Page 14 - World Journal of Laparoscopic Surgery

WJOLS
Incisional Hernias after Laparoscopic Surgery
REVIEW ARTICLE
Incisional Hernias after Laparoscopic Surgery

Mathews John
Department of General Surgery, Lifeline Hospital, Adoor, Pathanamthitta, Kerala, India

Correspondence: Mathews John, Department of General Surgery, Lifeline Hospital, Adoor, Pathanamthitta, Kerala, India
Phone: + 91-9663054330, e-mail: monoies@gmail.com

Abstract
Objective: To review about incisional hernia following laparoscopic abdominal surgery and the relationship between the pathogenesis
and clinical features and manifestation of trocar site hernias.

Methods: We searched for this subject on Medline and Google search by combining all these words like “trocar,” “port,” “hernia, and
“laparoscopy.”

Results: We were not able to find a common factor that analyzed the factors related to trocar site hernia by multivariate analysis.

Therefore, we could not indicate the only independent risk factor. However, we have referred to many reports that have logically

indicated pathogenesis. The literature what we have gone through frequently point out that the main pathogenesis is not host factors but

rather technical ones; besides, most accurate reason is that a large trocar size, leaving the fascial defect open, and stretching the port

site were closely related to the occurrence of trocar site hernias.
Conclusion: The highlight of this review article is that the drain sites can possibly be one of the sources for bowel complications. We
recommend closure of all 10 mm ports. If an intraperitoneal drain is necessary, it should be placed through a 5 mm port only.
Keywords: Laparoscopy, incisional hernia, small bowel obstruction.
INTRODUCTION Data Extraction and Study Selection: We limited the

In 1987, Mouret performed the first laparoscopic cholecys- laparoscopic surgeries to cholecystectomy, colon and rectal

tectomy changing surgical practice and it was mentioned surgery, fundoplication, and gastric surgery; finding a total

1
by Rosen and Ponsky. Then the laparoscopic abdominal of 44 reports on these procedures. Out of these, 19 case
surgery increased and was common by the 1990s. 2 The reports, 18 original articles and 7 technical notes on “how

adoption of this new technique resulted new, specific to do it” were collected. Another 19 additional reports were

operative complications. Incisional hernias at the site of entry obtained using the references of those previously obtained

of a trocar is a serious complication in laparoscopy, 3 as study. So a total of 63 reports were reviewed (24 case
most trocar site hernias require further surgery. 4 reports, 27 original articles, 7 technical notes, and 5 review

5
Fear reported first a trocar site hernia in his large series articles).
on abdominal laparoscopy in gynecological diagnosis. Many

authors haverecognized still this as the first report on trocar Data Synthesis: In this review study, we classified trocar

9
site hernias. 2,6-8 Maio and Ruchman then reported on the site hernia into 3 types. The early-onset type being the first

trocar site hernia associated with small-bowel obstruction that occurred immediately afterthe operation, with a small-

occurring immediately after laparoscopic cholecystectomy; bowel obstruction, especially the Richter hernia. The late-
this being the first report on trocar site hernias in digestive onset type being the second one thatoccurred several months

surgery. In the published reports there is enormously wide after the operation, mostly with localabdominal bulging with

variation in the clinical aspects of trocar site hernias; so no small-bowel obstruction developing and the third one a

nowadays we became more concerned about the meaning special type that occurred indicated the protrusion of the

of the medical term “trocar site hernia,” as it is not clearly
intestine and/or omentum.
defined.
MATERIALS AND METHODS REVIEW OF LITERATURE
Data Sources: We searched for this subject on Medline Crist and Gadacz 10 defined trocar site hernia as the

and Google search by combining all these words like development of a hernia at the cannula site, and this same

“trocar,” “port,” “hernia”, and “laparoscopy.” term hasbeen used in many articles over this time; however,
World Journal of Laparoscopic Surgery, January-April 2010;3(1):13-17 13