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Lateral laparoscopic port sites should all be closed: the incisional "spigelian" hernia
C P Morrison1, S A Wemyss-Holden, H Iswariah
1University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
Abstract:
Incisional hernias are a recognized complication of all abdominal surgery, including laparoscopic surgery. Although most cases of laparoscopic port incisional hernias are seen in the midline, particularly around the umbilicus, there are several reports of herniation at laterally placed ports. Accepted surgical practice is to close the deep fascial layers at midline laparoscopic ports. However, the deep layers at the lateral ports are not usually closed. Two near-identical cases are reported in which incisional hernias have developed at the site where laterally placed 10-mm ports have pierced the spigelian fascia. Hernia development at an iatrogenic defect in an area that is already potentially weak, and therefore prone to herniation, has implications for lateral 10-mm port site closure. The closure of the deep layers of all lateral laparoscopic ports is advocated, especially if the spigelian fascia is pierced.
Insights
Incisional hernias can occur at lateral laparoscopic ports, especially when the spigelian fascia is pierced. Closing deep fascial layers at these lateral ports is recommended to prevent such hernias.
Area of Science:
- Laparoscopic surgery
- Abdominal surgery
- Surgical complications
Background:
- Incisional hernias are a known complication of abdominal surgery, including laparoscopic procedures.
- While midline port sites are common for incisional hernias, lateral port sites also present a risk.
- Current practice often omits deep fascial closure at lateral laparoscopic ports.
Observation:
- Two cases of incisional hernias at lateral 10-mm port sites piercing the spigelian fascia are reported.
- The spigelian fascia represents a potentially weak area prone to herniation.
- Hernia development occurred at iatrogenic defects in this vulnerable anatomical region.
Findings:
- Incisional hernias developed at lateral 10-mm port sites where the spigelian fascia was breached.
- The combination of an iatrogenic defect and a naturally weak anatomical area facilitates hernia formation.
- Lateral port sites, particularly those involving the spigelian fascia, are susceptible to incisional hernias.
Implications:
- The findings suggest that current practices for lateral port site closure may be inadequate.
- Closure of deep fascial layers at all lateral laparoscopic ports is advocated.
- This recommendation is especially pertinent when the spigelian fascia is identified as being pierced by the port.