Port site hernia: What are the risk factors?

Tayeb S. Kareem; Renas A. Farman

doi:10.18282/gs.v3i1.705

Tayeb S. Kareem College of Medicine, Hawler Medical University, Rizgary Teaching Hospital
Renas A. Farman Senior House officer of General Surgery, Rizgary Teaching Hospital

DOI: https://doi.org/10.18282/gs.v3i1.705

Keywords: Hernia, port site, laparoscopic surgery

Abstract

Background & Aim: The port site hernia is a type of incisional hernia that occurs at port sites after laparoscopic surgery. Various factors have been implicated in the development of port site hernia.

The aim of this study was to know the risk factors of the port site hernia.

Patients & Methods: A retrospective study of patients who underwent different elective laparoscopic procedures in Rizgary Teaching Hospital in Erbil in a period from March 2013 to September 2014.

Results: Out of 300 patients only 8 (2.7%) patients developed port site hernia. The time of the hernia occurrence ranged from 3 weeks to six months postoperatively. Half of the hernias were found in cases of age group (60-80) years. Six (75%) of the cases were female patients. All 8 hernias developed after laparoscopic cholecystectomy. Six (75%) hernias developed after open port entrance technique. All hernias occurred when the fascia in 10 mm port was not closed. Seven hernias (87.5%) occurred in patients with BMI ranged (25-34).

Conclusion: Age of the patients, technique of entrance, site and size of the port with unclosed fascial layer are important factors for developing port site hernia.

Author Biography

Tayeb S. Kareem, College of Medicine, Hawler Medical University, Rizgary Teaching Hospital

Professor Tayeb Sabir Kareem MBChB, FICMS, FACS, FRCS
Professor & Consultant General & GIT Surgeon
Department of Surgery, College of Medicine, Hawler Medical University.
Rizgary Teaching Hospital And PAR Hospital.
Program Director of GIT surgery of Kurdistan Board for Medical Specialization.
Coordinator of Arab Board for Health Specialization in Erbil.
Erbil, Kurdistan Region, Iraq

References

Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar Site Hernia. Arch Surg. 2004; 139: 1248-1256.

Crist DW, Gadacz TR. Complications of laparoscopic surgery. Surg Clin North Am. 1993; 73: 265-289.

Duron JJ, Hay JM, Msika S, Gaschard D, Domergue J, Gainant A, et al. Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: A retrospective multicenter study. Arch Surg. 2000; 135(2): 208-212.

Maio A, Ruchman RB. CT diagnosis of post laparoscopic hernia. J Comput Assist Tomogr. 1991; 15: 1054-1055.

kabir SF and Haque A. Incidence of Trocar (Port) Site Hernias After Laproscopic Cholecystectomy-Study of 100 Cases. Bangladesh J. Anat. 2011; 9(2): 110-112.

Di Lorenzo N, Coscarcella G, Liorosi F, Gaspari A. Port site closure: A new problem, an old device. JSLS. 2002; 6: 181-183.

Di Lorenzo N, Coscarcella G, Lirosi F, Pietrantuono M, Suanna F, Gaspari A. Trocars and hernias: A simple, cheap remedy Chir Ital. 2005; 57: 87-90.

Kouba EJ, Hubbard JS, Wallen E, Pruthi RS. Incisional hernia in a 12-mm non-bladed trocar site following laparoscopic nephrectomy. Urol Int. 2007; 79: 276-9.

Moreno-Sanz C, Picazo-Yeste JS, Manzanera-Daz M, Herrero-Bogajo ML, Cortina-Oliva J, Tadeo-Ruiz G. Prevention of trocar site hernias: Description of the safe port plug technique and preliminary results. Surg Innov. 2008; 15: 100-4.

Munro MG. Laparoscopic access: complications, technologies and techniques, Curr Opin Obstet Gynaecol. 2002; 14: 365-474.

Bruyere F, Sun J, Cosson JP, Kouri G. Incarceration of bowel through opening of a 5-mm port. J Endourol 2004; 18: 675-676.

Memon MR, Arshad S, Rafiq S, Bozdar AG, Abbas Shah SQ. Port –Site Hernia: A serious complication of laparoscopy. Rawal Med J 2011; 36: 14-17.

Bergermann JL, Hibbert ML, Harkins G, Narvaez, Asato A. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. Laparo endosc Adv Surg Tech A. 2001; 11: 171-3.

Jassim SK, AL-Hawaz MH, Jasim DS. Port site incisional hernia after minimal access surgery. Bas J Surg. 2011; 17: 37-44.

Uslu HY, Erkek AB, Cakmak A, Kepenekci I, Sozener U, KoccayFA, etal. Trocar Site Hernia After Laproscopic Cholestectomy. J Laparo endosc Adv Surg Tech A. 2007; 17(5): 600-603.

Comajuncosas J, Hermoso J, Gris P, JimenoJ, Orbeal R, Vallverdu H, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: A prospective 3-year follow-up study. American J surg. 2013; 9; 207(1): 1-7.

Hussain A, Mahmood H, Singhal T,Balakrishnan S, Nicholls J, El-Hasani S. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS. 2009; 13(3): 346–349.

Chiong E, Hegarty PK, Davis JW, Kamat AM, Pisters LL, Matin SF. Port-site hernias occurring after the use of bladeless radially expanding trocars. Urology. 2010; 75: 574–580.

Plaus WJ. Laparoscopic trocar site hernias. J Laparo endosc Surg. 1993; 3: 567–570.

Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional hernias. I. Related risk factors. Dig Surg. 2003; 20: 3–9.

Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet. 1993; 176: 228–23.

Burcharth J, Rosenberg J. Hernias as medical disease. [article in Danish] UgeskrLaeger. 2008; 170: 3314–3318.

White B, Osier C, Gletsu N, Jeansonne L, Baghai M, Sherman M, et al. Abnormal primary tissue collagen composition in the skin of recurrent incisional hernia patients. Am Surg. 2007; 73: 1254–1258.

Cottam DR, Gorecki PJ, Curvelo M, Weltman D, Angus LD, Shaftan G. Preperitoneal herniation into a laparoscopic port site without a fascial defect. Obes Surg. 2002; 12: 121–123.

Khatami SM, Fanaie SA. The protective effect of body mass index in overweight patients with herniation through unclosed port of trocar: A randomized clinical trial. IRCMJ. 2007; 9(2): 69-73.

Azurin DJ, Go LS, Arroyo LR, Kirkland ML. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 1995; 61: 718-720.

Ahmad SA, Schuricht AL, Azurin DJ, Arroyo LR, Paskin DL, Bar AH, et al. Complications of laparoscopic cholecystectomy: The experience of a university-affiliated teaching hospital. JLAST. 1997; 7: 29-35.