Small bowel obstruction in a lateral trocar site following laparoscopic bariatric surgery
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Hellenic Journal of Surgery (2017) 89:5-6, 228-231
Small Bowel Obstruction in a Lateral Trocar Site Following Laparoscopic Bariatric Surgery Lorentziadis ML, Amir Mounir Hussein, Mustafa Mahmoud Nafady Hego
Abstract Introduction: One of the complications of laparoscopic surgery is incisional hernia at the port trocar site. It is a
rare complication, with a reported incidence varying between 0.65% and 2.8%, and it is documented in both adults and children. Case presentation: An obese 62-year-old woman underwent a laparoscopic mini gastric bypass for body weight
reduction at another hospital. On the third post-operative day, she developed abdominal pain with vomiting and was admitted to our hospital. Imaging studies confirmed a small bowel loop obstruction at the lateral 12mm trocar site and the patient was operated on immediately. The viability of the entrapped bowel was confirmed at the trocar site opening, the bowel loop was returned into the abdominal cavity and the defect was closed. Two days later, the patient was discharged in good condition. Discussion: Trocar site or port site hernia is defined as an incisional hernia which occurs after minimal invasive
surgery, at the trocar site incision. Following bariatric surgery its reported incidence is 1% - 1.6%. Its cause is multifactorial, including obesity and old age, the size and site of the inserted trocar and the angle of insertion, and excessive manipulations. Although there is no clear consensus on closure at port sites, it is recommended that fascial defects of larger than 10mm in adults and 5mm in children should be closed. Conclusion: Trocar site hernia is a rare complication of laparoscopic procedures, and one that can be minimized.
Viscus entrapment in a port site hernia should be suspected during the post-operative period whenever the patient presents with abdominal distension, pain and vomiting since, particularly in the case of bariatric surgery, the findings on physical examination may be inconclusive, due to obesity. Key words: Laparoscopic complication; trocar site hernia; small bowel obstruction; bariatric surgery complication
Introduction Since its introduction in 1987 into the general surgery repertoire, laparoscopic or robotic surgery has been associated with incisional hernia at the port-trocar site which can result in protrusion of a bowel loop through the defect, with strangulation. The first documented report of trocar site hernia was that of Fear in 1968, who described a large series of patients who underwent diagnostic gynecological laparoscopy [1]. Trocar site or port site hernia is defined as an incisional hernia which occurs after minimal invasive Lorentziadis ML Consultant Surgeon Amir Mounir Hussein, Mustafa Mahmoud Nafady Hego Associate Consultant Surgeon Imam Abdulrahman bin Faisal Hospital, Dammam, KSA Corresponding author: Lorentziadis ML Imam Abdulrahman bin Faisal Hospital, NGHA, Dammam 31412, KSA e-mail: [email protected] Received July 16, 2017; Accepted August 28, 2017 Hellenic Journal of Surgery 89
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