H E Sikar1, K Çetin2, K Eyvaz2, Ö Altin2, S Kaya2, M Gökçeimam2, H F Küçük2. 1. Department of General Surgery, Dr. Lutfi Kirdar Kartal Research and Education Hospital, Semsi Denizer Street, Cevizli, Kartal, Istanbul, Turkey. hasan.sikar@me.com. 2. Department of General Surgery, Dr. Lutfi Kirdar Kartal Research and Education Hospital, Semsi Denizer Street, Cevizli, Kartal, Istanbul, Turkey.
Abstract
PURPOSE: Trocar site hernias (TSH) at the umbilical site following laparoscopic cholecystectomy forms the majority of the studies about TSH and there is a missing data in literature about lateral sided TSH. We aimed to evaluate the incidence and factors affecting lateral sided TSH occurrence following laparoscopic abdominal wall hernia repair (LAHR). METHODS: Patients who underwent LAHR between March 2013 and 2015 were included in the study. Open approach with blunt dissection for optical trocar insertion and z-shaped suture for closure were used in 22 cases initially (Group 1). Sharp dissection and continuous suture for closure were used for the rest of the patients (Group 2). RESULTS: 285 patients-237 females (83.2%) and 48 males (16.8%)-with a mean age of 50.14 ± 12.03 were included in the study. Most of the patients were overweight or obese and mean BMI was 29.25 ± 5.04 kg/m2. BMI was significantly higher in patients with TSH (p:0.025) and TSH occurrence is significantly higher in Group 1 patients (p < 0.001). CONCLUSIONS: Trocar insertion and closure technique have a major role in lateral sided TSH occurrence. Trying to avoid blunt dissection during trocar insertion, closure of trocar site with continuous suture and enlargement of skin incision to provide good view decreases lateral sided TSH occurrence. In addition, increase at the level of BMI has increased the probability of TSH occurrence and further studies are needed to evaluate efficiency of prophylactic prosthetic closure for obese patients.
PURPOSE: Trocar site hernias (TSH) at the umbilical site following laparoscopic cholecystectomy forms the majority of the studies about TSH and there is a missing data in literature about lateral sided TSH. We aimed to evaluate the incidence and factors affecting lateral sided TSH occurrence following laparoscopic abdominal wall hernia repair (LAHR). METHODS:Patients who underwent LAHR between March 2013 and 2015 were included in the study. Open approach with blunt dissection for optical trocar insertion and z-shaped suture for closure were used in 22 cases initially (Group 1). Sharp dissection and continuous suture for closure were used for the rest of the patients (Group 2). RESULTS: 285 patients-237 females (83.2%) and 48 males (16.8%)-with a mean age of 50.14 ± 12.03 were included in the study. Most of the patients were overweight or obese and mean BMI was 29.25 ± 5.04 kg/m2. BMI was significantly higher in patients with TSH (p:0.025) and TSH occurrence is significantly higher in Group 1 patients (p < 0.001). CONCLUSIONS: Trocar insertion and closure technique have a major role in lateral sided TSH occurrence. Trying to avoid blunt dissection during trocar insertion, closure of trocar site with continuous suture and enlargement of skin incision to provide good view decreases lateral sided TSH occurrence. In addition, increase at the level of BMI has increased the probability of TSH occurrence and further studies are needed to evaluate efficiency of prophylactic prosthetic closure for obesepatients.
Entities:
Keywords:
Incisional hernia; Laparoscopy; Surgical mesh; Trocar site hernia
Authors: Laura Armañanzas; Jaime Ruiz-Tovar; Antonio Arroyo; Pedro García-Peche; Ernesto Armañanzas; María Diez; Isabel Galindo; Rafael Calpena Journal: J Am Coll Surg Date: 2014-02-18 Impact factor: 6.113
Authors: G Chatzimavroudis; B Papaziogas; I Galanis; I Koutelidakis; S Atmatzidis; P Evangelatos; N Voloudakis; A Ananiadis; A Doundis; E Christoforidis Journal: Hernia Date: 2017-10-25 Impact factor: 4.739
Authors: E Erdas; C Dazzi; F Secchi; S Aresu; A Pitzalis; M Barbarossa; A Garau; A Murgia; P Contu; S Licheri; M Pomata; G Farina Journal: Hernia Date: 2012-06-20 Impact factor: 4.739
Authors: F E Muysoms; S A Antoniou; K Bury; G Campanelli; J Conze; D Cuccurullo; A C de Beaux; E B Deerenberg; B East; R H Fortelny; J-F Gillion; N A Henriksen; L Israelsson; A Jairam; A Jänes; J Jeekel; M López-Cano; M Miserez; S Morales-Conde; D L Sanders; M P Simons; M Śmietański; L Venclauskas; F Berrevoet Journal: Hernia Date: 2015-01-25 Impact factor: 4.739
Authors: Pilar Hernández-Granados; Manuel López-Cano; Salvador Morales-Conde; Filip Muysoms; Josep García-Alamino; José Antonio Pereira-Rodríguez Journal: Cir Esp (Engl Ed) Date: 2018-02-14
Authors: E Boldó; G Perez de Lucia; J P Aracil; F Martin; J Escrig; D Martinez; J M Miralles; A Armelles Journal: Surg Endosc Date: 2006-12-20 Impact factor: 3.453
Authors: Hasan Ediz Sikar; Kenan Çetin; Kemal Eyvaz; Levent Kaptanoglu; Hasan Fehmi Küçük Journal: Wideochir Inne Tech Maloinwazyjne Date: 2017-07-03 Impact factor: 1.195