Long-Term Surgical Outcome of Trocar Site Hernia Repair

2017 ◽  
Vol 83 (2) ◽  
pp. 176-182
Author(s):  
Yoon-Hye Kwon ◽  
Eun Kyung Choe ◽  
Seung-Bum Ryoo ◽  
Jeong-Ki Kim ◽  
Kyu Joo Park
Keyword(s):  
Laparoscopic Surgery ◽  
Recurrence Rate ◽  
Late Onset ◽  
The Body ◽  
Port Site ◽  
Trocar Site ◽  
Mesh Reinforcement ◽  
Trocar Site Hernia ◽  
Onset Group

Port site hernias are emerging as a problematic complication of laparoscopic surgery. The aim of this study was to elucidate the characteristics of port site hernias and determine the long-term outcomes based on the interval between primary surgery and hernia occurrence. Twenty-four patients were surgically treated for trocar site hernia between 1997 and 2013. The patients were grouped into early-onset group (EOG; less than one month) and late-onset group (LOG; more than one month) based on the interval between laparoscopic surgery and hernia onset. A retrospective analysis was performed. There were seven patients in the EOG and 17 patients in the LOG. The body mass index was significantly higher (P = 0.033) in the LOG. In the EOG, primary closure was performed, and there were no recurrences. In the LOG, mesh reinforcement was applied in 58.8 per cent of patients, and 29.4 per cent of patients had recurrences. This recurrence rate was higher than the recurrence rate after primary repair of incisional hernia after open laparotomy (P = 0.088). In conclusion, In the EOG, small bowel resection was more frequent, but once repaired, there were no recurrences. Although mesh reinforcement was applied in the LOG, the recurrence rate was not less than the EOG.

scholarly journals Trocar-site hernia following laparoscopic salpingo-oophorectomy in a middle-aged Japanese woman: an initial case report after 40 years of experience at a single center and a brief literature review

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuniaki Ota ◽  
Yukiko Katagiri ◽  
Masafumi Katakura ◽  
Takafumi Mukai ◽  
Kentaro Nakaoka ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Small Bowel ◽  
Emergency Surgery ◽  
Japanese Woman ◽  
Port Site ◽  
Bowel Loop ◽  
Trocar Site ◽  
Invasive Approach ◽  
Trocar Site Hernia ◽  
Less Invasive Approach

Abstract Background In gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min. Case presentation A 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence. Conclusions The TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment.

Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: A long-term follow-up study

Hernia ◽  
2012 ◽  
Vol 16 (4) ◽  
pp. 431-437 ◽  
Author(s):  
E. Erdas ◽  
C. Dazzi ◽  
F. Secchi ◽  
S. Aresu ◽  
A. Pitzalis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Trocar Site ◽  
Follow Up Study ◽  
Trocar Site Hernia ◽  
Long Term Follow Up

scholarly journals Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Jim Byrne ◽  
John D Kehoe ◽  
Mohammed Yasser Kayyal
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Repair ◽  
Late Onset ◽  
Fascial Closure ◽  
Perforated Duodenal Ulcer ◽  
Trocar Site ◽  
Hernia Sac ◽  
Trocar Site Hernia ◽  
Trocar Placement ◽  
Increased Risk

Abstract Trocar-site hernia is an uncommon complication of laparoscopic surgery and can be classified as early-onset, late-onset or special type. Special type hernias usually occur in the early postoperative period and result in evisceration of intra-abdominal contents through all layers of the abdominal wall without an overlying hernia sac. We present a case of special type herniation of the appendix through a 5-mm trocar site in the right iliac fossa following laparoscopic repair of a perforated duodenal ulcer. In this case, herniation occurred after removal of a drain inserted through the trocar site intraoperatively and was treated with emergent open appendicectomy. A number of patient and technical factors may be associated with an increased risk of trocar-site herniation including increasing age, elevated body mass index, increasing trocar size, longer procedure duration and absence of fascial closure. These factors must be borne in mind when planning trocar placement and number to reduce the risk of herniation.

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

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
P Iranmanesh ◽  
K Bajwa ◽  
B Snyder ◽  
T Wilson ◽  
K Chandwani ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Port Site ◽  
Fascial Closure ◽  
Laparoscopic Bariatric Surgery ◽  
Trocar Site ◽  
Randomized Controlled ◽  
Trocar Site Hernia ◽  
Port Closure

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

Low risk of trocar site hernia repair 12 years after primary laparoscopic surgery

2011 ◽  
Vol 25 (11) ◽  
pp. 3678-3682 ◽  
Author(s):  
Frederik Helgstrand ◽  
Jacob Rosenberg ◽  
Henrik Kehlet ◽  
Thue Bisgaard
Keyword(s):  
Laparoscopic Surgery ◽  
Hernia Repair ◽  
Low Risk ◽  
Trocar Site ◽  
Trocar Site Hernia

scholarly journals No Need of Fascia Closure to Reduce Trocar Site Hernia Rate in Laparoscopic Surgery: A Prospective Study of 200 Non-Obese Patients

2016 ◽  
Vol 9 (4-5) ◽  
pp. 70-73 ◽  
Author(s):  
Rikki Singal ◽  
Muzzafar Zaman ◽  
Amit Mittal ◽  
Samita Singal ◽  
Karamjot Sandhu ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Prospective Study ◽  
Obese Patients ◽  
Trocar Site ◽  
Trocar Site Hernia ◽  
A Prospective Study ◽  
Fascia Closure

Use of Polypropylene Mesh in Addition to Internal Obturator Transposition: A Review of 59 Cases (2000–2004)

2007 ◽  
Vol 43 (3) ◽  
pp. 136-142 ◽  
Author(s):  
Stephanie Szabo ◽  
Brent Wilkens ◽  
Robert M. Radasch
Keyword(s):  
Medical Treatment ◽  
Success Rate ◽  
Recurrence Rate ◽  
Polypropylene Mesh ◽  
Mesh Reinforcement ◽  
Long Term Follow Up ◽  
Perineal Swelling ◽  
Poor Outcomes

Fifty-nine dogs with a total of 69 perineal hernias that were repaired by internal obturator transposition and polypropylene mesh reinforcement were reviewed. Thirty-six dogs were available for follow-up at a mean of 29.4 months postoperatively. Six dogs had complications within the first 60 days of surgery, such as perineal swelling, persistent tenesmus, and incisional infections. Twenty-two dogs had excellent outcomes; seven dogs needed continued medical treatment after surgery; and seven dogs had poor outcomes. Hernias recurred in five dogs. The incisional infection rate was 5.6%; the recurrence rate was 12.5%; and the overall success rate was 80.5% for the 36 dogs with long-term follow-up.

Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome

Lupus ◽  
2018 ◽  
Vol 28 (1) ◽  
pp. 123-128 ◽  
Author(s):  
M R Ugolini-Lopes ◽  
L P S Santos ◽  
C Stagnaro ◽  
L P C Seguro ◽  
M Mosca ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Early Onset ◽  
Late Onset ◽  
Long Term Outcomes ◽  
Systemic Lupus ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Onset Group ◽  
Early Onset Group

Background/Purpose Lupus nephritis (LN) usually develops within the first years of systemic lupus erythematosus (SLE) onset and rarely after that. There are scarce studies comparing early- versus late-onset nephritis (before versus after five years of SLE diagnosis). The aim of this study was to compare the severity and long-term outcome (after 7 years) in these two, late-onset and early-onset, nephritis groups. Methods This study included 93 patients from rheumatology tertiary centers from Brazil and Italy, all of them with biopsy-proven LN with > 7 years follow-up. Patients were divided in two groups: early-onset nephritis ( n = 75) and late-onset nephritis ( n = 18). Clinical and laboratorial data were obtained using a standardized electronic chart database protocol carried out at 1–6 months interval and established in 2000. Patients >50 years or with concomitant autoimmune diseases were excluded. Variables evaluated at the LN presentation were Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), creatinine, albumin, anti-DNA positivity and nephritis class. Variables evaluated at the long-term outcome (after 7 years) were Systemic Lupus International Collaborating Clinics Damage Index (SDI), creatinine, dialysis and mortality. Results The average time of LN presentation was 10.94 ± 3.73 years for the late-onset and 1.20 ± 1.60 years for the early-onset group. Their similar nephritis duration (12.44 ± 3.2 versus 13.28 ± 4.03 years, p = 0.41) and comparable mean ages (49.17 ± 9.9 versus 44.11 ± 10.8 years old, p = 0.06) allow a more accurate comparison. Regarding severity, late-onset was similar to early-onset group: SLEDAI (8 (range: 6–22) versus 12 (range: 2–24), p = 0.47), creatinine (1.36 ± 0.94 versus 1.36 ± 1.13 mg/dl, p = 0.99); albumin (2.84 ± 0.65 versus 2.59 ± 0.84 mg/dl, p = 0.30); proteinuria (3.77 ± 2.18 versus 5.01 ± 4.51 g/vol, p = 0.26); proliferative nephritis (44% ( n = 8) versus 60% ( n = 45), p = 0.23). There was also no difference in the long-term outcomes between groups: SDI (1 (range: 0–5) versus 0.5 (range: 0–5), p = 0.27); creatinine (2.04 ± 2.38 versus 1.69 ± 2.26 mg/dl, p = 0.56); dialysis (22% ( n = 4) versus 13% ( n = 10), p = 0.46) and mortality (0% ( n = 0) versus 12% ( n = 9), p = 0.19). Conclusion This study provides novel evidence of comparable long-term outcomes between late-onset and early-onset nephritis, which is most likely explained by the observation that at presentation, the clinical, laboratorial and histological features of late-onset and early-onset nephritis are similar. This suggests that there should be no distinct treatment targets and therapeutic interventions for the late- and early-onset groups.

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