Incarcerated Right Lateral Trocar-Site Hernia as a Rare Complication of Robot-Assisted Laparoscopic Prostatectomy

Abstract

Background: Trocar-site hernia (TSH) is an uncommon complication following laparoscopic surgery and a potential cause of significant morbidity if bowel incarceration or strangulation occurs. Lateral trocar sites are intrinsically less susceptible to hernia development and traditionally do not mandate fascial closure. We present an unusual case involving an incarcerated TSH from a 12-mm right lateral port after robotic prostatectomy. Case Presentation: The patient is a 76-year-old man with localized intermediate risk, high-volume prostate cancer who underwent a robot-assisted, laparoscopic prostatectomy. He developed generalized malaise and no flatus or bowel movements at 7 days postoperatively. Cross-sectional imaging revealed small bowel dilatation with a transition point along the right lateral 12-mm trocar site. A minilaparotomy (extension of lateral port incision) confirmed incarcerated but viable small bowel. This was reduced and fascia closed without surgical resection. Conclusion: While rare, TSH is an important clinical entity to recognize after minimally invasive surgery. It is critical to properly review trocar technique and maintain a low threshold for close postoperative follow-up, if there is clinical concern for a trocar hernia.

Keywords: incarcerated trocar-site hernia; minimally invasive surgery; prostate cancer; robotic prostatectomy.

FIG. 1.

Noncontrast CT axial and coronal images. Incarcerated small bowel loop within the right lateral trocar site, with a transition point in the right lower quadrant (red circle).