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Port site Richter’s hernia. Case report and review

  • Abdominal Wall
  • Published:
Hellenic Journal of Surgery

Abstract

The incidence of port site hernia (PSH) after a range of laparoscopic procedures has been variously reported as between 0.14% and 22%. In addition to pain, PSH may be associated with severe complications, including bowel obstruction, strangulation, and perforation. The case is reported of Richter’s hernia in a 45-year-old male at a 5 mm port site 6 years after laparoscopic cholecystectomy (LC).He presented with a lump in the right lumbar region associated with sudden onset pain and non-passage of stool for two days. With a diagnosis of PSH, he underwent exploratory laparotomy with a right lumbar skin incision, which revealed herniation of the omentum and part of the antimesenteric wall of a small bowel loop through the port site defect of about 1 x 1 cm.

The gangrenous omentum was excised and the rest of the omentum and viable bowel loops were reposited.

PubMed database search 1991 to 2016 showed an incidence of PSH ranging from 0.38% to 5.4% with an overall incidence of 1.7% in a review from 1995 to 2008. The umbilicus was the most common port to be associated with incisional hernia. It is rarely associated with strangulation or bowel obstruction. Not closing the fascial defect is thought to be implicated, although closing the fascia is not preventive.

PSH at secondary port sites is very rare. Richter’s hernia with strangulation at a 5 mm port-site is the rarest presentation.

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References

  1. Reynolds W Jr. The first laparoscop ic cholecystectomy. JSLS 2001;5:89–94.

    PubMed  PubMed Central  Google Scholar 

  2. Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia. Arch Surg 2004;139:1248–56.

    Article  PubMed  Google Scholar 

  3. Fear RE. Laparoscopy: A valuable aid in gynaecological diagnosis. Obstet Gynaecol 1968;31:297–309.

    Article  CAS  Google Scholar 

  4. Hussain A, Mahmood H, Singhal T, et al. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 2009;13:346–9.

    PubMed  PubMed Central  Google Scholar 

  5. Boldó E, Perez de Lucia G, Aracil JP, et al. Trocar site hernia after laparoscopic ventral hernia repair. Surg Endosc 2007;21:798–800.

    Article  PubMed  Google Scholar 

  6. McMurrick PJ, Polglase AL. Early incisional hernia after use of the 12mm port for laparoscopic surgery. Aust NZ J Surg 1993;63:574–5.

    Article  CAS  Google Scholar 

  7. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 2001;15:663–6.

    Article  CAS  PubMed  Google Scholar 

  8. Johnson WH, Fecher AM, Mc Mahon RL, et al. VersaStepTM trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc 2006;20:1584–6.

    Article  CAS  PubMed  Google Scholar 

  9. Coda A, Bossotti M, Ferri F, et al. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2000;10:34–8.

    CAS  Google Scholar 

  10. Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus. Br J Surg 1997;84:630–3.

    Article  CAS  PubMed  Google Scholar 

  11. Plaus WJ. Laparoscopic trocar site hernias. J Laparoendosc Surg 1993;3:567–70.

    Article  CAS  PubMed  Google Scholar 

  12. Duron JJ, Hay JM, Msika S, et al. Prevalence and mechanism of small intestinal obstruction following laparoscopic abdominal surgery: A retrospective multicenter study. French Association for Surgical ResearchArch Surg 2000;135:208–12.

    CAS  Google Scholar 

  13. Lee JH, Kim W. Strangulated small bowel hernia through the port site: A case report. World J Gastroenterol 2008;14:6881–3.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Azurin DJ, Go LS, Arroyo LR, et al. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 1995;61:718–20.

    CAS  PubMed  Google Scholar 

  15. Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, et al. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997;21:529–33.

    Article  CAS  PubMed  Google Scholar 

  16. Voyles CR, Petro AB, Meena AL, et al. A practical approach to laparoscopic cholecystectomy. Am J Surg 1991;161:365–70.

    Article  CAS  PubMed  Google Scholar 

  17. Larson GM, Vitale GC, Casey J, et al. Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg 1992;163:221–6.

    Article  CAS  PubMed  Google Scholar 

  18. Baird DR, Wilson JP, Mason EM, et al. An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. Am Surg 1992;58:206–10.

    CAS  PubMed  Google Scholar 

  19. Balakrishnan S, Samdani T, Singhal T, et al. Patient experience with gallstone disease in a National Health Service district hospital. JSLS 2008;12:389–94.

    PubMed  PubMed Central  Google Scholar 

  20. Sanz-Lopez R, Martinez-Ramos C, Nunez-Pena JR, et al. Incisional hernias after laparoscopic vs. open cholecystectomy. Surg Endosc 1999;13:922–4.

    Article  CAS  PubMed  Google Scholar 

  21. Munro MG. Laparoscopic access: Complications, technologies and techniques. Curr Opin Obstet Gynecol 2002;14:365–74.

    Article  PubMed  Google Scholar 

  22. Ahmad SA, Schuricht AL, Azurin DJ, et al. Complications of laparoscopic cholecystectomy: The experience of a universityaffiliated teaching hospital. J Laparoendosc Adv Surg Tech A 1997;7:29–35.

    Article  CAS  PubMed  Google Scholar 

  23. Bergemann J, Hibbert M, Harkins G, et al. Omental herniation through a 3-mm Umbilical trocar site: Unmasking a hidden umbilical hernia. J Laparoendosc Adv Surg Tech 2001;11:71–3.

    Article  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. Nakajima K, Wasa M, Kawahara H, et al. Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 1999; 9:294.

    Article  CAS  PubMed  Google Scholar 

  26. Waldhaussen JH. Incisional hernia in a 5-mm trocar site following paediatric laparoscopy. J Laparoendosc Surg 1996;6:S89–90.

    PubMed  Google Scholar 

  27. Moreaux G, Estrade-Huchon S, Bader G, et al. Five-millimeter trocar site small bowel eviscerations after gynaecologic laparoscopic surgery. J Minim Invasive Gynecol 2009;16:643–5.

    Article  PubMed  Google Scholar 

  28. Nezhat C, Nezhat F, Seidman DS, et al. Incisional hernias after laparoscopy. J Laparoendosc Adv Surg Tech 1997;7:111–5.

    Article  CAS  Google Scholar 

  29. Reissman P, Shilloni E, Gofrit O, et al. Incarcerated hernia in a lateral trocar site–an unusual early postoperative complication of laparoscopic surgery. Case Report. Eur J Surg 1994;160:191–2.

    CAS  PubMed  Google Scholar 

  30. Mahmoud HY, Ustuner EH, Sozener U, et al. Cannula site insertion technique prevents incisional hernia in laparoscopic fundoplication. Surg Laparosc Endosc Percutan Tech. 2007;7:267–70.

    Article  Google Scholar 

  31. Maio A, Ruchman RB. CT diagnosis of postlaparoscopic hernia. J Comput Assist Tomogr 1991;15:1054–5.

    Article  CAS  PubMed  Google Scholar 

  32. Ramachandran CS. Umbilical hernial defects encountered before and after abdominal laparoscopic procedures. Int Surg 1998;83:171–3.

    CAS  PubMed  Google Scholar 

  33. Yuen PM. Early incisional hernia following laparoscopic surgery. Aust N Z J Obstet Gynaecol. 1995;35:211–2.

    Article  CAS  PubMed  Google Scholar 

  34. David Mark Bunting. Port-Site Hernia Following Laparoscopic Cholecystectomy. JSLS 2010;14:490–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Uslu HY, Erkek AB, Cakmak A, et al. Trocar site hernia after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2007;17:600–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Dr. R. M. L. Hospital, New Delhi, India

    Naveen Kumar

  2. PGIMER, Dr.R.M.L Hospital, New Delhi, India

    Naveen Kumar

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  1. Naveen Kumar
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Correspondence to Naveen Kumar.

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Kumar, N. Port site Richter’s hernia. Case report and review. Hellenic J Surg 89, 166–171 (2017). https://doi.org/10.1007/s13126-017-0406-2

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  • DOI: https://doi.org/10.1007/s13126-017-0406-2

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