Abstract
Background
Laparoscopic bariatric surgery is increasingly being performed worldwide. It is estimated that trocar port hernias occur more often in obese patients due to their obesity and because the ports are not closed routinely. The aim of the present study was to analyze the incidence, risk factors, and management of patients with trocar port hernias after laparoscopic bariatric surgery.
Methods
All patients who were operated between 2006 and 2013 were included. During the study period, the trocar ports were not closed routinely. All patients who had any symptomatic abdominal wall hernia during follow-up were included.
Results
Overall, 1524 laparoscopic bariatric procedures were performed. There were 1249 female (82 %) and 275 male (18 %) patients. The mean age was 44 years, and median body mass index was 43 kg/m2. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 859), laparoscopic adjustable gastric banding (LAGB) (n = 364), laparoscopic sleeve gastrectomy (LSG) (n = 68), revisional surgery (n = 226), and other procedures (n = 7). Three hundred and one patients (20 %) had one or more postoperative complications and the overall mortality was 0.3 % (four patients). There were 14 patients (0.9 %) with an abdominal wall hernia, of which eight (0.5 %) had a trocar port hernia, three (0.2 %) an incisional hernia from other previous surgery, and three (0.2 %) an umbilical hernia. Gender, age, BMI, smoking, type II diabetes, procedure type, complications, and weight loss were not associated with the occurrence of abdominal wall hernias.
Conclusions
Trocar port hernias after bariatric surgery occur seldom if the trocar port is not routinely closed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.
Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243:181–8.
Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst. Rev. 2014;8:CD003641. doi:10.1002/14651858.CD003641.
Molloy D, Kaloo PD, Cooper M, et al. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002;42:246–54.
Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia. 2011;15(2):113–21. doi:10.1007/s10029-010-0757-x.
Rosenthal RJ, Szomstein S, Kennedy CI, et al. Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-Y gastric bypass. Surg Endosc Other Interv Tech. 2007;21:124–8.
Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):596–600.
Johnson WH, Fecher AM, McMahon RL, et al. VersaStep™ trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc Other Interv Tech. 2006;20:1584–6.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.
Shaher Z. Port closure techniques. Surg Endosc Other Interv Tech. 2007;21:1264–74.
Israelsson LA, Jonsson T. Incisional hernia after midline laparotomy: a prospective study. Eur J Surg. 1996;162:125–9.
Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg [Internet]. 2005;140:119–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15723991.
Gislason H, Grønbech JE, Søreide O. Burst abdomen and incisional hernia after major gastrointestinal operations—comparison of three closure techniques. Eur J Surg. 1995;161(5):349–54.
Sugerman HJ, Kellum JM, Reines HD, et al. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171:80–4.
Guillou PJ, Donaldson DR, Hall TJ, et al. Vertical abdominal incisions-a choice? Br J Surg. 1980;67:395–9.
Kadar N, Reich H, Liu CY, et al. Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol. 1993;168:1493–5.
Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia. Arch Surg. 2004;139:1248–56.
Shafer DM, Khajanchee Y, Wong J, et al. Comparison of five different abdominal access trocar systems: analysis of insertion force, removal force, and defect size. Surg Innov. 2006;13:183–9.
Conflict of Interest
The authors declare that they have no competing interests.
Ethical Approval
This study was approved by our Institutional Research Committee and is in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Statement of Informed Consent
Informed consent from patients was not necessary.
Statement of Human and Animal Rights
This does not apply.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coblijn, U.K., de Raaff, C.A.L., van Wagensveld, B.A. et al. Trocar Port Hernias After Bariatric Surgery. OBES SURG 26, 546–551 (2016). https://doi.org/10.1007/s11695-015-1779-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-015-1779-3