HERNIAS IN TROCAR PORTS FOLLOWING ABDOMINAL LAPAROSCOPY - A REVIEW

Background. With increasing numbers of laparoscopies in gynecologic su rgery as well as the use of larger trocars more post-operative hernias can be expected. Most hernias occur as Richter's hernias without peri toneal lining and contain small or large intestines or omentum. The in cidence is around 1%, but rising with increasing size of trocars. Abou t one fourth of hernias are umbilical, the rest located extraumbilical . Results. The diagnosis is typically based on the presence of vomitin g or nausea with an extended and painful abdomen within two weeks of s urgery and can be established by a small bowel series. However, the co urse can be prolonged and ileus can occur up to one year following lap aroscopy. In the majority of cases the hernial content was small intes tines or omentum. Conclusions. In order to reduce the frequency of tro car hernias it is recommended to apply small trocars. Fascial closure must be done when trocars of 10 mm or larger have been employed and th e surgeon must ensure that peritoneal tissue is not drawn into the tro car canals when removing the probes. Also, umbilical hernias must be r uled out and, if found, closure must include the complete fascial defe ct. There are several techniques available for fascial closure. It is concluded that all precautions including fascial suturing must be take n to reduce the 1% incidence of post-laparoscopy hernias.