Early Incarcerated Hernia at an 8-mm Robotic Port Site After Robot-Assisted Ileocecal Resection: A Case Report

Port-site hernia (PSH) after minimally invasive surgery is uncommon but can lead to bowel incarceration. Although fascial closure is generally recommended for port sites measuring 10 mm or larger, closure of 8-mm robotic port sites remains controversial. A 73-year-old Japanese woman with ascending colon cancer (cT2N0M0) underwent robot-assisted ileocecal resection with D3 lymph node dissection. She had a thin body habitus (height, 146 cm; weight, 33 kg; body mass index, 15.5 kg/m²). One 12-mm umbilical port, four 8-mm robotic ports, and one 5-mm assistant port were used. The umbilical mini-laparotomy wound was closed with peritoneal and fascial sutures, whereas the 5-mm and 8-mm port sites were closed with dermal sutures alone. On postoperative day 5, she developed vomiting and abdominal distension. Ultrasonography showed a small-bowel protrusion into the subcutaneous space at a left lower abdominal 8-mm robotic port site. Manual reduction was initially successful, but contrast-enhanced computed tomography on postoperative day 8 showed recurrent incarceration, and emergency surgery was performed. Richter-type small-bowel incarceration was identified at the 8-mm fascial defect without bowel necrosis. The bowel was reduced, and the peritoneum and fascia were closed. She recovered uneventfully and had no recurrent PSH at 30 months. Although available data do not support routine closure of all 8-mm robotic ports, selective fascial and peritoneal closure may be considered in selected high-risk patients, such as older or thin patients with potentially fragile abdominal walls.