Page 38 - Journal of Laparoscopic Surgery

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Mohammed Arifuzaman, Asna Samreen 10.5005/jp-journals-10033-1342
REVIEW ARTICLE

Laparoscopic Port Closure Techniques and Incidence of

Port-site Hernias: A Review and Recommendations

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1 Mohammed Arifuzaman, Asna Samreen

ABSTRACT INTRODUCTION
Minimally invasive surgeries have dawned a new era in surgical Throughout our history, the abdominal surgical proce-
practice, cosmesis and safety. These have been heralded as dures have been performed through large incisions. Most
one of the best surgical methods to treat a multitude of surgical
disorders. Though the term minimally invasive seems attractive, of which were concurrently associated with multiple
in the real sense of the word, these surgeries are minimal access morbidities which include postoperative pain, wound
surgeries and do require incisions for trocars. The wounds must infections, wound dehiscence, longer hospital stay and a
be closed appropriately to prevent the incidence of port-site higher incidence of incisional hernias. With the advances
1
hernia. Though rare, port-site hernias can cause considerable in surgery, incisions started to get smaller, and it was not
morbidity. Most of these are seen in the midline, particularly
around the umbilicus, but there are reports of herniation at very late until laparoscopic procedures were introduced
laterally placed ports. The accepted surgical practice is to close in the early 1930s, when Ruddock, an American surgeon
the fascial layers at all midline laparoscopic ports. There is a described laparoscopy as diagnostic procedure superior
multitude of ways in which the ports can be closed. This article to Laparotomy. The modern era of laparoscopic surgery
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aims to review the various port closure techniques practiced is widely accepted to have commenced from September
by different surgeons and institutions to and reflect upon the 3
pathophysiology of port-site hernia and recommendations to 12, 1985, when Professor Mϋhe of Bӧblingen performed
minimize them. Systematic research of the literature was per- the first laparoscopic cholecystectomy (LC) in Germany.
formed using PubMed, Cochrane database, Google scholar and The procedure has been widely accepted and has become
ClinicalKey. Different port-site closure techniques are described a gold standard for surgical management of cholelithiasis. 4
and analyzed. Though not one technique has been found to be There are various access techniques used for the cre-
superior to the other, all of them have their pros and cons. All
of them produce similar results, and it is upon the discretion of ation of a pneumoperitoneum in laparoscopic surgery.
the surgeon to accept any one of these methods. The authors They can be widely classified into open access, closed
have also tried to provide recommendations to minimize the access, and advanced techniques.
incidence of port-site hernias.

Keywords: Laparoscopic hernia and port-site closure tech- Open Access
niques, Port-site closure, Trocar site hernia.
This is a direct entry into the abdomen under vision
How to cite this article: Arifuzaman M, Samreen A. Laparo- without the creation of a pneumoperitoneum, and the
scopic Port Closure Techniques and Incidence of Port-site insufflator is connected once the blunt trocar is inside
Hernias: A Review and Recommendations. World J Lap Surg the abdominal cavity. Various techniques include Has-
2018;11(2):90-102.
son’s technique, Scandinavian technique and Fielding
Source of support: Nil technique. 5-7
Conflict of interest: None
Closed Technique

Veress needle, named after Janos Veress, is used in this
technique to create a pneumoperitoneum first. This is a
1 Junior Consultant, Registrar
2
blind technique and is widely practiced.
1 Department of General and Laparoscopic Surgery, Princess
Durru Shehvar Children’s and General Hospital, Hyderabad,
Telangana, India Advanced Techniques
2 Department of Obstetrics and Gynecology, Princess Durru These include single incision laparoscopic surgery (SILS)
Shehvar Children’s and General Hospital, Hyderabad, and natural orifice transluminal endoscopic surgery
Telangana, India
(NOTES).
Corresponding Author: Mohammed Arifuzaman, Junior
Consultant, Department of General and Laparoscopic Surgery, Peritoneal Healing and Adhesions
Princess Durru Shehvar Children’s and General Hospital,
Hyderabad, Telangana, India, e-mail: mohammedarifuzaman@ All the above techniques require an opening of the parietal
yahoo.com
layer of the peritoneum to access the intraperitoneal
90