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KMID : 0386019960080010053
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Korean Journal of Gynecology Endoscopy and Minimally Invasive Surgery
1996 Volume.8 No. 1 p.53 ~ p.58
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Laparoscopic Management of Incisional Bowel Herniation after Operative Laparoscopy
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김성호/Kim, SH
서정호/박형무/허민/Seo, JH/Park, HM/Hur, M
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Abstract
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The evolution of laparoscopy from a diagnostic tool to a surgical route for major operative procedures continues at a rapid rate. Critical evaluation of newer laparoscopic procedures requires careful reporting of outcomes and complications. One complication that may be seen more frequently with operative procedures is incisional herniation. There are several reasons for the potential increase in this complication (1) the use of multiple ancillary ports, (2) extirpative procedures such as oophorectomy-or lymphadenectomy requiring larger ports of specimen removal, (3) newer instruments such as clip applicators and linear staplers requiring 10 and 12mm ports, (4) increased operating times with more port manipulation, potentially stretching the fascial defect, and (5) the use of port anchoring devices such as fascial screws, which may add an extra 1 to 2mm to the fascial defect. Many laparoscopists aware of this potential complication and attempt to close the fascia of larger laparoscopy incisions ; however, this is somtimes extremely difficult to perform or verify.
Herniation of abdominal contents through trocar incision sites is infrequent, but it can occur at any port site. The increased use of large cannulas at extraumbilical sites increases the tendency for herniation at these sites. Case reports in the literature generally described laparotomy repair of these events.
Two of our patients experienced incisional hernias after major laparoscopic surgery. We reduced a small bowel hernia after operative laparoscopy using the open laparoscopic approach.
Awareness of this clinical problem, its relationship to the site of of abdominal entry, possible enlargement of the fascial defect during operation and hence the need of meticulous closure of the fascia when a large trocar is used will avoid such occurrence.
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