Port site hernia (PSH) following laparoscopic procedures is a rare but serious complication. The aim of this study was to evaluate the rate of PSH after laparoscopic sleeve gastrectomy (LSG), and the efficacy of closure of the port site as a means of preventing PSH. A retrospective analysis was performed on 386 patients who underwent LSG between December 2009 and January 2015. 352 (91.2%) of the patient were followed up for at least 24 months. In the first 206 patients, the fascial layers of the trocar incisions were not closed, while in the next 146 cases, routine closure of the trocar sites was performed. The patients were reviewed in relation to demographics, comorbidities, complications, percentage of excess weight loss, and rates of PSH. The total cohort consisted of 220 female and 132 male patients with a mean age of 36.2 ± 12.3 years. Demographic data, initial BMI, and comorbidities were similar for the patients in both groups. The closure of the fascia was caused by the prolonged duration of the operation with no significant difference. The unclosed fascial defects were associated with a significantly increased incidence of PSH (1.3 vs. 3.9%, p < 0.05). All of the patients who experienced PSH had at least one comorbidity, and no complication was noted in the fascial closure cases. It was found that the rate of PSH after LSG is not as low as previously thought, and that routine closure of fascial defects at port sites may result in a decreased PSH rate.
Obesity Morbid Port site hernia Laparoscopy Trocar
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Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Research involving human participants and/or animals
All procedures performed in this study on human subjects were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments and comparable standards, with the ethical standards of General Medical Council’s Good Medical Practice.
Statement of informed consent
The need for patient informed consent for this retrospective study was waived by the institutional review board.
van Rutte PW, Smulders JF, de Zoete JP, Nienhuijs SW (2014) Outcomes of sleeve gastrectomy as a primary bariatric procedure. Br J Surg 101(6):661–668CrossRefPubMedGoogle Scholar
Alexandrou A, Armeni E, Kouskouni E, Tsoka E, Diamantis T, Lambrinoudaki I (2014) Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis 10(2):262–268CrossRefPubMedGoogle Scholar
Owens M, Barry M, Janjua AZ, Winter DC (2011) A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 9(4):218–224CrossRefPubMedGoogle Scholar
Helgstrand F, Rosenberg J, Bisgaard T (2011) Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15(2):113–121CrossRefPubMedGoogle Scholar
Coblijn UK, de Raaff CA, van Wagensveld BA, van Tets WF, de Castro SM (2016) Trocar port hernias after bariatric surgery. Obes Surg 26(3):546–551CrossRefPubMedGoogle Scholar
Derici S, Atila K, Bora S, Yener S (2016) Simple, safe, and cost-effective technique for resected stomach extraction in laparoscopic sleeve gastrectomy. Gastroenterol Res Pract 2016:7090128CrossRefPubMedPubMedCentralGoogle Scholar
Lee DY, Rehmani SS, Guend H, Park K, Ross RE, Alkhalifa M et al (2013) The incidence of trocar-site hernia in minimally invasive bariatric surgery: a comparison of multi versus single-port laparoscopy. Surg Endosc 27(4):1287–1291CrossRefPubMedGoogle Scholar
Duron JJ, Hay JM, Msika S, Gaschard D, Domergue J, Gainant A et al (2000) Prevalence and mechanism of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research. Arch Surg 135(2):208–212CrossRefPubMedGoogle Scholar
Coda A, Bossotti M, Ferri F, Mattio R, Ramellini G, Poma A et al (2000) Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 10:34–38CrossRefPubMedGoogle Scholar
Neri V, Fersini A, Ambrosi A, Tartaglia N, Valentino TP (2008) Umbilical port-site complications in laparoscopic cholecystectomy: role of topical antibiotic therapy. JSLS 12(2):126–132PubMedPubMedCentralGoogle Scholar
Moran DC, Kavanagh DO, Sahebally S, Neary PC (2012) Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach. Ir J Med Sci 181(4):463–466CrossRefPubMedGoogle Scholar
Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13(4):596–600CrossRefPubMedGoogle Scholar
Johnson WH, Fecher AM, McMahon RL, Grant JP, Pryor AD (2006) VersaStep™ trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc 20:1584–1586CrossRefPubMedGoogle Scholar