe incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.ConclusionsThe incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: A prospective randomized controlled trial

Abstract Objective Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery. Methods This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia. Results The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group. Conclusion Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up, especially in terms of long-term hernia recurrence rates.

What is the Real Incidence of Trocar Site Hernias?

What is the Real Incidence of Trocar Site Hernias?

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.

Asymptomatic trocar site hernias: An underestimated complication of laparoscopy

Objective:To estimate the exact incidence of trocar site hernia (TSH) through sonographic examination and to evaluate the predisposing risk factors of TSH.Materials and Methods:Three hundred patients who underwent laparoscopic surgery for benign gynecologic indications were included in this study and called back for a follow-up visit. All patients underwent an ultrasound evaluation for the detection of TSH. Risk factors for TSH formation were investigated.Results:Twenty-five (8.3%) TSHs were diagnosed among 300 postoperative laparoscopies. The highest rate of TSH development among the surgeries was found in tubal ligation cases with 19%. Parity ≥3 [odds ratio (OR), 3.13; 95% confidence interval (CI): 1.21-8.09; p=0.018], and not closing fascia (OR: 6.74; 95% CI: 2.72-16.70; p<0.001) were statistically significant risk factors for the development of TSH in multivariate analysis.Conclusion:The prevalence of TSH is higher than previously reported, and ultrasonographic examination is adequate for detecting subclinical types of this complication.

Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience.

Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia. A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013-2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed. A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%, p = 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12-41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%, p = 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (p = 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22-174.0, p < 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04-89.5, p = 0.007) were independent risk factors for TSH. Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence.

PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY Alireza Ghoreifi*, Gilbert Whang, Khoa Tran, Tapas Tejura, Simin Hajian, Benjamin Liu, Jie Cai, Xiaomeng Lei, Mohammad Aslzare, Madeleine Burg, Steven Cen, Mihir Desai, Monish Aron, Inderbir Gill, Vinay Duddalwar, and Hooman Djaladat Alireza Ghoreifi*Alireza Ghoreifi* More articles by this author , Gilbert WhangGilbert Whang More articles by this author , Khoa TranKhoa Tran More articles by this author , Tapas TejuraTapas Tejura More articles by this author , Simin HajianSimin Hajian More articles by this author , Benjamin LiuBenjamin Liu More articles by this author , Jie CaiJie Cai More articles by this author , Xiaomeng LeiXiaomeng Lei More articles by this author , Mohammad AslzareMohammad Aslzare More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Steven CenSteven Cen More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000845.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no available data on the natural history of radiologic trocar site hernia (TSH) especially in urologic surgeries. The aim of this study is to evaluate the incidence and natural history of radiologic TSH in patients who underwent robotic partial or radical nephrectomy. METHODS: We retrospectively reviewed the records of patients who underwent robotic partial or radical nephrectomy for kidney tumor at USC between January 2011 and April 2017. All pre and postoperative imagings were re-reviewed for detection of TSH per Tonouchi classification by three uro-radiologists with high Intra Class Correlation (ICC=0.94, 95% CI 0.86-0.97). Patients who developed hernia were followed up and classified into stable or progressive group (Figure 1). Progressive TSH was defines as either significant size change, upgrading per Tonouchi classification, or becoming symptomatic. RESULTS: A total of 247 patients (169 partial and 78 radical nephrectomy) were included in the study. Pathologic stage was T1 (74.5%), T2 (5.7%), T3 (19.4%), and T4 (0.4%). The incidence of radiologic TSH was 27.53%, graded as early-onset (35.3%), late-onset (51.5%) and bowel/fat-containing (13.2%). The locations were midline (58.8%: including ≥ 10 mm assistant port), anterolateral (36.8%), and posterior (4.4.%). The incidence of TSH was not different between partial and radical nephrectomy cases (26.6% and 29.5%, p=0.43). Median time to radiologic TSH was 1.7 years (IQR 0.84-2.52). During the follow up of 68 patients who developed hernia, 33 (48.5%) had progressive TSH. Median time to progression was 1.5 years (IQR 0.68-2.01). On multivariable analysis, adjuvant therapy was an independent predictor for radiologic hernia development (HR 3.23, 95% CI 1.44-7.27, p=0.005). Pathologic T stage ≥ 2 and history of open abdominal surgery were also significantly associated with hernia progression (HR 3.93, 95% CI 1.74-8.89, p=0.001 and HR 3.47, 95% CI 1.53-7.93, p=0.003, respectively). CONCLUSIONS: Radiologic TSH following robotic partial or radical nephrectomy is common. Progression rate is as high as 50% with median time to progression of 1.5 years. Adjuvant therapy is an independent predictor for TSH development, while higher stage and history of open abdominal surgery are associated with TSH progression Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e256-e256 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi* More articles by this author Gilbert Whang More articles by this author Khoa Tran More articles by this author Tapas Tejura More articles by this author Simin Hajian More articles by this author Benjamin Liu More articles by this author Jie Cai More articles by this author Xiaomeng Lei More articles by this author Mohammad Aslzare More articles by this author Madeleine Burg More articles by this author Steven Cen More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Vinay Duddalwar More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

Does Using a 5 mm Telescope in Laparoscopic Cholecystectomy Reduce the Incidence of Trocar Site Hernia?

Does Using a 5 mm Telescope in Laparoscopic Cholecystectomy Reduce the Incidence of Trocar Site Hernia?

Single-Port Versus Conventional Laparoscopic Cholecystectomy: Better Cosmesis at the Price of an Increased Incisional Hernia Rate?

Background: The incidence of trocar site hernia (TSH) in single-port laparoscopic cholecystectomy (SPC) is still a debated issue. Aim of this retrospective study was to compare the incidence of postoperative hernia and cosmetic results among patients undergoing SPC and multiport laparoscopic cholecystectomy (MPC) performed at a single institution. Methods: A series of 60 SPC and 60 MPC patients operated on between July 2016 and May 2018 were compared. Primary endpoint was to assess the incidence of TSH at long term. All the patients were admitted as outpatients for physical examination and scar measurement. Secondary endpoints were the cosmetic results assessed by a cosmesis score (CS) and the body image questionnaire (BIQ). Results: After a median 18-month follow-up (range: 6-29 months), a hernia in umbilical trocar site was detected in 4 (7.1%) SPC patients and 1 (2%) MPC patient, the difference not being statistically significant (P = .216). BIQ was almost equivalent in SPC and MPC groups (5.15 versus 5.27; P = .518), respectively. Statistically significant differences in favor of SPC were found in CS (22.3 versus 19.72; P = .001) and in total length of scars (1.2 cm versus 4 cm; P < .001). Conclusions: SPC technique has proved to be safe and effective in experienced hands. Superior cosmesis of SPC over MPC is confirmed, but close attention to fascial closure is a vital component of SPC, and surgeons performing single-site surgery need to be aware of this increased potential for hernia formation.

Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: a prospective randomized controlled trial

Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery. This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia. The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3cm vs 5.2cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group. Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up.

Trocar Site Hernias in Bariatric Surgery—an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis

The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.

Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience.

Laparoscopic cholecystectomy (LC) is the gold standard of treatment for patients with symptomatic cholelithiasis. Compared to open cholecystectomy, LC is associated with significantly lower postoperative complications. Trocar site hernia (TSH) is an uncommon, but potentially dangerous, complication of LC. The aim of this study was to evaluate the incidence of TSH following LC. The records of all patients who underwent elective LC between January 2004 and December 2013 were retrospectively reviewed. The open technique with a vertical incision infraumbilically was used to establish pneumoperitoneum. Two or three other skin incisions were made and trocars were inserted. In all cases, only the fascia at the site of infra-umbilical incision was closed. Following hospital discharge, all patients were regularly re-examined 1, 4 and 52weeks postoperatively and were contacted by phone during November-December 2015. Based on the findings from clinical and telephone follow-ups, the incidence of TSH was recorded. Using univariate/multivariate analysis, we investigated several variables to identify risk factors for TSH development. During the study period, 1172 patients were eligible and included in the final analysis. Seven patients (0.6%) presented TSH at 1-year follow-up. At the end of the study and with a mean follow-up of 65.86±25.19months, 11 patients (0.94%) presented TSH. Interestingly, all TSHs were developed at the infra-umbilical site. Multivariate analysis identified obesity as an independent risk factor for TSH. The incidence of TSH following LC is considerably low. Obesity is an independent risk factor for TSH development, while closure of fascial incision of 10mm below the xiphoid is not justified.

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

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.

The Incidence of Trocar Site Hernia After Single-Port Laparoscopic Cholecystectomy-A Single Center Analysis and Literature Review.

Single-port laparoscopic cholecystectomy (SLC) requires a larger initial umbilical incision than conventional multiport laparoscopic cholecystectomy (MLC). In this retrospective analysis study we compared the demographics, clinical data, and incidence of postoperative trocar site hernias (TSH) in patients undergoing SLC with those in patients undergoing MLC. A total of 161 patients were included in this study. Of these patients, 104 underwent MLC, 57 SLC. Patients in the MLC group were operated on using the four-trocar technique, patients in the SLC-port group using a fully reusable multi-trocar port system (X-Cone™). The earliest follow-up point was 12 months, the average follow-up period was 16.4 months (range 12-24 mos). The follow-up examinations for all patients consisted of a review of their medical history, a thorough physical examination, and an ultrasound examination of all existing trocar site scars. Patients in the SLC group had a lower mean American Society of Anesthesiologists score and a lower mean body mass index compared to patients in the MLC group. The average operating time was shorter for the patients in the SLC group, but the difference was not statistically significant. Ten (9.6%) patients in the MLC group and 3 (5.3%) in the SLC group developed a TSH (p = .55). At midterm follow-up the incidence of umbilical incisional hernias was not greater for SLC compared to MLC. The incidence of TSH after MLC was significantly higher than expected.

Herniation formation in women undergoing robotically assisted laparoscopy or laparotomy for endometrial cancer

ObjectiveTo compare the incidence of trocar site hernia in women who underwent robotically assisted laparoscopic surgery (RBT) for endometrial cancer staging with the incidence of ventral hernia formation in patients who underwent laparotomy (LAP) for the same indication. To analyze risk factors for hernia formation in women undergoing RBT for endometrial cancer. MethodsWe retrospectively identified all patients who underwent surgical staging for endometrial cancer via RBT or LAP from 2009–2012. Clinicopathologic data were analyzed. Appropriate statistical tests were used. Results738 patients were staged via RBT (n=567) or LAP (n=171). Overall median age was 61years (RBT range, 33–90; LAP range,28–86; p=0.4). Median BMI was 29.5kg/m2 (range, 17.9–66) and 30.3kg/m2 (range, 16.8–67.2), respectively (p=1.0). Eleven (1.9%) of 567 patients in the RBT cohort developed a trocar site hernia compared with 11 (6.4%) of 171 LAP patients who developed a ventral hernia (p=0.002). Median time to diagnosis was 18months (range, 3–49) and 17months (range, 7–30), respectively (p=0.7). Of the 11 RBT patients who developed a trocar site hernia, 10 (91%) were midline defects and 1 (9%) was a lateral defect of a prior inferior epigastric port site. No hernias required emergent operative intervention. Four (0.7%) of 567 RBT patients compared with 2 (1.2%) of 171 LAP patients required surgical hernia repair (p=0.4). ConclusionsTrocar site herniation after RBT staging for endometrial cancer is uncommon and less likely to occur than ventral hernia formation with LAP staging. Furthermore, surgical revision rates are low.

An Unusual Trocar Site Hernia after Prostatectomy.

Trocar site hernias are rare complications after laparoscopic surgery but most commonly occur at larger trocar sites placed at the umbilicus. With increased utilization of the laparoscopic approach the incidence of trocar site hernia is increasing. We report a case of a trocar site hernia following an otherwise uncomplicated robotic prostatectomy at a 12 mm right lower quadrant port. The vermiform appendix was incarcerated within the trocar site hernia. Subsequent appendectomy and primary repair of the hernia were performed without complication.