Clinical Analysis of 12 Cases of Trocar Site Hernia After Laparoscopic Surgery / 中国微创外科杂志

ABSTRACT

Objective To summarize the clinical features,diagnosis and treatment and prognosis of trocar site hernia(TSH).Methods Clinical data of 12 patients with TSH receiving laparoscopic surgery from January 2019 to January 2023 were retrospectively analyzed.The clinical manifestations included intestinal obstruction in 8 cases,trocar incision prolongation with fluid seepage in 1 case,and no obvious symptoms in 3 cases.The patients were diagnosed by abdominal CT in 9 cases,by small intestine contrast imaging in 1 case,by abdominal MRI in 1 case,and by abdominal plain film combined with abdominal color ultrasound in 1 case.The hernia was located in the right lower abdomen in 5 cases,the left lower abdomen in 4 cases,and the right upper abdomen in 3 cases.The trocar diameter was 12 mm in 6 cases,10 mm in 5 cases,and 5 mm in 1 case.A drainage tube was placed at trocar site in 5 cases.Open operations were performed in 11 cases,including small intestine reduction and abdominal wall layer-by-layer suture in 4 cases,partial small intestine resection and anastomosis in 3 cases,Onlay repair in 3 cases,and partial omentectomy,transverse colon reduction and Onlay repair in 1 case.Another case developed trocar site refractoriness which did not heal,and the patient refused surgery,who was given dynamic observation.Results The operation was successful in the 11 cases.Postoperatively,1 case of inflammatory intestinal obstruction underwent intestinal decompression tube implantation,1 case of incision bleeding underwent emergency operation again to stop bleeding,and the rest recovered smoothly.All the 12 patients were followed up for 5-48 months,with a median of 13 months.The patient without surgery had persistent induration and intermittent exudation at the trocar site.One case died due to tumor metastasis,and none of the others had hernia recurrence.Conclusions The most common manifestation of TSH is intestinal obstruction,which mostly occurs at trocar with diameter≥10 mm.If there are symptoms,it should be treated by surgery as soon as possible.