Trocar site hernia after bariatric surgery: our experience without fascial closure

Abstract

Introduction: The spreading of laparoscopic surgery has increased the occurrence of trocar site hernias, along with their related complications. Bariatric surgery combines two important risk factors in hernia formation: obesity and complexity of port-site closure. Several techniques and devices have been proposed to close the trocar wounds to minimize the risk of hernia occurrence.

Materials and methods: The records of 624 obese patients who underwent laparoscopic bariatric procedures between January 2006 and December 2012 were retrospectively reviewed. In no patient was performed the closure of the fascial layers of trocar incisions. Weight, BMI, E%WL and onset of complications were monthly collected for the first year after the procedure, then every six month.

Results: 10 patients showed trocar site hernia, for an overall prevalence of 1.6%. The mean time of occurrence was 15 months. None developed intestinal obstruction or other complications as a consequence of the hernia. The mean time of follow-up was 54 months. The mean weight and BMI before interventions were 136.3 ± 17.7 kg and 46.0 ± 4.6 kg/m² respectively. The mean percentage of excess weight loss (E%WL) at one year was 45.9%.

Conclusion: We avoided complicating the wound closure with fascia closure, accepting the risks related to the BMI. So far our procedure for port-site closure is relatively simple, safe, less invasive, less time-consuming and costless. These advantages could arise from the fact that our patients benefit from a remarkable weight loss after the intervention thus reducing one of the most important risk factors in the onset of trocar site hernia.

Keywords: Bariatric surgery; Incisional hernia; Laparoscopy; Obesity; Trocar site.