Incisional hernia in a 5-mm trocar site following pediatric laparoscopy.

Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. When hernias do occur they are generally through trocar sites 10 mm or greater in size. To prevent hernias, laparoscopic incisions are usually closed at the fascial level. Five-mm trocar sites are usually closed only at the subcutaneous level because of the difficulty of exposing the fascia through the small skin incision and the rarity of herniation through these trocar sites. This is a report of a 22-month, 13.5-kg child who underwent laparoscopic Toupet fundoplication for gastroesophageal reflux. Postoperatively he developed a small bowel obstruction secondary to a Richter's hernia from small bowel incarceration in a 5-mm left lower quadrant trocar site. The reason for the incarceration was the small size of the infant bowel. It has a proportional size relationship to a 5-mm trocar as does adult bowel to a 10-mm trocar; 5-mm trocar sites should be closed at the fascial level in infants to prevent this complication.