Related Experiment Videos
Preperitoneal Richter hernia after a laparoscopic gastric bypass
B D Matthews1, B T Heniford, R F Sing
1Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA. bmatthews@carolinas.org
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|March 28, 2001
Summary
Richter hernias can develop at trocar sites, even with intact fascial closure, particularly in morbidly obese patients. Closing trocar sites, including the peritoneum, is recommended to prevent this complication.
Area of Science:
- Bariatric Surgery
- Surgical Complications
- Hernia Surgery
Background:
- Trocar-site incisional hernias pose a risk for developing into Richter hernias.
- Laparoscopic Roux-en-Y gastric bypass is a common bariatric procedure.
- Morbid obesity presents unique surgical challenges.
Observation:
- An unusual Richter hernia occurred at a 10-mm trocar site post-laparoscopic isolated Roux-en-Y gastric bypass.
- The hernia developed through the peritoneum into the preperitoneal space despite intact fascial closure.
- The preperitoneal space in morbidly obese patients may facilitate hernia formation.
Findings:
- Adequate fascial closure alone may not prevent Richter hernias in morbidly obese patients.
- The peritoneum and preperitoneal space play a critical role in trocar-site hernia development.
- Richter hernias can occur even when fascial closure appears intact.
Implications:
- Recommend closing all 10-mm and 12-mm trocar sites.
- Incorporate peritoneal closure into fascial closure to obliterate the preperitoneal space.
- This technique aims to prevent Richter hernias and other postoperative complications in bariatric surgery patients.