Prevention of herniation after laparoscopic surgery

Complications in laparoscopic surgery are becoming more prevalent as more open procedures convert to laparoscopic procedures. This article will address incisional herniation of trocar wound sites and management of inferior epigastric bleeds. A trocar wound closure device allows for avoidance and rapid management of both the aforementioned complications. Clinical reports on the incidence of incisional hernias vary widely. However, the largest current clinical study (Kadar, Reich, Liu, et al.) regarding the incidence at .17% (3.1% in 12-mm extraumbilical sites and 0.23% at 10-mm extraumbilical sites). Some physicians feel that closure of the fascia is adequate for reducing the chance of incisional hernias. However, of the hernias reported in the Kadar study, one-half of the hernias occurred despite attempts to close the fascia. Another clinical paper reports two of the three hernias presented occurred in the preperitoneal space. In the past, if the fascia could easily be closed using conventional techniques, it was done; but if obesity made it difficult, only the skin was closed. This can no longer be considered good surgical technique.