Port Site Hernia Research Articles

Derivation of a complication burden score based on disability-adjusted life years to assess patient burden following surgery: a pilot study

Comparing adverse outcomes following alternative surgical interventions is a complex process for both patients and providers. Disability-adjusted life years (DALYs) are used globally as a quantitative indicator of burden of disease. However, DALYs have not been applied to the burden of postoperative complications. This study explores the feasibility and utility of DALYs in measuring the burden of postoperative complications, using 2 pediatric surgical procedures as a test model. A literature review was undertaken of postoperative complications following pediatric inguinal hernia repair and intestinal atresia repair. Relevant studies were included, and incidence rates and durations of all key complications were identified. Using existing disability weights of equivalent health states to the complications, we estimated the burden in DALYs of each complication. These estimates were combined into a unitary procedure-specific complication burden score. The key complications contributing to the postoperative burden following inguinal hernia repair were recurrence (0.016 DALYs), hydrocele (0.010), metachronous hernia (0.014) and port-site hernia (0.012). In the case of intestinal atresia repair, death (6.278), reoperation (12.100), stenosis (5.025) and anastomotic stricture (5.327) accounted for most of the postoperative DALYs. The complication burden score was 0.06 DALYs for inguinal hernia and 36.86 for intestinal atresia repair. As a proof of concept, this study supports the feasibility of using DALYs to derive a complication burden score following surgical intervention, and to our knowledge it represents the first application of burden of disease metrics to postoperative adverse outcomes. Future studies should focus on deriving de novo disability weights for common postoperative complications and adverse outcomes.

Laparoscopic subtotal cholecystectomy in severe cholecystitis with unclear anatomy

Background: Aim of the study was to determine the differences between laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy as regards bile duct injury and post-operative complications rates in patients with severe cholecystitis and obscure anatomy.Methods: We retrospectively reviewed the charts and postoperative outcomes of 293 patients with severe cholecystitis who underwent either laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy between September 2011 and January 2020. Patients with intraoperative altered anatomy which leaded to difficult dissection were defined as having severe cholecystitis.Results: There were 304 cholecystectomies done for patients with severe cholecystitis. Of those, 203 underwent laparoscopic cholecystectomy (LC group), 90 underwent laparoscopic subtotal cholecystectomy (LSC group). There was no significant difference in male to female ratio, age, cases performed on an elective or emergency basis, hospital length of stay or initial operative findings. There were 5 patients with detected intraoperative biliary injury in LC group only. Postoperative bile leaks were significantly higher in the LSC (11.1%) than in the LC group (3.9%). Postoperative collections which needed percutaneous aspiration were also significantly higher in the LSC group (18.9%) than in the LC group (7.4%). Reoperation for collection was required in 8 patients in LC group and in 5 patients in LSC group. The rates of retained common bile duct stones, port site hernia, wound infections, and total complications were not significantly different between the two groups (28.1% v. 45.6%).Conclusions: Our study demonstrated that laparoscopic subtotal cholecystectomy is a safe procedure which reduces the risk of bile duct injury and is comparable to laparoscopic cholecystectomy in patients with severe cholecystitis with unclear anatomy.

Port Site Hernias Following Laparoscopic Ventral Hernia Repair.

Port site hernias (PSH) are underreported following laparoscopic ventral hernia repair (LVHR). Most occur at the site of laterally placed 10-12-mm ports used to introduce large pieces of mesh. One alternative is to place the large port through the ventral hernia defect; however, there is potential for increased risk of surgical site infection (SSI). This study evaluates the outcomes when introducing mesh through a 10-12-mm port placed through the hernia defect. This was a retrospective case series of patients who underwent LVHR in three prospective trials from 2014-2017 at one institution. All patients had mesh introduced through a 10-12-mm port placed through the ventral hernia defect. The primary outcome was SSI. Secondary outcomes were hernia occurrences including recurrences and PSH. A total of 315 eligible patients underwent LVHR with a median (range) follow-up of 21 (11-41) months. Many patients were obese (66.9%), recently quit tobacco use (8.8%), or had diabetes (18.9%). Most patients had an incisional hernia (61.2%), and 19.2% were recurrent. Hernias were on average 4.8 ± 3.8cm in width. Two patients (0.6%) had an SSI. Fourteen patients had a hernia occurrence-13 (4.4%) had a recurrent hernia, and one patient (0.3%) had a PSH. During LVHR, introduction of mesh through a 10-12-mm port placed through the hernia defect is associated with a low risk of SSI and low risk of hernia occurrence. While further studies are needed to confirm these results, mesh can be safely introduced through a port through the defect.

Port site hernia: Minor but severe complication of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a gold standard procedure for the management of patients with cholelithiasis with fewer complications but still port site hernia is one of the severe complications if not treated properly may lead adverse result. This usually results from improper closure or infection of the musculoaponeurotic layers of the abdominal wall. The frequency of port site hernia is variable in literature and its association with infection and other co-morbidities is less explored. Objectives: To determine the frequency of port-site hernia after laparoscopic cholecystectomy at a tertiary care hospital Larkana and its association with infection and co-morbidities. Study Design: Descriptive Case Series study. Setting: Department of Surgery, Chandka Medical College Teaching Hospital, Larkana. Period: December 2018 to December 2019. Material & Methods: One hundred forty-eight patients undergoing elective laparoscopic cholecystectomies, who fulfilled the inclusion criteria and gave informed consent were selected for this study. All the patients were followed for 6 months. Data was recorded for age, gender, BMI, smoking and diabetes mellitus status. Infection and port site hernia were observed during the follow-up period. The SPSS version 21 was used for data analysis. Results: The majority of the patients 79 (53.4%) were above the age of 35 years. The mean age of the patients was 40.14 ±11.40 years. Females were younger than males. Among them 19 (12.8%) were males compared to 129 (87.2%) females. Mean BMI (kg/m2) of male patients were 25.98±3.53 and female patients were 24.80±3.04. The mean duration of surgery was 63.72 (+18.20) minutes, mostly accomplished is within 80mins (54.1%). Out of 148 patients in 5 (3.4%) patients port site hernia was observed. In all these patients wound to get infected and surgery was for a prolonged period. A significant association has been found between port site hernia, operative time and port site infection. However, no significant association has been found between port site hernia and gender, age, smoking and Diabetes (P>0.05). Conclusion: The frequency of port site hernia is low but could be disastrous if the bowel gets obstructed. Using good technique and reducing operative time are effective measures in reducing the port site infection and the port site hernia.

Urogynecology

Urogynecology

Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review

Since the introduction of laparoscopic surgery, it has become more popular with many advantages over open surgery including faster recovery, shorter hospital stays, and decreased tissue trauma. Despite its benefits, laparoscopic surgery can result in its own unique complications, such as the formation of a trocar site hernia (TSH), which have been reported in approximately 0-1.0% of laparoscopic cases when using non-bladed trocars. A literature review was performed from June 1990 to June 2019. PubMed was searched using the keywords "laparoscopic surgery," "trocar site hernia," and "port site hernia." Only articles in English were identified but not limited to the USA. The total number of patients in all articles was 18,533 with a mean follow-up period of 22.50 ± 1.76months. The overall trocar site hernia rate was 0.104%. When comparing open vs. closed ports, there was no significant difference in the hernia incidence rate for 5-mm and 10-mm ports. When comparing bladed versus non-bladed trocars left open, there was a statistically significant difference with lower hernia incidence rates for non-bladed trocars over bladed trocars for 5-mm, 10-mm, and 12-mm ports. And when comparing trocar location from midline versus off-midline, there was a statistically significant higher TSH incidence in midline trocar locations. Results suggest that TSH rate is lower when using non-bladed trocars for any size of trocar. When comparing whether fascial closure had an effect, the 5-mm and 10-mm ports had no difference in incidence rates and leaving the fascia open can reduce operative time, risk of needlestick injuries, and overall procedural cost. In addition, trocars at midline locations resulted in higher TSH incidence rates. Future research is still needed to assess for other factors that may influence hernia formation and how it can be minimized.

Incidence of acute postoperative robotic port-site hernias: results from a high-volume multispecialty center.

Fascial closure at 8-mm robotic port sites continues to be controversial. As the use of the robotic platform increases across multiple abdominal specialties, there are more case reports describing reoperation and small bowel resection for acute port-site hernias. A retrospective review of all robotic abdominal surgeries performed from 2012 to 2019 at NYU Langone Medical Center was conducted. Patients who had a reoperation in our facility within 30days were identified, and medical records reviewed for indications for reoperation and findings. The study included 11,566 patients, of which 82 patients (0.71%) underwent a reoperation related to the index robotic surgery within 30days. Fifteen of 11,566 patients (0.13%) had acute port-site hernias, and 3 of these 15 patients required small bowel resection. Eleven of 15 acute port-site hernias (73%) were at 8-mm robotic port site, 2 of which required a small bowel resection. More than a third of the patients had a hernia at an 8-mm port site where a surgical drain had been placed. Considering that each robotic case, regardless of specialty, has three ports at a minimum, the true incidence of acute postoperative robotic port-site hernia is 0.032% (11/34,698), with the incidence of concomitant small bowel resection being 0.006% (2/34,698). The incidence of acute port-site hernias from 8-mm robotic ports is exceedingly low across specialties. Our results do not support routine fascial closure at 8-mm robotic port sites due to an extremely low incidence. However, drain sites require special consideration.

Laparoscopic orchidopexy and its outcome in the management of nonpalpable testis

Background: Management of impalpable testis represents a significant diagnostic and operative challenge. The aim of this work was to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of impalpable testis.Methods: 51 patients with 58 nonpalpable were included in our study. Study design was case series. We have conducted this study at Surat Municipal Institute for Medical Education and Research, Surat. For each patient laparoscopy orchidopexy was performed and either testis or blind ending cord structure are searched for. The testis either brought down to the scrotum or removed depending on the condition. The patients were followed up for 12 months.Results: On diagnostic laparoscopy the number of testis found normal 54, followed by 3 hypoplastic and 1 atrophic. There were 8 testis found to be present at high intraabdominal (>2 cm from deep ring), 46 were present at low intra-abdominal (<2 cm from deep ring), intracanalicular 4. Postoperative complication included minor wound infection in one patient, none of them were diagnosed scrotal hematoma, port site hernia, and testicular atrophy.Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with nonpalpable testis. Intraabdominal dissection allows more testis to be brought down to scrotum. Laparoscopy clearly demonstrate the anatomy and provide visual information upon which a definitive decision can be made.

A safe and reliable technique for fascial closure without special devices after laparoscopic surgery.

To prevent port-site hernia, we established a simple and low-cost closure method that uses a venous catheter needle and suture, without any other special devices. We used the inner needle of a 16-G venous catheter and a 2-0 absorbable bladed suture. To evaluate the efficacy of this technique, the procedure time was noted and compared among three operators (an experienced surgeon and two inexperienced surgeons). The median suturing time was 60.5 seconds (range, 26-130 seconds) per incision. Even an unexperienced surgeon can close the fascia safely and quickly after some experience with the procedure.

SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy.
 METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated.
 RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study.
 CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

Umbilical Port Site Hernia and Diastasis Recti.

PurposeThe port site hernia (PSH) is a specific type of incisional hernia related to the trocar sites of laparoscopic surgery. Diastasis recti of the abdominis muscle (DR) is the separation of the rectus muscle by a certain distance. The present study aims to present our experience with umbilical PSH and concomitant DR and to raise awareness of DR as one of the risk factors of umbilical PSH.MethodsEighteen patients with umbilical PSH after laparoscopic abdominal surgery, was retrospectively reviewed. Preoperative CT was analyzed to measure the Inter-recti distance (IRD) for all patients. Other factors, such as trocar size, wound infection, obesity (BMI), port extension, suture materials, and pre-existing co-morbidities, were recorded and analyzed.ResultsExtension of the port incision was associated with umbilical PSH. Ten out of eighteen umbilical PSH patients (56%) had DR before they had first laparoscopic surgery. Nine (50%) patients showed sarcopenia. Moreover, four out of five recurrences had DR. More than two recurrences were all associated with DR.ConclusionPort extension and sarcopenia were risk factors of umbilical PSH. Also, DR might be a possible risk factor of umbilical PSH occurrence and recurrence. Surgeons should be aware of the presence of DR before the planning of the laparoscopic surgery by diagnostic imaging. If DR is associated with umbilical PSH, we need to consider the correction of both pathologies at the same time.

Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy.

Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3months following laparoscopic sacrocolpopexy. Two surgical interventions of a case with narrated video footage is presented. Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.

A novel technique: hemostatic agents for port-site closure post robotic-assisted urological surgeries. a pilot study

Background: Many techniques and devices are used to close the surgical ports post minimally invasive procedures. However, they have limitations and may entail complications such as hernia, infection and dehiscence. This paper proposes novel plugging technique for port-site closure using a hemostatic agent to overcome these limitations and lower the complication rate. Objective: To assess the safety and efficacy of a novel Surgicel® plug technique for portsite closure post minimally invasive urological surgeries. Methods: A retrospective study conducted at King Fahad Medical City/Riyadh/Saudi Arabia with 114 sample size. Patients included are those who underwent robotic assisted urological surgery (from January 2010 to December 2013) in which their port-sites were closed by the novel Surgicel® plug technique with a minimum of 5-years follow-up period. All data were statistically analyzed using SPSS (version 23). Descriptive variables were presented as numbers and percentages. Patient demographics, type of surgery, and followup results. Resuls: A total of 114 patients were collected. 50 were males with a mean age of 41.9 (SD=18.2) and 64 were females with a mean age of 39.2 (SD=18.3). The male-female ratio is 1:1.2. In total, two cases (1.7%) developed port-site non-infectious discharge during radical nephrectomy and pyeloplasty, and one case (0.8%) developed port-site hernia during ureteric reimplantation. 111 cases (97.3%) had no port-site complications. Conclusion: This study showed that the novel plugging technique of port-site closure post minimally invasive urological procedures using a hemostatic agent (Surgicel®) is feasible, safe, easy, and effective in the group of patients studiedand could be considered as a newapproachfor trocar sites closure.

Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse

Evidence on laparoscopic sacrocolpopexy (LSC) is lacking. Herein, we describe the complications and outcomes of LSC. This single-centre, retrospective cohort study included women with pelvic organ prolapse (POP) who underwent LSC between 2015 and 2017. Preoperative, intraoperative, postoperative, and demographic data were collected. We evaluated patients using the Pelvic Organ Prolapse Quantification system and questionnaires. The primary outcomes were operative characteristics, perioperative complications, early postoperative complications, and anatomical results at 12 months. Forty-six patients (median age: 71 years) underwent LSC. The median follow-up period was 12.0 ± 5.0 (range: 11–26) months. The perioperative complications were bladder perforation and vaginal injury (2.2%). Two (4.3%) patients required reoperation for port-site hernia. One (2.2%) patient developed a retroperitoneal abscess, and one (2.2%) had worsened stress urinary incontinence after LSC. Three (6.5%) patients presented with recurrence of prolapse. LSC is safe and effective for POP. IMPACT STATEMENT What is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has become a widely used intervention strategy during the last decade; nevertheless, few studies have reported its outcomes and complications. What do the results of this study add? We demonstrate that LSC for pelvic organ prolapse (POP) has favourable anatomical and voiding functional results, and few perioperative complications. However, it is important to preoperatively inform patients regarding the incidence of mesh-related postoperative complications, although they are not life-threatening, and secure their informed consent. What are the implications of these findings for clinical practice and/or further research? We believe that the LSC procedure, because of its short-term and functional outcomes in the lower urinary tract discussed here, will be more commonly available in clinical practice as a feasible and safe surgical option for POP. However, prospective, large-sample studies should be performed to verify the efficacy of LSC, as further evaluation of the procedure is required.

Assessment of Port Site Complication in Laparoscopic Abdominal Surgery

Abstract Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.

Is Specialisation Needed in Laparoscopic Cholecystectomy? A Retrospective Cohort Study of 5122 Patients

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.

Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate

Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.

Risk of port site hernia after laparoscopic sleeve gastrectomy

Aim: Recently, one of the most preferred options in the surgical treatment of obesity is laparoscopic sleeve gastrectomy The purpose of this study is to investigate the incidence of port site hernia formation and the factors affecting the fascia defect in the group with and without closure after LSG.Material and Methods: The data of patients who were operated due to morbid obesity in a single center between March 2014 and June 2018 was reviewed and analyzed retrospectively. The patients were divided into two groups, being those in whom the fascial defect at the 12-mm trocar insertion site from which the gastric remnant was removed during surgery was closed, and those in whom the fascial defect was not closed. The incidence of port site hernia and the factors affecting the development of port site hernia were evaluated with physical and ultrasound examinations 1year after surgery.Results: The study was completed with a total of 207 patients, of which 112 fascias was not closed and 95 fascia was closed. The rate of hernia formation was significantly lower in the fascial closure group than in the non-fascial closure group (p:0,036). Aside from this parameter, no significant difference was identified in the other parameters of the two groups. Age was significantly higher in patients that developed hernias following surgery than in those who did not develop hernias.Conclusion: This study determined that the closure of the fascial defect is a protective factor against the development of port site hernia when compared to non-fascial closure.

Risk of port site hernia after laparoscopic sleeve gastrectomy

Risk of port site hernia after laparoscopic sleeve gastrectomy

Blood clot causing small bowel obstruction after Roux en-Y Gastric bypass: a Case Report & Review of Literature

The gold standard procedure and most commonly performed bariatric surgery internationally is the Roux En-Y Gastric Bypass (RYBG) surgery. A major complication of the RYGB is small bowel obstruction (SBO; 5% incidence), most frequently caused by intra-abdominal adhesions (65–75%), followed by internal hernias, volvulus, malignancy, intussusception, Crohn’s disease, carcinomatosis, intraluminal blood clot, port site hernias, jejunojejunostomy anastomosis strictures, paralytic ileus, and superior mesenteric artery syndrome. In this review of literature, we present a small bowl obstruction case caused by a blood clot (inside the lumen) at a bleeding site within a jejunojejunostomy staple line of a surgical patient. The patient’s past-medical history is significant for recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE). The SBO was diagnosed by computed tomography (CT) post-operatively and the patient underwent emergent explorative laparoscopy for management. The intraluminal clot that was found upon examination was evacuated by enterotomy followed by a primary closure with no evidence of continued active bleeding and without need for revision of the jejunojejunal anastomosis. It was concluded that the anti-coagulant medication (Enoxaparin 50 mg BID) being administered to the patient most likely precipitated the intraluminal bleeding at the anastomosis. Based on our findings, early diagnosis and management of SBO in the early perioperative period could likely reduce the percent of this in bariatric patients.