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Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique
Lionel Rebibo1, Abdennaceur Dhahri1, Cyril Chivot2
1Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
Summary
Trocar site hernias (TSH) after sleeve gastrectomy (SG) are significantly underestimated by clinical evaluation. Abdominal CT scans reveal a higher TSH incidence, particularly at the epigastric site, necessitating routine closure.
Area of Science:
- Bariatric Surgery
- Laparoscopic Surgery
- Surgical Complications
Background:
- Obesity is a known risk factor for trocar site hernias (TSH) following laparoscopic procedures.
- Previous studies may underestimate TSH rates after bariatric surgery, with reported incidences from 0% to 1.6% based on clinical evaluation.
- Accurate TSH assessment is crucial for patient safety and surgical technique refinement.
Purpose of the Study:
- To determine the actual incidence of TSH after sleeve gastrectomy (SG) using abdominal computed tomography (CT) scans.
- To identify the common locations of TSH following SG.
- To evaluate the effectiveness of the authors' open laparoscopy technique in minimizing TSH.
Main Methods:
- Retrospective review of patients who underwent first-line SG and subsequent abdominal CT scan between March 2004 and February 2014.
- Primary endpoint: incidence of TSH. Secondary endpoints: TSH site, TSH rate with open laparoscopy, and risk factors.
- Analysis included 228 patients with a mean age of 45.1 years and mean BMI of 47.6 kg/m².
Main Results:
- A total of 44 TSH were detected in 43 patients (18.8%) via CT scan.
- The most frequent TSH site was epigastric (16.6%), followed by open laparoscopy sites (1.7%) and right subcostal margin (0.8%).
- In patients with over one year of follow-up, the TSH rate was 19.7%.
Conclusions:
- The incidence of TSH after bariatric surgery is significantly higher than previously reported.
- The authors' open laparoscopy technique demonstrates a low TSH rate, indicating its reliability.
- Routine closure of the epigastric trocar site is recommended following SG based on these findings.
