Preperitoneal Richter hernia after a laparoscopic gastric bypass.
Trocar-site incisional hernias are potentially dangerous because of their susceptibility to become Richter hernias. The authors describe a morbidly obese patient in whom developed an unusual type of Richter hernia after a laparoscopic isolated Roux-en-Y gastric bypass at a 10-mm trocar site. Although the fascial closure of the trocar hernia site was intact, a hernia developed through the peritoneum into the preperitoneal space. For morbidly obese patients, the thick preperitoneum is a potential space that allows for the development of a Richter hernia, despite adequate fascial closure. It is recommended that all 10-mm and 12-mm trocar sites be closed, incorporating the peritoneum into the fascial closure to obliterate the preperitoneal space, to prevent this postoperative complication.
Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA. bmatthews@carolinas.org
B D
BD
Matthews
B T
BT
Heniford
R F
RF
Sing
D000328:Adult; D005260:Female; D015390:Gastric Bypass; D006555:Hernia, Ventral / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications