Intramuscular Port-Site Hernia after Robot-Assisted Colorectal Surgery despite Fascial Closure: A Case Report

Port-site hernia (PSH) is a rare but potentially serious complication of minimally invasive surgery. Although adequate fascial closure is recommended, PSH may occur even after apparently appropriate closure. Intramuscular PSH, in which the bowel becomes incarcerated between abdominal wall muscle layers without overt fascial dehiscence, is particularly uncommon.

An 80-year-old woman underwent robot-assisted right hemicolectomy and high anterior resection using the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA). A 12-mm robotic port was placed in the right lower abdomen, and the external oblique aponeurosis at the port site was closed with a single interrupted suture. On POD 8, she developed symptoms of bowel obstruction. CT revealed incarceration of the small intestine within the abdominal wall at the port site. Emergency surgery confirmed intramuscular herniation between the external and internal oblique muscles without fascial dehiscence, and partial small bowel resection was required.

Intramuscular PSH can occur despite appropriate fascial closure, particularly when a single robotic port is subjected to extensive multidirectional manipulation centered on the remote center. Careful postoperative monitoring and consideration of full-thickness layered closure may help prevent this complication.