Trocar Site Hernia after Laparoscopic Colectomy

Abstract

Purpose Trocar site hernia (TSH) is an uncommon sequela of laparoscopic procedures. In this retrospective study, we determined the incidence of TSH and investigated the associated risk factors in patients undergoing laparoscopic colectomy (LC).
Subjects Three hundred and ten patients who underwent LC for colorectal disease between December 1993 and February 2008 in our hospital.
Results In this series, the incidence of TSH was 1.6% (5patients). There were no differences in age, gender, body mass index (BMI), tumor site or diabetes mellitus between the TSH and non–TSH groups. Comparison between patients with and without TSH revealed no differences in trocar size, type or site. However, there were significant differences in drain placement and fascial closure at the trocar insertion site after trocar removal. All TSH occurred in the left lower abdominal region, where an abdominal trocar had been placed for sigmoid or rectosigmoid colon cancer surgery and a drain had been placed after the trocar removement. The trocar diameter was 10–mm in 3 and 5–mm in 2 patients. Surgical treatment was provided to two patients with early–onset TSH and incarceration of the small intestine, and to one with late–onset TSH patient and abdominal pain. In the other two patients, who had omental hernias after drain removal, the fascias at the trocar sites were closed under local anesthesia.
Conclusion The range of intraoperative port movement and drain placement through a port site, which involve dilatation of the trocar orifice or disturbance of the fascial closure, are risk factors for the occurrence of TSH.