Hernia at 5-mm laparoscopic port site presenting as early postoperative small bowel obstruction

A decade has passed since laparoscopy became a popular tool in general surg ery. New technologies continue to surface, and surgeons are still trying to expand the applications of this technique. Parallel to the development of new techniques, we are also measuring the presentation of new complications . Incisional hernias are not new complications. Although their avoidance ha s been one of the proposed benefits of laparoscopy, several cases of port-s ite hernias have been reported. Current surgical wisdom suggests closure of 10-mm or larger port sites to avoid herniation. Most surgeons do not routi nely close 5-mm port sites, believing that such fascial defects are not lar ge enough to create a significant risk of hernia formation, thus not justif ying the extra time and effort needed to close them. Although this practice may be reasonable for most cases, it should be reconsidered in lengthy pro cedures, particularly if the port has been used for active operative instru ments. Under these circumstances, the repetitive motions in different direc tions may cause the 5-mm defect to enlarge significantly, allowing a hernia of considerable size to develop, with the obvious clinical implications of such a complication. We present a case of a hernia through a 5-mm port sit e presenting as small-bowel obstruction in the early postoperative period a fter a laparoscopic paraesophageal hernia repair.