Related Experiment Videos
Incisional hernia in a 5-mm trocar site following pediatric laparoscopy
1Division of Pediatric Surgery, Children's Hospital and Medical Center, University of Washington, Seattle, Washington, USA.
Insights
Incisional hernias at 5-mm trocar sites are rare but can occur in infants. Closing these sites at the fascial level is recommended to prevent serious complications like bowel incarceration.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Laparoscopic surgery utilizes trocar incisions for instrument insertion.
- Herniation through trocar sites is a known complication, typically occurring at larger (≥10 mm) sites.
- Standard practice closes larger trocar sites at the fascial level, but 5-mm sites are often closed subcutaneously due to perceived low risk and technical difficulty.
Observation:
- A case report details a 22-month-old infant undergoing laparoscopic Toupet fundoplication.
- The infant developed a small bowel obstruction due to a Richter's hernia.
- The hernia involved incarceration of small bowel within a 5-mm left lower quadrant trocar site.
Findings:
- Infant abdominal organs have a proportional size relative to small trocar diameters.
- The small bowel's size in an infant can pose a risk for incarceration in a 5-mm port site.
- This case highlights the potential for herniation and incarceration even at smaller trocar sites in pediatric patients.
Implications:
- Fascial closure of 5-mm trocar sites in infants is crucial to prevent serious complications.
- This recommendation aims to enhance patient safety in pediatric laparoscopic procedures.
- Revising closure techniques for small-port sites in infants may be warranted to mitigate hernia risks.
Abstract:
Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. When hernias do occur they are generally through trocar sites 10 mm or greater in size. To prevent hernias, laparoscopic incisions are usually closed at the fascial level. Five-mm trocar sites are usually closed only at the subcutaneous level because of the difficulty of exposing the fascia through the small skin incision and the rarity of herniation through these trocar sites. This is a report of a 22-month, 13.5-kg child who underwent laparoscopic Toupet fundoplication for gastroesophageal reflux. Postoperatively he developed a small bowel obstruction secondary to a Richter's hernia from small bowel incarceration in a 5-mm left lower quadrant trocar site. The reason for the incarceration was the small size of the infant bowel. It has a proportional size relationship to a 5-mm trocar as does adult bowel to a 10-mm trocar; 5-mm trocar sites should be closed at the fascial level in infants to prevent this complication.