EVALUATION OF THE FREQUENCY OF TROCAR SITE HERNIA AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

Yıl 2022, Cilt: 85 Sayı: 1, 35 - 40, 25.01.2022

Anıl Ergin , Mehmet Mahir Fersahoğlu , Nuriye Esen Bulut , Aziz Bora Karip Ahmet Yalın İşcan , Hüseyin Çiyiltepe Yasin Güneş İksan Taşdelen Kemal Memişoğlu

https://doi.org/10.26650/IUITFD.947187

Öz

Objective: Today, laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric surgical method. One of the complications seen after LSG is trocar site hernia (TSH). There is no clear information about the rate of TSH detected radiologically after LSG. A thick abdominal wall and the failure to adequately expose the fascial defect related to this, as well as mobility limitations due to excessive subcutaneous fatty tissue, are the reasons for increased incidence of TSH. Materials and Methods: The demographic characteristics and postoperative weight loss of patients who underwent LSG procedures and whose fascial defects in the trocar region were repaired with the Carter-Thomason Suture Passer (CTSP) in our clinic between January 2015 and June 2017 were evaluated. TSH evaluation was performed both through physical examination and superficial USG by a general surgeon who had radiological training on concurrent superficial abdominal ultrasonography (USG). Detected TSHs were divided into two groups: symptomatic and asymptomatic. Results: A total of 61 patients were included in the study. The mean period after operation was calculated as 36 months (min 20, max 52). TSH was detected in seven (11.5%) of 61 patients, two of whom had symptomatic and five of whom had asymptomatic TSH. Being over 40 years of age and having a calculated body mass index (BMI) value greater than 30 kg/m2 during measurement were found to be the factors that significantly increased the incidence of TSH (p<0.05). Conclusions: Advanced age and inadequate weight loss are the factors that increase the rate of TSH after Sleeve Gastrectomy.

Anahtar Kelimeler

Morbid obesity, Laparoscopic sleeve gastrectomy, trocar site hernia, Carter-Thomason suture passer

LAPAROSKOPİK SLEEVE GASTREKTOMİ AMELİYATI SONRASI TROKAR YERİ HERNİSİ GELİŞİM SIKLIĞININ ARAŞTIRILMASI

Öz

Objective: Today, laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric surgical method. One of the complications seen after LSG is trocar site hernia (TSH). There is no clear information about the rate of TSH detected radiologically after LSG. A thick abdominal wall and the failure to adequately expose the fascial defect related to this, as well as mobility limitations due to excessive subcutaneous fatty tissue, are the reasons for increased incidence of TSH. Materials and Methods: The demographic characteristics and postoperative weight loss of patients who underwent LSG procedures and whose fascial defects in the trocar region were repaired with the Carter-Thomason Suture Passer (CTSP) in our clinic between January 2015 and June 2017 were evaluated. TSH evaluation was performed both through physical examination and superficial USG by a general surgeon who had radiological training on concurrent superficial abdominal ultrasonography (USG). Detected TSHs were divided into two groups: symptomatic and asymptomatic. Results: A total of 61 patients were included in the study. The mean period after operation was calculated as 36 months (min 20, max 52). TSH was detected in seven (11.5%) of 61 patients, two of whom had symptomatic and five of whom had asymptomatic TSH. Being over 40 years of age and having a calculated body mass index (BMI) value greater than 30 kg/m2 during measurement were found to be the factors that significantly increased the incidence of TSH (p<0.05). Conclusions: Advanced age and inadequate weight loss are the factors that increase the rate of TSH after Sleeve Gastrectomy.

Anahtar Kelimeler

Morbid obezite, Laparoskopik sleeve gastrektomi, Trokar yeri fıtığı, Carter-Thomason sütür geçirici

Kaynakça

• 1. Ahmad G, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev 2008;(2):CD006583. [CrossRef]
• 2. Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos- Kemper TC, Trimbos JB. Complications of laparoscopy: An inquiry about closed- versus open-entry technique. Am J Obstet Gynecol 2004;190(3):634-8. [CrossRef]
• 3. Azziz R, Murphy AA. Practical Manual of operative Laparoscopy and hysteroscopy. New York: Springer-Verlag; 1992. pp. 1-8. [CrossRef]
• 4. Shah PR, Naguib N, Thippeswammy K, Masoud AG. Port site closure after laparoscopic surgery. J Minim Access Surg 2010;6(1):22-3. [CrossRef]
• 5. Botea F, Torzilli G, Sarbu V. A simple, effective technique for port-site closure after laparoscopy. JSLS 2011;15(1):77-80. [CrossRef]
• 6. Bonatti H, Hoeller E, Kirchmayr W, Muhlmann G, Zitt M, Aigner F, et al. Ventral hernia repair in bariatric surgery. Obes Surg 2004;14(5):655-8. [CrossRef]
• 7. Fuller J, Ashar BS, Carey-Corrado J. Trocar-associated injuries and fatalities: An analysis of 1399 reports to the FDA. J Minim Invasive Gynecol 2005;12(4):302-7. [CrossRef]
• 8. Kadar N, Reich H, Liu CY, Manko GF, Gimpelson R. Incisional hernias after major laparoscopic gynecological procedures. Am J Obstet Gynecol 1993;168(5):1493-5. [CrossRef]
• 9. Mendoza D, Newman RC, Albala D, Cohen MS, Tewari A, Lingeman J, et al. Laparoscopic complications in markedly obese urologic patients (a multi-institutional review). Urology 1996;48(4):562-7. [CrossRef]
• 10. Iranmanesh P, Rivera AR, Bajwa KS, Alibhai M, Snyder BE, Wilson TD, et al. Trocar site closure with a novel anchor‑based (neoClose®) system versus standard suture closure: a prospective randomized controlled trial. Surg Endosc 2020;34(3):1270-6. [CrossRef]
• 11. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351(26):2683-93. [CrossRef]
• 12. Eid GM, Collins J. Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients. Obes Surg 2005;15(6):871-3. [CrossRef]
• 13. Nakada SY, McDougall EM, Gardner SM, Gonzalez G, Clayman RV. Comparison of newer laparoscopic port closure techniques in the porcine model. J Endourol 1995;9(5):397-401. [CrossRef]
• 14. Pamela D, Roberto C, Francesco LM, Umberto M, Carla M, Vincenzo N, et al. Trocar site hernia after laparoscopic colectomy: a case report and literature review. ISRN Surg 2011;2011:725601. [CrossRef]
• 15. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15(2):113-21. [CrossRef]
• 16. Ng WT. A full review of port-closure techniques. Surg Endosc 2007;21(10):1895-7. [CrossRef]