Incarcerated incisional hernia after laparoscopy. A case report

A woman who had undergone operative laparoscopy with myomectomy, appendectomy and coagulation of endometriosis was readmitted on postoperative day 3 with a small bowel obstruction. At laparotomy she was found to have an incarcerated loop of small bowel through a 12-mm trocar site in the left midabdomen. A bowel resection was not required. The defect was closed, and the patient recovered without difficulty. Two points should be made about avoiding hernias, especially through a larger trocar site. First, the trocar sheath should be opened to room air during its removal to avoid creating a vacuum and pulling a loop of bowel into the incision. Second, the fascia should be closed after removal of larger trocars. This can be accomplished during direct visualization through the laparoscope prior to removal of the pneumoperitoneum to avoid placing the suture through the bowel.