Port-site hernia following laparoscopic cholecystectomy

David Mark Bunting, David Mark Bunting

Abstract

Background: Port-site hernia is a rare but potentially serious complication of laparoscopic cholecystectomy. This study aimed to review the current literature, assess the incidence and causes of port-site hernias, and identify methods to reduce the risk.

Methods: A systematic search of the literature published in English from 1995 to 2010 was conducted using PubMed to identify all reports of port-site, trocar-site, or incisional hernia following laparoscopic cholecystectomy. Studies in over 100 patients were identified before the application of defined exclusion criteria. The incidence of port-site hernia was calculated and compared with historical data. Predisposing factors were reviewed.

Results: Seven studies met the search criteria, with 99 port-site hernias in 5984 patients. The overall incidence of port-site hernia was 1.7% (range, 0.3% to 5.4). The most important factors were older age, higher body mass index, preexisting hernia, trocar design, trocar diameter, increased duration of surgery, and extension of the port site for gallbladder extraction.

Conclusion: The incidence of port-site hernia is low but likely to be underestimated and has not declined over time. Awareness of the predisposing factors and modification of techniques may help to reduce the risk.

References

    1. Reynolds W., Jr The first laparoscopic cholecystectomy. JSLS. 2001; 5 (1): 89–94
    1. Tonouchi H, Ohmori Y, Kobayashi M, Kusonoki M. Trocar site hernia. Arch Surg. 2004; 139: 1248–1256
    1. Fear RE. Laparoscopy: a valuable aid in gynaecological diagnosis. Obstet Gynaecol. 1968; 31: 297–309
    1. Maio A, Ruchman RB. CT diagnosis of postlaparoscopic hernia. J Comput Assist Tomogr. 1991. Nov-Dec;15(6):1054–1055
    1. Hussain A, Mahmood H, Singhal T, Balakrishnan S, Nicholls J, El-Hasani S. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS. 2009; 13 (3): 346–349
    1. Boldó E, Perez de Lucia G, Aracil JP, et al. Trocar site hernia after laparoscopic ventral hernia repair. Surg Endosc. 2007; 21 (5): 798–800
    1. McMurrick PJ, Polglase AL. Early incisional hernia after use of the 12mm port for laparoscopic surgery. Aust NZ J Surg. 1993; 63: 574–575
    1. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc. 2001; 15: 663–666
    1. Johnson WH, Fecher AM, McMahon RL, Grant JP, Pryor AD. VersaStepTM trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc. 2006; 20: 1584–1586
    1. Coda A, Bossotti M, Ferri F, et al. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech. 2000; 10: 34–38
    1. Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997; 84: 630–633
    1. Plaus WJ. Laparoscopic trocar site hernias. J Laparoendosc Surg. 1993; 3 (6): 567–570
    1. Uslu HY, Erkek AB, Cakmak A, et al. Trocar site hernia after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2007; 17 (5): 600–603
    1. Duron JJ, Hay JM, Msika S, et al. Prevalence and mechanism of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research Arch Surg. 2000; 135 (2): 208–212
    1. Lee JH, Kim W. Strangulated small bowel hernia through the port site: A case report. World J Gastroenterol. 2008; 14 (44): 6881–6883
    1. Leblanc F, Champagne BJ, Augestad KM, et al. Single Incision Laparoscopic Colectomy: Technical Aspects, Feasibility, and Expected Benefits. Diagnostic and Therapeutic Endoscopy. 2010. Published online Article ID 913216 doi:10.1155/2010/913216
    1. Azurin DJ, Go LS, Arroyo LR, Kirkland ML. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg. 1995; 61: 718–720
    1. Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona JA, Fernandez-Represa JA. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg. 1997; 21: 529–533
    1. Voyles CR, Petro AB, Meena AL, Haick AJ, Koury AM. A practical approach to laparoscopic cholecystectomy. Am J Surg. 1991; 161 (3): 365–370
    1. Larson GM, Vitale GC, Casey J, et al. Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg. 1992; 163 (2): 221–226
    1. Baird DR, Wilson JP, Mason EM, et al. An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. Am Surg. 1992; 58 (3): 206–210
    1. Balakrishnan S, Samdani T, Singhal T, et al. Patient experience with gallstone disease in a National Health Service district hospital. JSLS. 2008; 12 (4): 389–394
    1. Sanz-Lopez R, Martinez-Ramos C, Nunez-Pena JR, Ruiz de Gopegui M, Pastor- Sirera L, Tamames-Escobar S. Incisional hernias after laparoscopic vs. open cholecystectomy. Surg Endosc. 1999; 13: 922–924
    1. Munro MG. Laparoscopic access: complications, technologies and techniques. Curr Opin Obstet Gynecol. 2002; 14 (4): 365–374
    1. Ahmad SA, Schuricht AL, Azurin DJ, et al. Complications of laparoscopic cholecystectomy: the experience of a university-affiliated teaching hospital. J Laparoendosc Adv Surg Tech A. 1997; 7: 29–35
    1. Bergemann J, Hibbert M, Harkins G, Narvaez J, Asato A. Omental herniation through a 3-mm Umbilical trocar site: unmasking a hidden umbilical hernia. J Laparoendosc Adv Surg Tech. 2001; 11 (3): 171–173
    1. Raftopoulos I, Courcoulas AP. Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc. 2007; 21: 2293–2297
    1. Shafer DM, Khajanchee Y, Wong J, Swanström LL. Comparison of five different abdominal access trocar systems: analysis of insertion force, removal force, and defect size. Surg Innov. 2006. September;13(3):183–189
    1. Nakajima K, Wasa M, Kawahara H, et al. Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery. Surg Laparosc Endosc Percutan Tech. 1999; 9 (4): 294
    1. Waldhaussen JH. Incisional hernia in a 5-mm trocar site following paediatric laparoscopy. J Laparoendosc Surg. 1996;6 Suppl 1:S89–90
    1. Moreaux G, Estrade-Huchon S, Bader G, et al. Five-millimeter trocar site small bowel eviscerations after gynaecologic laparoscopic surgery. J Minim Invasive Gynecol. 2009; 16 (5): 643–645
    1. Nezhat C, Nezhat F, Seidman DS, Nezhat C. Incisional hernias after laparoscopy. J Laparoendosc Adv Surg Tech. 1997; 7 (2): 111–115
    1. Reissman P, Shilloni E, Gofrit O, Rivkind A, Durst A. Incarcerated hernia in a lateral trocar site – an unusual early postoperative complication of laparoscopic surgery. Case Report. Eur J Surg. 1994; 160: 191–192
    1. Rosenthal RJ, Szomstein S, Kennedy CI, Zundel N. Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-y gastric bypass. Surg Endosc. 2007; 21: 124–128
    1. Antoniou SA, Pointer R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc. 2010; epub ahead of print. DOI 10.1007/s00464-010-1214-8
    1. MacDonald ER, Alkari B, Ahmed I. “Single-port” laparoscopic cholecystectomy – the Aberdeen technique. Surg Laparosc Endosc Percutan Tech. 2010; 20 (1): e7–9
    1. Edwards C, Bradshaw A, Ahearne P, et al. Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases. Surg Endosc. 2010; epub ahead of print. DOI: 10.1007/s00464-010-0943-z
    1. Hodgett SE, Hernandez JM, Morton CA, et al. Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg. 2009; 13 (2): 188–192
    1. Mahmoud HY, Ustuner EH, Sozener U, Ozis SE, Turkcapar AG. Cannula site insertion technique prevents incisional hernia in laparoscopic fundoplication. Surg Laparosc Endosc Percutan Tech. 2007; 17 (4): 267–270
    1. Calik A, Yucel Y, Topaloglu S, Hos G, Aktas A, Piskin B. Umbilical trocar site closure with Berci's needle after laparoscopic cholecystectomy. Hepato-Gastroenterology. 2008; 55: 1958–1961
    1. Di Lorenzo N, Coscarella G, Lirosi F, Gaspari A. Port-site closure: a new problem, an old device. JSLS. 2002; 6: 181–183
    1. Neri V, Fersini A, Ambrosi A, Tartaglia N, Valentino TP. Umbilical port-site complications in laparoscopic cholecystectomy: role of topical antibiotic therapy. JSLS. 2008; 12 (2): 126–132

Source: PubMed

3
購読する