Trocar site hernia after laparoscopic surgery: a qualitative systematic review

Area of Science:

• Laparoscopic Surgery
• Surgical Complications
• Hernia Research

Background:

• Trocar site hernias (TSH) are a known complication of laparoscopic surgery.
• Existing data on TSH incidence and risk factors is limited and often based on retrospective studies with short follow-up periods.
• Surgical techniques and patient comorbidities are suspected risk factors for TSH.

Purpose of the Study:

• To systematically analyze the incidence of TSH.
• To identify and discuss surgical and patient-related risk factors for TSH development.
• To provide evidence-based recommendations for TSH prevention.

Main Methods:

• A systematic literature review was conducted up to May 19, 2010.
• Included studies were randomized controlled trials, prospective non-controlled studies (>200 patients), and retrospective studies (>200 patients).
• Studies defined TSH as either surgical repair or clinical diagnosis during follow-up, adhering to PRISMA guidelines.

Main Results:

• A total of 19 adult studies and 3 pediatric studies were analyzed, encompassing 30,568 adults and 1,098 children.
• The overall incidence of TSH ranged from 0% to 5.2%.
• TSH predominantly occurred in trocar sites ≥10 mm, particularly in the umbilical region (82%). Higher incidence was noted when fascia was not sutured and in pre-school children.

Conclusions:

• The incidence of TSH is relatively low, but closure of all trocar incisions of 10 mm or larger is recommended.
• Specific attention should be given to closing all port sites in pre-school children undergoing laparoscopic procedures.
• Standardizing trocar site closure can mitigate TSH risk.