Page 45 - Journal of Laparoscopic Surgery

WJOLS

Laparoscopic Port Closure Techniques and Incidence of Port-site Hernias: A Review and Recommendations
Port Plug incorporation of bowel in port-site closures, and their
complications. Inadequate suturing of the fascial defect,
A bioabsorbable hernia plug (Fig. 13) is used in the trocar infection, or suture disruption may lead to an incisional
site with the help if bioabsorbable hernia plug device.
30
Moreno et al. used this technique in a pilot study on hernia or ascitic fluid leakage in the case of patients with
cirrhosis.
17 patients undergoing laparoscopic surgery. The mean
The incidence of port-site hernia has been reported
follow-up was 14.6 months, and no complications were at about 0.23% at the 10 mm port-site, 1.9% at the 12 mm
reported. Different methods of placement of the hernia port-site. Most of the studies have reported hernias in
plug are show in Figures 14 and 15.
port size 10 mm or higher. 31,32 The 5 mm port has shown
a very low incidence of port-site hernias.
DISCUSSION
Meticulous closure of laparoscopic ports is pertinent Classification
to prevent the occurrence of port-site incisional hernia,
Port-site hernias can be classified into:
• Early onset: occurring within 2 weeks of surgery with
dehiscence of fascial planes and peritoneum. These
present most commonly with small bowel obstruction.
• Late-onset: Occurring after 2 weeks with dehiscence
of the fascial plane with intact peritoneal hernia
sac. Around 12.50% of these present with intestinal
obstruction.
• Special: Which presents with dehiscence of the whole
abdominal wall. 33

Port-site Hernia Pathogenesis

Various factors play a role in the pathogenesis of a port-
site hernia:
• Large trocar size: Trocar size and access technique used
Fig. 11: Looped needle formed of Long needle (20 cm outer sheath)
and metal stent (25 cm put inside the outer sheath needle) has can affect the rate of hernia formation. Port-site hernia
large loop (plastic wire). is related to more complex procedures that require

Fig. 12: Steps of closure using the looped needle
World Journal of Laparoscopic Surgery, May-August 2018;11(2):90-102 97