Page 35 - World Journal of Laparoscopic Surgery

Majid A Hamood

Figs 10A and B: Suture carrier

Figs 12A and B: Lowsley retractor with hand closure

Figs 11A and B: Dual-hemostat technique

13
0-absorbable suture on a curved needle. The closed straight
Lowsley retractor is passed through the 12 mm port and into
the peritoneal cavity (Fig. 12A). The blades of the Lowsley
retractor are next opened maximally to 180°. The port then is
removed from the abdomen along the shaft of the Lowsley Figs 13A and B: Reverdin and Deschamps needle
retractor, leaving only the retractor in the wound. The retractor
and the port are pulled upward. The fascia is tented toward the trocar site after laparoscopy may arise from failure to
skin surface and exposed. A standard hand-sutured closure reapproximate fascial wound edges ,infection, premature suture
with 0-absorbable suture then is performed (Fig. 12B). 23 disruption, a bulge at a previous port site should immediately
raise suspicion. 23
PORT PLUG TECHNIQUE Hernia at trocar ports is classified into three types:
1. The early-onset type (i.e., occurring immediately after the
In this technique using the bioabsorbable hernia plug hernin in operation, with small-bowel obstruction (especially Richter
trocar site,the device was implanted in the umbilical trocar hernia) frequently developing, (2) the late-onset type (i.e.,
(10 mm) implantation of the bioabsorbable hernia plug device occurring several months after the operation, mostly with
by the safe port possible in all cases. 28
local abdominal bulging and no small-bowel obstruction
developing [laparocele]), and (3) and the special type (i.e.,
DISCUSSION
indicating protrusion of the intestine and/or omentum). 20
The port site hernias are found with incidence of 0.23% at the The Richter hernia usually presents days later, and the
10 mm port site and 1.9% at the 12 mm port site. This incidence patients experience a delay in diagnosis due to persistence
markedly increases to 6.3% for obese patients with a body mass of bowel function leading to significant morbidity.This
index (BMI) greater than 30. 10, 12,14 This incisional hernia at a complication of minimally invasive surgery is rare, but

34
JAYPEE