Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery.
We report the case of a 6-month-old female infant who developed post-operative bowel obstruction due to an incarcerated hernia through a 5-mm laparoscopic wound. The patient underwent laparoscopic Nissen fundoplication for gastroesophageal reflux. On day 6, she showed symptoms of ileus, and the diagnosis of a trocar wound hernia was made on day 13. The herniated intestine was reduced and the defective peritoneum and fascia were closed under relaparoscopic guidance, thus avoiding full-scale laparotomy. A trocar wound hernia causing early postoperative bowel obstruction is a rare complication, especially at 5-mm trocar puncture sites. Intraoperative dislodgment and reinsertion of working trocars may create fascial defects larger than the actual size of the trocar. All laparoscopic puncture wounds, even those <10 mm in size, should be closed at the fascial level in infants. Revision laparoscopy is considered preferable to manage trocar site complications in children.
Nakajima
K
K
Department of Pediatric Surgery, Osaka University Medical School, Suita, Japan.
Wasa
M
M
Kawahara
H
H
Hasegawa
T
T
Soh
H
H
Taniguchi
E
E
Ohashi
S
S
Okada
A
A
D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery; D006554:Hernia, Umbilical / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D016896:Treatment Outcome