Trocar Site Hernias in Bariatric Surgery—an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis

  • Ioannis Karampinis
  • Eliette Lion
  • Maurizio Grilli
  • Svetlana Hetjens
  • Christel Weiss
  • Georgi Vassilev
  • Steffen Seyfried
  • Mirko OttoEmail author
Review Article


The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms ‘laparoscopy’ and ‘bariatric surgery’, ‘trocar/port’ and ‘hernia’. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0–39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.


Port site hernia Surgical morbidity Adipositas Bariatric surgery Incisional hernia 


Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical Approval Statement

For this type of study, formal consent is not required.

Informed Consent Statement

Does not apply.


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Authors and Affiliations

  1. 1.Department of SurgeryHeidelberg UniversityMannheimGermany
  2. 2.Department of Library and Information SciencesHeidelberg UniversityMannheimGermany
  3. 3.Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  4. 4.Department of Surgery, Mannheim University Medical CentreUniversity of HeidelbergMannheimGermany

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