Trocar Site Hernia After Gastric Bypass

Area of Science:

• Bariatric surgery outcomes
• Minimally invasive surgery complications
• Diagnostic imaging in obesity

Background:

• Trocar site incisional hernia (TSIH) rates may be underestimated.
• Clinical examination for TSIH is challenging in obese patients.
• Novel radiological methods are needed for accurate TSIH detection.

Purpose of the Study:

• To evaluate the correlation between clinical examination and computed tomography (CT) for TSIH detection.
• To assess the reliability of a novel radiological examination in obese patients.
• To determine the accuracy of CT scans in identifying TSIH post-laparoscopic gastric bypass.

Main Methods:

• Twenty-six obese patients who underwent laparoscopic gastric bypass were assessed.
• Clinical and CT examinations were performed by three independent assessors each.
• CT scans were conducted with patients in the prone position.

Main Results:

• Clinical examination identified TSIH in 6 of 26 patients; CT scan identified it in 4.
• CT scan demonstrated high inter-rater reliability (Fleiss' Kappa = 1) for TSIH detection.
• Herniation was diagnosed in 3 of 26 closed umbilical trocar sites and 1 of 130 other sites via CT.

Conclusions:

• Clinical examination is unreliable for diagnosing TSIH in obese individuals.
• CT scans in the prone position are highly reliable for TSIH detection.
• Prone CT scanning shows potential as a standard diagnostic method for TSIH in obese patients.