Purpose: After laparoscopic surgery, hernia at trocar site is very rare complication but it occurs more frequently in accordance with increasing laparoscopic surgery. Richter´s hernia is characterized as hernia in which only a part of the circumference of the bowel is engaged into a hernia sac. Because only a portion of the bowel wall is entrapped, it is associated with partial intestinal obstruction. As we describe the Richter´s hernia, the following is a report of six bowel obstruction from symptomatic Richter´s hernia.
Methods: Between January 1999 and July 2004, we reviewed six cases of diagnosed Richter´s hernia among the 2327 laparoscopic surgeries in Kyung Hee University Hospital.
Results: All cases had abdominal pain. The four cases had nausea and vomiting. The average period between operations and development of symptoms was three days, except only one case which showed symptoms six years later. We diagnosed all the cases as an intestinal obstruction by abdominalradiography. The three cases were diagnosed as Richter´s hernia by abdominal CT. However, we couldn´t diagnose the two cases with abdominal ultrasonography. Hernia occurred at 5 mm trocar site with drain tube in the two cases and 10mm trocar site in four cases.
Conclusion: The intestinal obstruction after laparoscopic surgery is not a common complication, but might result in the emergence of new, specific operative complication, Richter´s hernia. The complications-such as incarceration, strangulation and perforation- can occur in this case. Therefore, it is necessary to perform abdominal CT for an early diagnosis and to confirm whether it is hernia at trocar site or not if patients develop intestinal obstruction after laparoscopic surgery.
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