Access-related complications - an analysis of 6023 consecutive laparoscopic hernia repairs

In order to investigate incidence rates and types of access-related complic ations that may occur during laparoscopic hernioplasty, we carried out a sy stematic analysis of our collected results. The aim was to identify risk fa ctors and to develop useful modifications of the surgical technique and the instrumentation used. Since we first introduced laparoscopic hernioplasty in our clinic, we have carried out standardised, prospective documentation of relevant data from all consecutive operations in an electronic database. We performed a systematic analysis of access related complications and the ir possible influencing factors, taking into special account the type of in struments used, port-site and prior intra-abdominal operations. Between Apr il 1993 and March 2000, 4857 consecutive patients received a total of 6023 laparoscopic hernia repairs. In 510 patients three-edged, sharp trocars wer e used and in 4347 patients conical obturators were used to insert the port . The incidence of access related complications was 0.9% (44/4857) in the t otal collection (incision hernias 0.5%, bleeding from abdominal-wall vessel s 0.2%, bowel injury 0.06%, wound infections 0.06%), Injuries to intra-abdo minal or retroperitoneal vessels were not observed. A differentiated analys is of the various trocar types, taking into consideration the number of ins erted ports, showed that for incisions outside the linea alba the incidence of bleeding from abdominal-wall vessels was 12 times higher (0.7%, 7/1020 versus 0.06%, 5/8694). The incidence of incision hernias increased signific antly (1.2%, 12/1020 versus 0.02%, 2/8694; p = 0.03) when three-edged troca rs were used, as opposed to conical obturators. Our results demonstrate tha t, outside the linea alba, three-edged trocars should no longer be used for port-insertion. The results of our differentiated analysis of laparoscopic hernia repairs, taking into account the type of obturator, the port-site a nd number of ports inserted, also can be applied to other laparoscopic oper ations.