A simple method of closure of a laparoscopic trocar site

Trocar site herniation is a recognized complication of laparoscopic surgery. Omental herniation, and more importantly small-intestinal herniation with incarceration and obstruction, has been documented in surgical literature, occurring particularly at the large trocar sites (> or = 10 mm) that were not sutured at operation. Secure closure of the trocar site fascial wound is often technically difficult, being hampered by the limited size of skin incision, the depth of the subcutaneous fatty layer, and the concern about placing deep sutures blindly after the abdomen has been decompressed. We describe a simple technique to effect this closure securely and safely, and briefly discuss its other applications and limitations.