Authors: DJ Bowrey D Blom PF Crookes CG Bremner JLM Johansson RV Lord JA Hagen SR DeMeester TR DeMeester JH Peters
Publish Date: 2014/04/09
Volume: 15, Issue: 7, Pages: 663-666
Abstract
Background Although there have been case reports describing trocar site herniation after laparoscopic fundoplication its overall prevalence and the risk factors for its development are unclear Methods The records of 320 patients undergoing primary laparoscopic fundoplication as treatment for gastroesophageal reflex disease GERD or hiatal hernia between 1991 and 1999 were reviewed retrospectively Placement of the initial supraumbilical trocar was by the open Hassan technique in all patients Results Nine patients five male with a mean age 54 years range 3775 developed trocar site herniation for an overall prevalence of 3 The mean interval between surgery and diagnosis was 12 months range 421 In all patients the hernia occurred at the supraumbilical camera port site Patients with trocar hernias tended to have a higher body mass index BMI than those without hernias mean BMI 294 kg/m2 vs 272 kg/m2 p = 013 None of the patients developed intestinal obstruction as a consequence of herniation To date all but one of the hernias have been repaired Six of them required the insertion of a prosthetic mesh Conclusions The prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3 All hernias occurred at the midline supraumbilical port the only site where open trocar insertion was employed As a consequence of these observations we have developed a new method of open trocar placement This method utilizes a paramedian skin incision and separate fascial incisions through anterior and posterior rectus sheathes with retraction of the rectus abdominis muscle laterally
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