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[Richter hernia in trocar site after laparoscopic herniotomy]
A K Bendsen1, T Bauer, T P Johansen
1Kirurgisk afdeling og røntgenafdelingen, Centralsygehuset i Holbaek.
Ugeskrift for Laeger
|November 13, 1995
Summary
An incarcerated Richter's hernia occurred through a 12-mm trocar site after laparoscopic surgery. Prompt reoperation and fascial defect closure are crucial for managing this rare complication.
Area of Science:
- Laparoscopic surgery
- Surgical complications
- Hernia repair
Background:
- Laparoscopic herniorrhaphy is a common procedure for recurrent inguinal hernias.
- Trocar site herniation is a known but rare complication of laparoscopic surgery.
- Richter's hernia, involving the antimesenteric border of the bowel, is uncommon, especially at trocar sites.
Observation:
- A 72-year-old male developed symptoms of bowel obstruction six days post-laparoscopic herniorrhaphy.
- Imaging revealed herniation of the small bowel through a 12-mm trocar site fascial defect.
- The incarcerated hernia contained a portion of the small intestine.
Findings:
- The patient underwent immediate reoperation for reduction of the incarcerated Richter's hernia.
- The fascial defect at the trocar site was initially closed.
- A subsequent surgery was required due to small bowel perforation and a persistent fascial defect.
Implications:
- This case highlights the risk of incarcerated Richter's hernia through trocar sites, even with standard closure techniques.
- Prompt diagnosis and surgical intervention are essential for favorable outcomes.
- Closing fascial defects of 10 mm or larger is recommended to prevent trocar site herniation.