INCISIONAL HERNIAS AFTER OPERATIVE LAPAROSCOPY

The objective of this study was to determine the possible risk factors of incisional hernias after operative laparoscopy. A retrospective ca se review was performed in a single referral obstetrics/gynecology cli nic and center for special pelvic surgery considering the last 5300 su rgeries. Of the approximately 5300 patients who underwent laparoscopy from January 1988 through June 1996, 10 women were evaluated for incis ional hernias. A total of 11 hernias occurred, which is an incidence o f approximately 0.2%. Omentum herniated in seven cases and bowel herni ated in four cases. In one case, the sigmoid epiploica irreducibly her niated through the peritoneum and not the fascia. The hernia occurred through a 5-mm trocar incision site in five cases. The median duration of the laparoscopic surgeries was 192 minutes (range, 25-375 minutes) . Six women required laparoscopic surgery in order to retract the entr apped omentum or bowel. In one case, laparoscopically assisted bowel r esection was necessary. The underlying fascia and peritoneum should be closed not only when using trocars of 10 mm and larger as previously suggested but also when extensive manipulation is performed through a 5-mm trocar port, causing extension of the incision.