Routine suture closure of laparoscopic ports urged to avoid Richter's hernia

The most common sites of Richter's hernias today are laparoscopic ports that are left open or inadequately closed, said James E. Carter, MD, clinical assistant professor of obstetrics and gynecology at the University of California at Irvine.

Carter, who was attending the Laparoendoscopic Surgical Complications meeting in Seattle, said that Richter's hernias are the type seen most often at trocar sites. The umbilical site is not spared, he said.

Carter pointed out the potential seriousness of complications with Richter's hernias. There have been case reports in which small bowel resection was required. Even when resection is not needed, open surgery is the usual method of treatment.

Spontaneous healing of such hernias does not occur. Be highly suspicious of Richter's in any case where a patient develops nausea, vomiting and evidence of small bowel obstruction after laparoscopy.

Recognizing a Richter's hernia may be difficult, because bowel sounds may persist despite a worsening situation. Delay in diagnosis occurs because only a part of the bowel wall is involved and , as a result, the rest of the bowel may be functioning. The problem which may involve omentum as well as bowel is unlikely to be detected on conventional x-ray films of the abdomen or by an upper GI series; instead, a CT scan is recommended.