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Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery
K Nakajima1, M Wasa, H Kawahara
1Department of Pediatric Surgery, Osaka University Medical School, Suita, Japan.
Insights
A rare trocar wound hernia caused bowel obstruction in an infant after laparoscopic surgery. Revision laparoscopy successfully repaired the hernia, highlighting the need to close all infant laparoscopic wounds.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Gastroesophageal reflux is common in infants, often treated with laparoscopic Nissen fundoplication.
- Laparoscopic surgery offers benefits but carries risks, including trocar site hernias.
Observation:
- A 6-month-old infant developed bowel obstruction 6 days after laparoscopic Nissen fundoplication.
- The obstruction was caused by an incarcerated hernia through a 5-mm trocar wound.
Findings:
- Diagnosis of trocar wound hernia was confirmed on postoperative day 13.
- Successful hernia reduction and repair were achieved using relaparoscopy, avoiding laparotomy.
- This complication is rare, particularly at small (5-mm) trocar sites.
Implications:
- Fascial closure of all laparoscopic puncture sites, even those <10 mm, is crucial in infants.
- Revision laparoscopy is an effective management strategy for pediatric trocar site complications.
Abstract:
We report the case of a 6-month-old female infant who developed post-operative bowel obstruction due to an incarcerated hernia through a 5-mm laparoscopic wound. The patient underwent laparoscopic Nissen fundoplication for gastroesophageal reflux. On day 6, she showed symptoms of ileus, and the diagnosis of a trocar wound hernia was made on day 13. The herniated intestine was reduced and the defective peritoneum and fascia were closed under relaparoscopic guidance, thus avoiding full-scale laparotomy. A trocar wound hernia causing early postoperative bowel obstruction is a rare complication, especially at 5-mm trocar puncture sites. Intraoperative dislodgment and reinsertion of working trocars may create fascial defects larger than the actual size of the trocar. All laparoscopic puncture wounds, even those <10 mm in size, should be closed at the fascial level in infants. Revision laparoscopy is considered preferable to manage trocar site complications in children.