Incisional hernias after operative laparoscopy

Objective

To determine the possible risk factors of incisional hernias after operative laparoscopy.

Study Design

A retrospective case review was performed in a single referral obstetrics/gynecology clinic and center for special pelvic surgery considering the approximately 5300 patients who underwent laparoscopy from January 1988 through June 1996.

Results

Eleven cases of incisional hernia occurring in 10 patients for an incidence of approximately 0.2%. Omentum herniated in seven cases and bowel herniated in four cases. In one case, the sigmoid epiploica irreducibly herniated through the peritoneum and not 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 entrapped omentum or bowel. In one case, laparoscopically assisted bowel resection was necessary. After an average follow-up time of 17.7 months, all patients were doing well.

Discussion

Recent reports of incisional hernia after laparoscopy have stressed the relationship of this complication with the use of ports 10 mm in diameter or larger. Incisional hernia occurred in half (5 of 10) of our patients in ports 5 mm in size in the left lower quadrant site. In our opinion, this can probably be attributed to increased operating times which result in excessive manipulation of the port site, thereby widening the fascial and peritoneal defects.

Conclusion

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 thorough a 5-mm trocar port, causing extension of the incision.