Page 27 - WJOLS - Surgery Journal

Malbari Pradeep Kumar Bhaskar

Figs 1A to D: Classification of the 3 trocar site hernias. (A) Normal stab wound of trocar site. (B) Early-onset type: dehiscence of anterior and
posterior fascial plane and peritoneum. (C) Late-onset type: dehiscence of anterior and posterior fascial plane. Peritoneum constitutes hernia
sac. (D) Special type: dehiscence of whole abdominal wall. Protrusion on intestine and/or omentum

about postoperative complication in GI surgery. The incidence We think fascial defect open can be clearly correlated with
of trocar site hernia is shown to be 0.65 to 2.80%, Mayol et al, the trocar site hernia. Insufficient closure will also increase the

and Nassar et al,studied based on data collected prospectively trocar site hernia risks.
and follow of patient for minimum of several months. So it is
supposed that the report made by them of the incidence (1.50 to Open/Closed Laparoscopy
1.80%) could be standard reasonably. Pneumoperitoneum is established by Veress needle or by
Hasson trocar. Trocar site hernia in closed method by Veress
PATHOGENESIS needle was more than in open method by Hasson trocar.
Mayol et al commented that in infection of wound may be more
Trocar Size
common in close type which in turn increases the incidence of

Crist and Gadacz, regarded large trocar used as predisposing trocar site hernia. Wallace and O’Dwyer 52 did open laparoscopy
factor for development of hernia. in 568 patients where no hernia was reported.
Closing Fascial Defects or Leaving them Open Location
2
Duoron et al said that fascia closer of trocar site may preclude Many authors stated that most hernia occurred at midland trocar
or decrease the incidence of obstructions. And indicate that and umbilical sites were more common. 2,4,6,8 In American
adhesions can occur after fascial closure. Incomplete closure association of gynecological laparoscopists, umbilical hernia
may lead to trocar site hernia. Many surgeons advised fascial was found to be more common (75.70%), lateral hernias were
closure. 3,4 23.70% of 152 trocar site hernias.

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