Trocar Site Hernia Research Articles

TROCAR SITE CLOSURE WITH OMENTAL PLUG INSERTION IN LAPAROSCOPIC BARIATRIC OPERATIONS: EFFICACY, SAFETY, AND OUTCOMES

Introduction:Trocar site herniation (TSH) remains a significant complication following laparoscopic bariatric surgery. Conventional closure techniques often prove challenging and may lead to inadequate closure, increasing the risk of TSH. This study aimed to evaluate the effectiveness and safety of a novel omental plug technique for closing trocar sites in laparoscopic bariatric surgery. Methodology:A retrospective study included 256 patients who underwent laparoscopic bariatric surgery (LSG, OAGB, or RYGB) between 2019 and 2023 at Armed Forces Hospital, Taif, Saudi Arabia. We used an innovative omental plug technique to close trocar sites ≥10mm. The primary outcome was the incidence of TSH within 12 months postoperatively, assessed clinically and with an ultrasonography examination. Secondary outcomes included wound infections, seroma formation, and reoperation for trocar site complications. Results:We observed no cases of TSH, indicating significant efficacy in preventing this complication. Other postoperative complications were minimal, with only one case (0.4%) of a superficial wound infection. Conclusion:In laparoscopic bariatric surgery, the omental plug technique demonstrated promising results in preventing TSH and reducing postoperative complications. Its ease of use, safety profile, and potential biological advantages suggest it may be a valuable alternative to traditional fascial closure methods. We warrant future larger, multicentric studies with longer follow-up to confirm these findings.

Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial

BackgroundRobotic-assisted laparoscopic surgery (RALS) has become a widely and increasingly used modality of minimally invasive surgery in the treatment of endometrial cancer (EC). Due to its technical advantages, RALS offers benefits, such as a lower rate of conversions compared to conventional laparoscopy (CLS). Yet, data on long-term oncological outcomes after RALS is scarce and based on retrospective cohort studies only. ObjectivesThis study aimed to assess overall survival (OS), progression-free survival (PFS), and long-term surgical complications in EC patients randomly assigned to RALS or CLS. Study DesignThis randomized controlled trial was conducted at the Department of Gynecology and Obstetrics of Tampere University Hospital, Finland. Between 2010 and 2013, 101 patients with low-grade EC scheduled for minimally invasive surgery were randomized preoperatively 1:1 either to RALS or CLS. All patients underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. A total of 97 patients (49 in the RALS group and 48 in the CLS group) were followed up for a minimum of 10 years. Survival was analyzed using Kaplan-Meier curves, log-rank test, and Cox proportional hazard models. Binary logistic regression analysis was used to analyze risk factors for trocar site hernia. ResultsIn the multivariable regression analysis, OS was favorable in the RALS group (HR 0.39; 95% CI, 0.15–0.99, p=.047) compared to the CLS group. There was no difference in PFS (log-rank test, p=.598). The three-, 5- and 10-year OS were 98.0% (95% CI, 94.0–100) vs. 97.9% (93.8–100), 91.8% (84.2–99.4) vs. 93.7% (86.8–100), and 75.5% (64.5–87.5) vs. 85.4% (75.4–95.4) in the CLS and the RALS group, respectively. Trocar site hernia developed more often in the RALS group compared to the CLS group 18.2% vs. 4.1% (OR 5.42, 95% CI, 1.11–26.59, p=.028). The incidence of lymphocele, lymphedema, or other long-term complications did not differ between the groups. ConclusionsThe results of this RCT suggest a minor OS benefit in EC after RALS compared to CLS. Hence, the use of RALS in the treatment of EC seems safe, but larger RCTs are needed to confirm the potential survival benefit of RALS. No alarming safety signals were detected in the RALS group since the rate of long-term complications differed only in the incidence of trocar site hernia.

Trocar-site incisional hernia after 8-mm robotic trocar placement: A prospective study.

The current literature supports the closure of trocar sites ≥10-mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5-mm trocars. To date, evidence regarding the closure of 8-mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8-mm trocars. We prospectively collected data on all patients undergoing robotic-assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8-mm trocars was not closed. The enrolled patients underwent a follow-up visit during which we conducted clinical and sonographic evaluations of all 8-mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port-site hernia. We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1±14.0years, and mean BMI was 27.0±3.9kg/m2. The follow-up visits were carried out after a median follow-up of 14.5 (9.0-23.2) months. Only one case developed an asymptomatic 1×1cm supra-umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8-mm trocars and skin sutures of 9.8±0.5 out of 10 points. The occurrence of a trocar-site hernia after 8-mm robotic access is extremely low. Hence, the fascia closure may not be necessary.

Robotic 8-mm trocar fascial wounds: To close or not to close?

The aim of this study was to investigate 8-mm robotic trocar site hernia (TSH) rate over the short and long term, providing aids to manage the related fascial wounds. A retrospective analysis of 320 patients undergoing robotic surgery was conducted. The primary outcome was 8-mm TSH rate with a minimum follow-up of 12months. The secondary outcome was the rate of haematomas and infections related to 8-mm wounds and their association with patient comorbidities and trocar position. One case of TSH was observed (0.31%). There were 15 cases of wound infection (4.68%) and 22 cases of wound haematoma (6.87%). Trocar related complications were significantly associated with patient comorbidities, not with trocar position. Our results do not justify the 8-mm fascial wound closure. Data concerning the association between trocar-related complications and patient comorbidities strengthen the need to implement the control of metabolic state and correct administration of perioperative therapy in high-risk patients.

A virtual simulation approach to assess the effect of trocar-site placement and scar characteristics on the abdominal wall biomechanics

Analyses of registries and medical imaging suggest that laparoscopic surgery may be penalized with a high incidence of trocar-site hernias (TSH). In addition to trocar diameter, the location of the surgical wound (SW) may affect TSH incidence. The intra-abdominal pressure (IAP) exerted on the abdominal wall (AW) might also influence the appearance of TSH. In the present study, we used finite element (FE) simulations to predict the influence of trocar location and SW characteristics (stiffness) on the mechanical behavior of the AW subject to an IAP. Two models of laparoscopy patterns on the AW, with trocars in the 5–12 mm range, were generated. FE simulations for IAP values within the 4 kPa–20 kPa range were carried out using the Code Aster open-source software. Different stiffness levels of the SW tissue were considered. We found that midline-located surgical wounds barely deformed, even though they moved outwards along with the regular LA tissue. Laterally located SWs hardly changed their location but they experienced significant variations in their volume and shape. The amount of deformation of lateral SWs was found to strongly depend on their stiffness. Trocar incisions placed in a LA with non-diastatic dimensions do not compromise its mechanical integrity. The more lateral the trocars are placed, the greater is their deformation, regardless of their size. Thus, to prevent TSH it might be advisable to close lateral trocars with a suture, or even use a prosthetic reinforcement depending on the patient's risk factors (e.g., obesity).

Does the angle of trocar insertion affect the fascial defect caused? A porcine model

IntroductionWith an incidence of 0–5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model.MethodsIn October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis.ResultsThe bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007).ConclusionWhen conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia.

Women have a 3% lifetime chance of developing an inguinal hernia, which is not as common in men. Due to its cosmetic benefits, single-incision laparoscopic transabdominal preperitoneal (SIL-TAPP) inguinal hernia repair is becoming increasingly popular in the management of inguinal hernia in women. However, there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal (CL-TAPP) inguinal hernia repair for the treatment of inguinal hernia in women. To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients. We retrospectively compared the clinical information and follow-up data of female inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hospital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts. This study included 123 patients, with 71 undergoing SIL-TAPP repair and 52 undergoing CL-TAPP repair. The two cohorts of patients and inguinal hernia characteristics were similar, with no statistically meaningful difference. The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort (0, 0%) than in patients in the CL-TAPP cohort (4, 7.7%) and was significantly different (P < 0.05). In addition, the median [interquartile range (IQR)] total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort [$3287 (3218-3325)] than in patients in the CL-TAPP cohort [$3511 (3491-3599)]. Postoperatively, the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort (0, 0%) than in the CL-TAPP cohort (4, 7.7%), and the median (IQR) cosmetic score was significantly higher in the SIL-TAPP cohort [10 (10-10)] than in the CL-TAPP cohort [9 (9-10)]. SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female inguinal hernia patients. Moreover, female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who underwent CL-TAPP repair. In addition, female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision. Therefore, SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

"Slim-Mesh" Technique for Diastasis Recti Abdominis, Including Obesity-Related Cases.

We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti muscles without plicating and traumatizing them. Additional objectives were to decrease operation time and intra- and postoperative complications. We considered T1 cases diastasis after pregnancy and T2 cases obesity (BMI ≥ 30 mg/kg2); D1, D2, and D3 when the diastasis measured 2-3, 3-5, and ≥ 5 cm, respectively; H0 and H1 without and concomitant umbilical and/or epigastric hernia, respectively. At our Department, between May 2010 and November 2022, 47 patients with diastasis recti were operated on with the "Slim-Mesh" technique to reinforce/repair the traumatized linea alba/recti muscles, without plicating them. This was a prospective (83%)-retrospective study. We studied 23 males and 24 females. Mean age and BMI was 58 years and 29 kg/m2, respectively. Groups D1, D2, and D3 comprised 6, 23 and 18 patients, respectively; groups T1, T2, H0 and H1 comprised 22, 25, 13 and 34 patients, respectively. Mean operation time for all cases was 100 minutes. Mean length of hospital stay was 2.3 days and follow-up time was 5 years. We had 6 late postoperative complications: 3 hernia recurrences and 3 trocar site hernias. Considering the lack of agreement on the best surgery for diastasis recti abdominis repair, in our experience the "Slim-Mesh" technique is a valid, safe and easy-to-reproduce way to save, repair and reinforce linea alba/recti muscles in diastasis recti patients, including the obese population (53%).

Madany closure: a novel technique for fascial closure in laparoscopic surgery

Background Laparoscopic surgery is now the accepted method of choice for practically all abdominal procedures. A number of trocar site closure techniques have been developed, but many of them are unaffordable and/or difficult to employ. Patients and methods The objective of this prospective interventional study is to assess the duration required to close the trocar site, the incidence of hemorrhage or other postoperative problems, and the safety and effectiveness of a novel fascial closure technique (the Madany closure). Patients who were eligible for laparoscopic cholecystectomy at the Aswan University Hospital’s General Surgery Department were included. Results One hundred and thirty patients were included in our study. Most of the participants were females, representing 93.08% of patients. The mean age of participants was 40.07±10.02 years, and the median (interquartile range) total time for the complete closure of the port site was 83.5 s (44.75 s). After the follow-up period of 6 months, no patient developed a trocar-site hernia. Conclusion The Madany closure technique provides a safe, fast, and effective technique for the closure of laparoscopic port sites.

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study.

Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage oftotal weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.

Onlay Repair Using Self-Gripping Mesh for Lateral Trocar Site Hernia After Laparoscopic Incisional Hernia Repair: A Case Report With Short- and Mid-Term Outcomes

Introduction Trocar site hernia (TSH) is an uncommon complication after laparoscopic surgery, but it may potentially require surgical intervention. The available data have shown the importance of prediction and prevention; the optimal surgical approach for TSH remains unclear, and its long-term outcome is scarcely available. Here, we present a case of a lateral TSH after laparoscopic incisional hernia repair, which was successfully repaired using the onlay technique with a self-gripping mesh. Case presentation A 74-year-old woman presented with an abdominal incisional hernia at the midline after an open cholecystectomy. She underwent laparoscopic surgery for incisional hernia with intraperitoneal onlay mesh repair. Fascial closure was performed for trocar sites. After 12 months, she noticed a painful bulge in the left upper quadrant suggestive of TSH. At the time of diagnosis, her body mass index was 32 kg/m2. TSH repair was performed under general anesthesia. A 3 × 3 cm defect was identified, and the hernial content was found to be the omentum. Defect closure was performed using interrupted sutures followed by placement of a self-gripping mesh (11 × 11 cm in size, obtaining a 4-cm overlap for the defect). The operative time was 80 minutes. The postoperative course was uneventful except for a spontaneously resolved seroma. Computed tomography scan at the 1-year follow-up and physical examination at the 2-year visit showed no recurrence. Conclusion Our proposed onlay repair using self-gripping mesh may be considered as the treatment of choice for cases of lateral TSH after laparoscopic incisional hernia repair.

Laparoscopic Inguinal Hernia Repair and Synchronous Peritoneal Dialysis Catheter Placement: A Single-Center Experience.

Background: Peritoneal dialysis (PD) is a common method for treating end-stage renal disease (ESRD). Occurrence of inguinal hernia before and during PD is considered to be the main cause of treatment discontinuation, failure, and conversion to hemodialysis. In this study, we present a single-center experience about laparoscopic inguinal hernia repair and synchronous PD catheter placement and evaluated the feasibility and outcomes. Methods: During May 2018 to May 2022, a total of 216 consecutive patients with ESRD underwent laparoscopic PD catheter placement. Among them, 41 patients (27.7%) with coexistent inguinal hernia were included in this study. Individual information, complications, recurrent and new-onset hernias, and catheter survival were retrospectively analyzed. Results: Forty-one patients underwent laparoscopic inguinal hernia repair and synchronous PD catheter placement, 9 patients had bilateral inguinal hernia, and another 32 patients had unilateral inguinal hernia. The mean age was 46.49 years (range, 28-72 years), including 39 males and 2 females. There was no recurrent hernia and only 1 patient (2.4%) developed incisional hernia (trocar site hernia) which required hernia repair and discontinuation of PD. No postoperative complications were observed, such as bleeding, infection, and dialysate leakage. After a median follow-up of 37 months (20-58 months), there were no deaths and 97.6% (40/41) catheters were still working. Conclusions: Laparoscopic hernia repair and synchronous PD catheter placement is an effective and safe treatment for ESRD patients with coexisting inguinal hernia in virtue of low postoperative complications and high catheter survival.

Laparoscopic Sleeve Gastrectomy in Patients Over 60 Years Old: A Long-Term Follow-Up.

Purpose: This study analyzed the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients over 60 years old, in a long-term follow-up, in a high-volume bariatric center. Methods: We retrospectively analyzed all patients older than 60 years who underwent LSG in our center from January 2009 to December 2018. A prospectively collected database of 4991 consecutive LSG cases was reviewed. Results: One hundred seventy-nine sleeve gastrectomy procedures were performed in patients older than 60 years, 135 were aged 60-65 years (group A) and 44 were older than 65 years (group B). We reported five cases (2.7%) of early complications: three postoperative hemorrhages, one cardial leakage, and one perigastric abscess. No thromboembolic events or mortality rates were reported. The mean follow-up period was 5.5 years (66 months). The follow-up loss rate was about 29%. At last follow-up, the mean body-mass index/body mass/percentage of excess weight loss values were, respectively, 33.7 ± 7/86.1 ± 21/60.4 ± 28.6 in group A and 32.4 ± 6.4/82.6 ± 18/61.8 ± 33 in group B. We reported 5 (4.0%) trocar site hernias, 1 (0.8%) cardial junction stenosis, and 22 (18%) new outbreaks of gastroesophageal reflux (GERD). There were 7 reinterventions (5.7%): 5 for weight regain and 2 for GERD not responding to medical therapy. There were no statistically significant differences between the two age groups. Conclusions: LSG is a safe and effective treatment for severe obesity in people over 60 years old. There are no differences in results of patients over 65 years and between 60 and 65 years old. Scales that include associated medical problems and the patient's general condition must be considered.

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.

P-017 TROCAR SITE HERNIA: IS IT A MINOR PROBLEM ?

Abstract Aim Describe the characteristics of a trocar site hernia (TSH) in our center. Materials and methods Descriptive retrospective observational study. Tertiary hospital center. Period: July 2018 - November 2022. Inclusion criteria: Patients operated on for TSH. We analyzed patient characteristics, type of the primary procedure (appendectomy, cholecystectomy or other), TSH data and characteristics of TSH repair. Results 150 patients were included. Patient data: 65.3% were women. Median age: 59.54 years. BMI &amp;lt;35 in 47%. BMI was higher in cholecystectomies than in appendectomies. 66% were ASA II. 31.3% were active smokers. Surgical primary procedures: 59.4% cholecystectomy, 17.3% appendectomy, 23.3% others. Surgical TSH time: 30–90 minutes (59.6%) and 36.7% were performed as an emergency procedure. TSH data: 85.3% were M3, mean size was 3.8 cm Time between primary surgery and TSH: 39.6 months. The size of the TSH only had a statistically relationship with the time between primary surgery and TSH diagnosis. Furthermore, 17.3% of the TSH were recurrences, of which 77% already had a mesh. 91% of the TSH were scheduled surgery, with a mean surgical time of 70 minutes. All were repaired with a mesh, 68.6% preperitoneal/medial retromuscular. Regarding complications, 7.4% presented after a month and 1.3% recurred after 6 months. Conclusions According to our data, the TSH is not a minor problem with high morbility and resource consumption. The rate of TSH is greater in obese women undergoing cholecystectomy. Perhaps a prophylactic mesh policy should consider in these cases.

P-072 INCIDENCE OF TROCAR SITE HERNIA AFTER LAPAROSCOPIC BARIATRIC SURGERY, A LONG TERM FOLLOW UP

Abstract Aim Given the increased use of laparoscopic surgery, the possible complications associated with it must be considered. Trocar site hernias (TSH) are one of them, being more frequent in obese patients. With this study we want to know the importance of the problem and evaluate our own results. Methods We made an observational, descriptive, longitudinal and retrospective study in patients undergoing laparoscopic bariatric surgery with 12mm bladeless trocars without fascial closure between January 2015 and July 2016. They were interrogated about symptoms and postoperative infection in the ports, and an abdominal wall ultrasound were performed by an expert radiologist in December 2022. Results 45 patients were included. The average age was 49.9 years-old (77.8% women) with a mean initial BMI of 45.5kg/m2 and actual BMI of 30.2 kg/m2. Among risk factors we found 31.1% of smokers, 46.7% of diabetes and 64.4% of respiratory pathology. The main surgery was gastric bypass (88.9%). 7 patients presented TSH (15.6%) and 6 patients presented symptomatology in any trocar site (13.3%), although only 2 (4.4%) showed hernia ecographically at the symptomatic port. We studied 189 ports and detected a 3.7% TSH in the control echography 6–7 years after surgery, all of them in the epigastric trocar. Conclusions The incidence of TSH after bariatric surgery with 12mm bladeless trocars is low considering patient´s characteristics. All the THS were in the midline port, which raises the possibility of systematic closure, change its position or contemplate this low incidence as acceptable considering its difficulty of closing.

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 &amp; 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.

Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives

The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females.Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias.Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.

An individualised approach to reduce trocar site hernia

In systematic reviews, the calculated pooled prevalence of trocar site hernia (TSH) has been estimated at 0.5%. Increasing age, high body mass index, smoking, and wound infection potentially influence the incidence. Increasing trocar size, retrieval of specimens through trocar sites, excessive force used in manipulation of the trocar and frequent re-insertion of the trocar may also play a role in the enlargement of the muscolofascial defects. This paper reports a case of a Richter’s hernia within a 5 mm abdominal port site occurring in the early post operative period following laparoscopy. This is significant because it is an uncommon complication of a common procedure. We highlight that various factors may increase the likelihood of this uncommon condition, and provide a brief overview of TSHs.

¿Es preferible el TAPP por vía laparoscópica para el tratamiento de la hernia inguinal? Técnica, indicaciones y expectativas de futuro

The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguino-scrotal hernias and obese, being also a better alternative for females.Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias.Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.