Trocar Site Incisional Hernia Research Articles

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.

Modified optical port entry site for laparoscopic cholecystectomy: Our experience.

<b><br>Introduction:</b> The four-port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of optical port entry site modification.</br> <b><br>Material and Methods:</b> To assess the feasibility and safety of laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 60 patients at Seth GSMC and KEM Hospital, India between Jan 2022 and July 2022. Our study offered the benefit of a flexible optical port entry site, using a 5 mm optical trocar instead of the conventional 10 mm trocar. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.</br> <b><br>Results:</b> 60 cases of gallstone disease were subjected to the new technique of laparoscopic cholecystectomy over seven months. 39 cases were females and 21 were males. The age range of our patients was between 20 and 55 years with a median age of 39 years. Mean Body mass index 30 (range 25 - 37). The mean operative time was 30 min (range 15 - 45 min) and a follow-up period ranged from 10 to 14 months. No cases were converted to open. We did not encounter any untoward mishaps during surgery.</br> <b><br>Discussion:</b> Our modification of the optical port placement and size received good results and patient satisfaction. Moreover, the placement of the port at a site further from the midline and umbilicus decreases the risk of development of trocar site incisional hernia.</br&gt.

Laparoscopic Radical Nephrectomy with Transperitoneal Approach for Large Renal Tumors: Standardized Surgical Technique and Outcomes.

Background: Minimally invasive surgery is used only in selected cases of renal masses greater than 7 cm, and few studies exist in this setting. This study aimed to evaluate the safety and effectiveness of a laparoscopic surgical approach for the treatment of large renal tumors using a standardized technique. Materials and Methods: Data of patients who underwent laparoscopic nephrectomy (LN) using the transperitoneal approach were retrospectively evaluated from December 2019 to September 2022. The study population was divided into two groups: patients with renal masses <7 cm (Group A) and those with renal masses ≥7 cm in diameter (Group B). The intraoperative and postoperative outcomes were compared. Results: Forty patients were enrolled (16 in Group A and 24 in Group B) in this study. Although significant difference in terms of age and American Society of Anesthesiologists score were detected, the two groups did not differ in mean operative time (130 minutes standard deviation [SD] ± 64 versus 148 minutes DS ± 56; P = .376), intraoperative complications (0% versus 8.3%; P = .508), need for postoperative transfusion (12% versus 12%; P > .999), and length of stay (3.38 DS ± 0.62 days versus 3.92 DS ± 2.47; P = .313). One patient had a local recurrence and died ∼13 months after surgery. Furthermore, 2 patients developed trocar-site incisional hernia in Group B. Conclusion: In this cohort of patients, LN for large renal tumors appeared to be safe and feasible. Larger mass dimension does not appear to influence the outcomes when the surgery is performed using a standardized technique by experienced surgeons.

OC-031 TROCAR SITE INCISIONAL HERNIA PREVENTION BY ONLAY MESH PLACEMENT, NOT WHAT WAS EXPECTED

Abstract Aim The prevalence of Trocar site incisional hernia (TSIH) might be as high as 30%, due to this reason is paramount to find a better closure technique. Our aim is to test the TSIH preventive effect of the placement of an onlay mesh versus the standard fascial closure at the umbilical trocar site closure. Material&amp;Methods We designed a Two-Center Randomized Controlled Trial where adult participants presenting for elective laparoscopic cholecystectomy, were allocated into 2 groups (Prosthesis and Control). The Hasson technique was the pneumoperitoneum creation technique. The procedure in the Prosthesis group consisted in the complete closure of the umbilical vertical section of the aponeurosis by single 0 Polydioxanone stitches, a 2cm onlay plane dissection, the placement of a lightweight, large-pore synthetic mesh and its fixation applying cyanoacrylate glue, subcutaneous stitches, and skin staplers. The Control group aponeurosis was closed by single stitches of Polydioxanone followed by skin staplers. An ultrasound scan was performed at 12 postoperative months. Results At 12-month control, a 41.7% incidence of TSIH was recorded in the Prosthesis group while 28.5% in the control group. 6 patients developed a superficial wound infection at the umbilical port site in the Prosthesis group, and none in the Control group. 5 of the patients had to be operated for mesh removal as they developed 4 chronic infections and 1 seroma with bad wound pain control. Conclusions The preliminary results of the study show no benefit in the Prosthesis group for the prevention of TSIH and presented with a greater number of complications.

Topical use of hyperoxygenated fatty acids decreases surgical site infection in patients following laparoscopic cholecystectomy. A randomized controlled trial

BackgroundTo date, the topically effect of hyperoxygenated fatty acids (HOFA) on the control of surgical site infection (SSI) is still unclear. ObjectiveTo assess the effect of topical application of a HOFA solution on the umbilical trocar site after laparoscopic cholecystectomy on SSI. The occurrence of trocar site incisional hernia (TSIH) was also analyzed. MethodsA prospective, double-blind, randomized trial was conducted in patients undergoing laparoscopic cholecystectomy, who also presented at least one of the following associated risk factors for SSI and TSIH such as Body Mass Index (BMI) above 30 kg/m2, Diabetes Mellitus (DM), age over 65 years and Chronic Obstructive Pulmonary Disease (COPD). Patients were randomly allocated to topical application of a HOFA solution (HOFA arm) or saline physiological solution (non-HOFA arm) during closure of the umbilical trocar site with a polypropylene mesh. SSI was the primary outcome. TSIH was also assessed as a secondary outcome. Results103 patients were included, 51 (49.5%) in the HOFA group and 52 (50.5%) in the non-HOFA group. SSI rate was significantly lower in the HOFA group in comparison with the non-HOFA group (19.6% vs. 3.8%; p = 0.028). TSIH rates were similar in both groups (3.8% vs. 2%). Multivariate analyses showed that only HOFA decreased significantly SSI rate. ConclusionTopical application of a HOFA solution at the umbilical trocar site after laparoscopy cholecystectomy decreased SSI rate.

Trentino Hernia Team Technique Plus Endoscopic Transversus Abdominis Release for Large Ventral Incisional Hernias: Description of the First Case

Trentino Hernia Team Technique Plus Endoscopic Transversus Abdominis Release for Large Ventral Incisional Hernias: Description of the First Case

Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study

BackgroundTrocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors.MethodsA cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors.Results76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p < 0.001). Mean follow-up time was 34 months.ConclusionsTSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years.Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744

Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort

Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. 272 patients with a mean age of 70.7years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.

Laparoscopic repair of ventral/incisional hernias with the "Slim-Mesh" technique without transabdominal fixation sutures: preliminary report on short/midterm results.

This study details our experience with a new laparoscopic technique called "Slim-Mesh" without using transabdominal full-thickness stitches, to treat ventral and incisional hernias (V/IH). Since 2009-May 2015, 28 consecutive patients with V/IH were treated in our center, with this new SM technique. Fifty percent males were included in this retrospective study, averaging 59years (range 31-81years). Mean body mass index was 26 and VH size was <10cm in 24 cases and in 4 cases was larger, up to 22cm. Mean operative time in the 28 V/IH patients was 97min (range 57-160min) and in those with V/IH larger than 10cm it was 135min. In 14.2% of patients laparoscopy diagnosed others V/IH previously undetected by physical examination and CT-scan. In all patients a composite mesh was used, up to 30cm in size. In this series we had one intraoperative complication (3.6%) with transient bradycardia, but no conversion occurred; no early postoperative complication was detected. Mean length of hospital stay was 3.0days. Mean follow-up time was 40months (range 13-78months). Late surgical complications included one case (3.6%) of incisional hernia recurrence and one case of 10mm trocar site incisional hernia. This new surgical technique for V/IH repair, makes easy the handling and fixation of the composite mesh without using transabdominal fixation sutures, and appears in our experience fast, and simple.

Does single-port laparoscopic sleeve gastrectomy result in improved short-term perioperative outcomes compared to conventional multi-port laparoscopic sleeve gastrectomy?

A best evidence topic in bariatric surgery was written according to a structured protocol. The question asked whether single-port laparoscopic sleeve gastrectomy produces better short-term perioperative outcomes compared to the conventional multi-port laparoscopic sleeve gastrectomy in the treatment of morbid obesity. A Pubmed search generated 82 papers, 6 of which represented the best evidence to answer the clinical question. Of the 6, 1 paper was an updated analysis of the same patient cohort. The evidence on this subject is good. Five papers were level III, nonrandomized studies, 2 of which were prospective and 3 were retrospective cohort studies. The sixth paper was a level II, randomized, prospective study. We conclude that single-port laparoscopic sleeve gastrectomy results in less use of postoperative analgesia and better cosmetic satisfaction compared to multi-port laparoscopic sleeve gastrectomy in the short-term. The two groups showed comparable results in terms of mean operative time, mean hospitalization, and percentage excess weight loss. There was no difference in rate of postoperative complications including trocar site incisional hernia, staple line leaks, and bleeding.

Prophylactic Mesh vs Suture in the Closure of the Umbilical Trocar Site after Laparoscopic Cholecystectomy in High-Risk Patients for Incisional Hernia. A Randomized Clinical Trial

Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients. A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery. A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups. Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients.

Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study

BackgroundTrocar site incisional hernia (TSIH) is a common complication after laparoscopic cholecystectomy. The aim of this study was to evaluate the prevalence of TSIH and analyze the influence of several risk factors for this complication in a prospective series. MethodsFrom 2007 to 2008, a prospective observational study with 3 years of follow-up was performed including all consecutive patients with cholelithiasis who underwent elective laparoscopic cholecystectomy. A multivariate analysis was performed to identify risk factors for TSIH. ResultsOverall, 241 patients were included. During a median follow-up period of 46.8 months, 57 patients (25.9%) were diagnosed with umbilical TSIH by physical exam or ultrasound. The multivariate analysis revealed that incision enlargement (odds ratio [OR], 14.17; 95% confidence interval [CI], 3.61 to 55.51; P < .001), wound infection (OR, 5.62; 95% CI, 2.35 to 13.42; P < .001), diabetes mellitus (OR, 2.79; 95% CI, 1.05 to 7.37; P = .0038), and obesity (OR, 2.71; 95% CI, 1.28 to 5.75; P = .009) contributed to the risk for developing a TSIH. ConclusionsUmbilical TSIH is highly prevalent. This study identified several factors that could be useful to introduce preventive measures in high-risk patients.

A rare case of interparietal incisional hernia from 8 mm trocar site after robot-assisted laparoscopic prostatectomy

Trocar site hernia arising from 8mm robotic port is very rare despite the increasing prevalence of robot-assisted surgeries. To date, there had been only a single case reported in the literature. We report a case of small bowel obstruction secondary to an interparietal trocar site incisional hernia after robot-assisted laparoscopic prostatectomy. Meticulous closure of 8mm robotic trocar sites associated with large peritoneal defect at the end of surgery should be performed.

Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results

Laparoscopic ventral rectopexy limits the risk of autonomic nerve damage, and the colpopexy allows correction of a concomitant prolapse of the middle compartment. The aim of this study is to describe a modified laparoscopic ventral rectocolpopexy procedure with a low approach to the sacral hollow (laparoscopic low ventral rectocolpopexy: LLVR). We propose this technique to manage combined rectogenital prolapse. Between November 2006 and June 2009, all patients with symptomatic rectal prolapse associated with genital prolapse and/or enterocele underwent LLVR. Demographics, results of imaging studies, mortality, morbidity, and functional outcome were retrospectively analyzed. Thirty patients underwent LLVR: two patients suffered from a full-thickness rectal prolapse while 28 had symptomatic recto-anal intussusception. The mean operating time was 94 ± 39 minutes. Conversion to laparotomy was never needed. Hospital stay ranged between 2 and 14 days (mean of 5 ± 2.5 days). No mortality was recorded and only two complications occurred (6.6%): one trocar site incisional hernia and one vaginal suture erosion in a patient who had concomitant hysterectomy. After a mean follow-up of 13.9 months, constipation was completely resolved or improved in 92.8% patients. Significant reduction in the mean Altomare obstructed defecation score (14.7-5.6; p < 0.05) was recorded. Preoperative incontinence improved after the procedure in all patients affected. No new cases of postoperative constipation or fecal incontinence were registered. Only one case of recurrence in a patient with recto-anal intussusception was recorded (3.4%), after 19 months. Laparoscopic low ventral rectocolpopexy is safe and associated with very low morbidity. In the medium term, it provides good result for prolapse and associated symptoms.

Anatomical closure of trocar site by using tip hole needle and redirecting suture hook

The incidence of trocar site incisional hernia following laparoscopic surgery is reported to be relatively high. The main reasons are trocar diameter and design, pre-existing fascial defects, and some operation- and patient-related factors. The goal of this article is to present a new procedure for anatomical closure of the trocar site to prevent its herniation. In this study, 120 patients underwent laparoscopic cholecystectomy from June 2006 through February 2009 at the General Surgery Department, Zagazig University Hospital, Egypt. After the laparoscopic procedure was complete, the trocar sites were closed in anatomical layers by using a tip hole needle and a redirecting suture hook. The mean follow-up period was 2 years for any complication at these trocar sites. The mean hospital stay was 1.2 days, the mean age of the patients was 49.4 years, and the mean time to place one suture was 5 min. No trocar site hernia occurred with this technique during a mean follow-up of 2 years. Seven patients developed superficial infection at the trocar site and no mortality was reported. Good closure of the trocar site in layers by using a tip hole needle and a redirecting suture hook will prevent trocar site herniation.

A simplified laparoscopic ventral hernia repair: the scroll technique

Dear Sir, We read with great interest the article entitled A Simplified Laparoscopic Ventral Hernia Repair: The Scroll Technique published in Surgical Endoscopy [1]. We congratulate authors for their excellent results and their description of a new technique for mesh insertion in the laparoscopic repair of ventral hernia. With our technique, published in the JSLS [2], we introduce the mesh through a trocar placed in the center of the hernia defect itself. This provides two benefits. It prevents trocar-site incisional hernia, reported in other series [3], and avoids inducing weakness in other sites of the abdomen and a difficult closure, especially in obese patients. The orientation and placement of the mesh is ensured by putting a long suture in the center of the mesh and two stitches in the mesh at the 6 and 12 o’clock positions before insertion. The end of the long suture remains outside the abdomen through the trocar when the mesh is fully inside the abdomen. Pulling on that long suture helps to centralize the mesh in relation to the hernia defect. The two sutures in the 6 and 12 o’clock positions help to orient the mesh in longitudinal or transverse position according to the shape and size of the hernia defect. The authors reported one case of mesh infection, and we are interested in the way this problem has been managed. Also, they reported no case of incisional hernia at the 12-mm trocar site, and we are interested in knowing whether this issue was investigated during the follow-up period. Another point is seroma formation associated with polytetrafluoroethylene (PTFE). The authors explained this as due either to the tight weaving of the mesh or to the mesh material. They also recommend abdominal binder postoperatively to reduce the seroma formation. In our practice, we did not find a significant association between the type of mesh and seroma formation, which we believe is entirely related to the size of the hernia, the thickness of subcutaneous fat, extent of dissection and the hemo-static technique and not to the type of mesh. Having said that, we also advise abdominal binder postoperatively for 2 weeks because we believe this will reduce the seroma formation.

Small bowel obstruction at a Filshie clip applicator port site

Laparoscopic Filshie clip sterilisation remains a common method of permanent female contraception. Worldwide, approximately 190 million couples use tubal occlusion (United Nations world population monitoring. United Nations, 2002). Trocar site incisional hernia has been reported as a complication of laparoscopic surgery where a 10-mm port was employed (Tonouchi et al. Arch Surg 139(11):1248–1256, 2004). It is common practice to repair port sites of 10 mm or more to prevent herniation. Port sites of 5 mm are not routinely repaired by most surgeons because it is thought that such iatrogenic fascial defects are not large enough to predispose to hernia (Reardon et al. J Laparoendosc Adv Surg Tech A 9(6):523–525, 1999). We report a rare case of early Filshie clip applicator port site intestinal obstruction following laparoscopic sterilisation. The mechanism of hernia formation and a preventive strategy are discussed.