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. 2023 Jan 16;11(2):357-365.
doi: 10.12998/wjcc.v11.i2.357.

Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Santi Krittiyanitsakun  1 , Chawisa Nampoolsuksan  1 , Thikhamporn Tawantanakorn  1 , Tharathorn Suwatthanarak  1 , Nicha Srisuworanan  1 , Voraboot Taweerutchana  1 , Thammawat Parakonthun  1 , Chainarong Phalanusitthepha  1 , Jirawat Swangsri  1 , Thawatchai Akaraviputh  1 , Asada Methasate  1 , Vitoon Chinswangwatanakul  1 , Atthaphorn Trakarnsanga  2
Affiliations

Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up

Santi Krittiyanitsakun et al. World J Clin Cases. .

Abstract

Background: Despite the infrequency of trocar site hernias (TSHs), fascial closure continues to be recommended for their prevention when using a ≥ 10-mm trocar.

Aim: To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.

Methods: Between July 2010 and December 2018, all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed. All patients underwent cross-sectional imaging for TSH assessment. Clinicopathological characteristics were recorded. Incidence rates of TSH and postoperative results were analyzed.

Results: Of the 254 patients included, 70 (111 ports) were in the fascial closure (closed) group and 184 (279 ports) were in the nonfascial closure (open) group. The median follow up duration was 43 mo. During follow up, three patients in the open group developed TSHs, whereas none in the closed group developed the condition (1.1% vs 0%, P = 0.561). All TSHs occurred in the right lower abdomen. Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain. The open group had a significantly shorter operative time and lower blood loss than the closed group.

Conclusion: Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed. However, further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

Keywords: Fascial closure; Laparoscopic colorectal surgery; Nonbladed trocar; Port site hernia; Trocar site hernia.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flowchart of analysis. EL: Exploratory laparotomy; CNT: Connective tissue; F/U: Follow up.
Figure 2
Figure 2
Kaplan–Meier analysis of trocar site hernia events. GR: Group.
Figure 3
Figure 3
Fitted postoperative pain.
See this image and copyright information in PMC

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