BACKGROUND: Trocar entry points have been identified as a significant source of pain after laparoscopic surgery. This is particularly true of the larger 12-mm ports that require deep fascial closure to avoid port-site herniation. We investigated whether using radially expanding trocars not requiring fascial closure compared to conventional cutting trocars for the 12-mm port in transabdominal preperitoneal (TAPP) hernia repairs had any effect on postoperative analgesic requirements and return to work or normal activity. METHODS: The number of days analgesia was required postoperatively and the number of days taken to return to normal activity was recorded for 143 consecutive patients who underwent TAPP hernia repair by a single experienced laparoscopic surgeon. Exactly the same operative technique was used in these patients with the exception of the 12-mm port site entry. In group 1 (104 patients), a conventional cutting trocar was used requiring deep fascial closure. In group 2 (39 patients), a radially expanding trocar was used and the fascial defect was not closed. RESULTS: Analgesia was required for an average of 10.5 days in group 1 and 2.4 days in group 2 (P < 0.001). The average time to return to work or to normal activity was 23.4 days in group 1 and 15.6 days in group 2 (P = 0.004). There was no significant difference between the two groups with respect to the patients' age, sex, or operating time. CONCLUSION: Using the laparoscopic TAPP hernia repair as a standardised operation, changing from 12-mm fascial port closure to a technique that uses port dilation (not requiring a potentially "tight" deeper fascial closure) in a similar group of patients shows that there is a significant reduction in postoperative analgesic requirement and an earlier return to productive work or normal lifestyle. Perhaps dilating ports should replace those larger 10-, 12-, and 15-mm ports that require deeper sutures in all laparoscopic surgical operations.
BACKGROUND: Trocar entry points have been identified as a significant source of pain after laparoscopic surgery. This is particularly true of the larger 12-mm ports that require deep fascial closure to avoid port-site herniation. We investigated whether using radially expanding trocars not requiring fascial closure compared to conventional cutting trocars for the 12-mm port in transabdominal preperitoneal (TAPP) hernia repairs had any effect on postoperative analgesic requirements and return to work or normal activity. METHODS: The number of days analgesia was required postoperatively and the number of days taken to return to normal activity was recorded for 143 consecutive patients who underwent TAPP hernia repair by a single experienced laparoscopic surgeon. Exactly the same operative technique was used in these patients with the exception of the 12-mm port site entry. In group 1 (104 patients), a conventional cutting trocar was used requiring deep fascial closure. In group 2 (39 patients), a radially expanding trocar was used and the fascial defect was not closed. RESULTS:Analgesia was required for an average of 10.5 days in group 1 and 2.4 days in group 2 (P < 0.001). The average time to return to work or to normal activity was 23.4 days in group 1 and 15.6 days in group 2 (P = 0.004). There was no significant difference between the two groups with respect to the patients' age, sex, or operating time. CONCLUSION: Using the laparoscopic TAPP hernia repair as a standardised operation, changing from 12-mm fascial port closure to a technique that uses port dilation (not requiring a potentially "tight" deeper fascial closure) in a similar group of patients shows that there is a significant reduction in postoperative analgesic requirement and an earlier return to productive work or normal lifestyle. Perhaps dilating ports should replace those larger 10-, 12-, and 15-mm ports that require deeper sutures in all laparoscopic surgical operations.
Authors: Stavros A Antoniou; George A Antoniou; Oliver O Koch; Rudolph Pointner; Frank A Granderath Journal: Surg Endosc Date: 2013-02-07 Impact factor: 4.584