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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
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Thoughts on Trocar Site Hernia Prevention. A Narrative Review
1Spire Murrayfield Hospital, The University of Edinburgh, Edinburgh, United Kingdom.
Journal of Abdominal Wall Surgery : JAWS
|February 5, 2024
Summary
Trocar site hernias (TSH) are uncommon but can be reduced by managing patient and surgical factors. Identifying at-risk patients and trocar sites allows for targeted prevention strategies to minimize TSH incidence.
Area of Science:
- Minimally Invasive Surgery
- Surgical Complications
- Hernia Research
Background:
- Laparoscopic and robot-assisted surgery utilize trocar sites, which are potential locations for incisional hernias.
- Several factors are known to increase the risk of developing a trocar site hernia (TSH).
Purpose of the Study:
- To review existing literature and identify patient and trocar site factors associated with increased TSH risk.
- To inform the development of targeted prevention strategies for minimizing TSH incidence.
Main Methods:
- A comprehensive literature search was conducted on PubMed using MeSH terms related to trocars and hernias.
- Abstracts were screened, and relevant publications were selected for a narrative review.
Main Results:
- The search identified 961 abstracts, leading to the inclusion of a 2012 systematic review and 44 recent publications.
- Multiple patient, pre-operative, intra-operative, and post-operative factors were identified as potentially increasing TSH risk.
Conclusions:
- While clinically significant TSH is infrequent given the volume of procedures, it remains a common hernia encountered in general surgery.
- Patients, particularly those with hernias at the umbilical site, are at higher inherent risk.
- A multifaceted surgical approach, considering trocar selection, insertion technique, operative events, and fascial closure, is likely to cumulatively reduce TSH risk.
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