Mind the gap: pre-operative diastasis recti increases trocar site hernia risk after laparoscopic cholecystectomy

Trocar site hernias impact 1-10% of patients undergoing a laparoscopic cholecystectomy, typically at the 10 mm port site. Risk factors identified for trocar site hernias include obesity and age; however, little is known about the impact of pre-existing diastasis rectus abdominus (DRA) on trocar site hernia rates. Therefore, we aimed to determine the impact of pre-operative DRA on trocar site hernia rates after laparoscopic cholecystectomy.

We conducted a retrospective review of patients undergoing a laparoscopic cholecystectomy for benign gallbladder disease at a single institution from January 2010 to May 2020. CT scan review was used to determine the presence of pre-operative DRA and to diagnose trocar site hernia. Logistic regression was used to determine the factors associated with development of a trocar site hernia.

Of the 2,460 patients who underwent a laparoscopic cholecystectomy, 545 (22%) had both a pre- and post-operative CT scan and were included in analysis, with a 1.5 year median length of follow-up. Overall, 434 patients (80%) had pre-operative DRA and 88 patients (16%) developed a trocar site hernia. On logistic regression, presence of DRA was significantly associated with development of a trocar site hernia (OR = 4.12, 95% CI=[1.72,12.24], p = 0.004), while controlling for location of 10 mm port, BMI, age, sex, ASA classification, smoking status, whether surgery was elective, and presence of pre-operative umbilical hernia.

Radiologic diagnosis of both DRA and a trocar site hernia is highly prevalent within patients who undergo a laparoscopic cholecystectomy. Further, the presence of pre-operative DRA is significantly associated with development of a trocar site hernia after laparoscopic cholecystectomy.