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.
Matthews
B D
BD
Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA. bmatthews@carolinas.org
Heniford
B T
BT
Sing
R F
RF
D000328:Adult; D005260:Female; D015390:Gastric Bypass; D006555:Hernia, Ventral / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications