Page 26 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):27-29
Trocar Site Hernia
Trocar Site Hernia

Malbari Pradeep Kumar Bhaskar

Laparoscopic Surgeon, Trivandrum, Kerala, India

Abstract reports are published about cholecystectomy since then and
Aims and objectives: The aim of the study was to review relationship recently on gastrointestinal surgery. In all this published reports
of pathogenesis and clinical manifestations of the hernias at the trocar there is wide variation in the clinical aspect of hernia and trocar
site, for confirmation of the definition by classification of hernia at site, so much that we became concerned about the meaning of
trocar site. The following parameters were evaluated. medical term trocar site hernia, as it was not defined.
The operations were limited to cholecystectomy, rectal and colon
surgery fundoplication and gastric surgery; getting 44 reports. Of CONTENTS
these 18 original articles, 19 case report and 7 how to do it technical
notes were gathered. We also obtained 19 additional references. Thus Trocar site hernias were classified into three different types:
we reviewed a total of 63 reports. 1. Early onset type, which occurred immediately following
Material and methods: Material search was performed using Google, operation, having small boil obstruction like the Richter
Medline-Highwire press, and also Springer link. The following terms hernia (Figs 1A and B).
were used hernia, trocar, laparoscopy, complication and Port. 1000 2. Late onset type, which occurred several months after
citations were found in all. The selected papers were screened for surgery, with local abdominal bulge and no bowel obstruc-
further reference. Selection criteria of literature were the number of tion (Fig. 1C).
cases (excluded if less than 20), analysis method (statistical or 3. Special type, which occur with the protrusion of omentum
nonstatistical), operative procedure (only universally accepted and/or intestine (Fig. 1D).
procedures were taken into consideration) and the institution where
the study was conducted (Specialized laparoscopy institute). Trocar site with 10 mm fascial defect or bigger should be
closed, with peritoneum. The opinion differed if the 5 mm trocar
Conclusion: This is useful to classify clearly the trocar site hernias defect needs to be closed.
and to improve the management of laparoscopic procedures.
It is helpful to classify clearly the trocar site hernias for
Keywords: Hernia, trocar, laparoscopy, complication, port.
better management of laparoscopic procedures.
INTRODUCTION
INCIDENCE
1
As reported by Rosen and Ponsky. Mourat did the first
laparoscopy cholecystectomy change the surgical practice Large series are reported related to complication of laparoscopic
dramatically. Abdominal laparoscopy surgery increased and cholecystectomy where incidence of trocar site hernia was 1in

2
spread wide by 1990’s. This resulted in emergence of new 500 cases,3 in 1983 cases,1 in 800,11 in 1300 cases, and 10 in
3

technique with new specific complications due to surgery. Trocar 1453 cases. Callery et al. stated that overall incidence is very

site hernia becomes serious complication as most of these need low. Mayol et al,stated that the figure only represent the early
further surgery. results of gynecological laparoscopy. Moreover the actual
5
Fear, reported trocar site hernia in a series of gynecological incidence may be much high then the reported figures as the
diagnostic laparoscopy. Many recognize this as first report of unknown percentage of patients who are asymptomatic may
9
trocar site hernia. 2,6,8 Maio and Ruchman’s reported, trocar not seek medical advice. 6,8 Coda et al noticed that onset trocar
site hernia with obstruction of small bowel immediately after site hernia is rather late then immediately after surgery in many
cholecystectomy. This is report in digestive surgery. Many surveys recently the incidence of trocar site hernia is written
Clinical character according to classification
Classification Interval between the laparoscopic Main manifestation Incidence of Richter hernia
surgery and the onset of trocar
site hernia
Early onset type A few days SBO Frequent
Late onset type Several months Hernia without SBO Rare
Special type A few days to 10 days Protrusion of intestine/omentum None

27