Late epigastric incisional hernias following laparoscopic cholecystectomy

By the introduction of laparoscopic cholecystectomy a new "gold standard" procedure became a routinely performed operation in the field of biliary tract surgery. Thus, the incision related early and late complications are thought to diminish, especially the formation of incisional hernias. Five patients had been referred to our department suffering from chronic incisional hernias following laparoscopic cholecystectomy. All of the hernias were located to the site of the epigastric trocar. The contents of the hernias proved to be omentum. The documentation's of the laparoscopic cholecystectomies revealed the extraction of thick walled gallbladders that contain large stones, and the wounds through which the extraction was performed had not been closed. Taking into consideration the fact of the "Chimney Effect" caused by the desufflation of the pneumoperitoneum at the end of the laparoscopic operation, bowel or omentum can easily escape through the relatively large wound formed during the extraction of the gallbladder, resulting in the formation of incisional hernias. This can be avoided by the complete desufflation and the prompt closure of the wound.