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Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience

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Abstract

Introduction

Laparoscopic cholecystectomy (LC) is the gold standard of treatment for patients with symptomatic cholelithiasis. Compared to open cholecystectomy, LC is associated with significantly lower postoperative complications. Trocar site hernia (TSH) is an uncommon, but potentially dangerous, complication of LC. The aim of this study was to evaluate the incidence of TSH following LC.

Methods

The records of all patients who underwent elective LC between January 2004 and December 2013 were retrospectively reviewed. The open technique with a vertical incision infraumbilically was used to establish pneumoperitoneum. Two or three other skin incisions were made and trocars were inserted. In all cases, only the fascia at the site of infra-umbilical incision was closed. Following hospital discharge, all patients were regularly re-examined 1, 4 and 52 weeks postoperatively and were contacted by phone during November–December 2015. Based on the findings from clinical and telephone follow-ups, the incidence of TSH was recorded. Using univariate/multivariate analysis, we investigated several variables to identify risk factors for TSH development.

Results

During the study period, 1172 patients were eligible and included in the final analysis. Seven patients (0.6%) presented TSH at 1-year follow-up. At the end of the study and with a mean follow-up of 65.86 ± 25.19 months, 11 patients (0.94%) presented TSH. Interestingly, all TSHs were developed at the infra-umbilical site. Multivariate analysis identified obesity as an independent risk factor for TSH.

Conclusion

The incidence of TSH following LC is considerably low. Obesity is an independent risk factor for TSH development, while closure of fascial incision of 10 mm below the xiphoid is not justified.

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Authors and Affiliations

Authors

Contributions

Conception and design of the study was done by GC. Operations were performed by GC, BP, IG and IK. Acquisition of data was done by GC, SA, PA and AA. Analysis and interpretation of data was carried out by GC, NV and AD. Drafting the paper for important intellectual content was done by GC, BP, IG, IK and EC. All authors read and approved the final manuscript.

Corresponding author

Correspondence to G. Chatzimavroudis.

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Conflict of interest

GC declares no conflict of interest. BP declares no conflict of interest. IG declares no conflict of interest. IK declares no conflict of interest. SF declares no conflict of interest. PE declares no conflict of interest. NV declares no conflict of interest. AA declares no conflict of interest. AD declares no conflict of interest. EC declares no conflict of interest.

Ethical approval

The study was approved by the Hospital's Ethics Committee.

Human and animal rights

For this type of study, formal consent is not required. This study does not contain any studies with animals performed by any of the authors.

Informed consent

All patients were informed of the study and their right to decline the use of their data.

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Chatzimavroudis, G., Papaziogas, B., Galanis, I. et al. Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience. Hernia 21, 925–932 (2017). https://doi.org/10.1007/s10029-017-1699-3

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  • DOI: https://doi.org/10.1007/s10029-017-1699-3

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