title: Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication.
abstract: BACKGROUND
  Although there have been case reports describing trocar site herniation after laparoscopic fundoplication, its overall prevalence and the risk factors for its development are unclear.
  
  
  METHODS
  The records of 320 patients undergoing primary laparoscopic fundoplication as treatment for gastroesophageal reflex disease (GERD) or hiatal hernia between 1991 and 1999 were reviewed retrospectively. Placement of the initial supraumbilical trocar was by the open Hassan technique in all patients.
  
  
  RESULTS
  Nine patients (five male) with a mean age 54 years (range, 37-75) developed trocar site herniation, for an overall prevalence of 3%. The mean interval between surgery and diagnosis was 12 months (range, 4-21). In all patients, the hernia occurred at the supraumbilical camera port site. Patients with trocar hernias tended to have a higher body mass index (BMI) than those without hernias (mean BMI, 29.4 kg/m2 vs 27.2 kg/m2, p = 0.13). None of the patients developed intestinal obstruction as a consequence of herniation. To date, all but one of the hernias have been repaired. Six of them required the insertion of a prosthetic mesh.
  
  
  CONCLUSIONS
  The prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3%. All hernias occurred at the midline supraumbilical port, the only site where open trocar insertion was employed. As a consequence of these observations, we have developed a new method of open trocar placement. This method utilizes a paramedian skin incision and separate fascial incisions through anterior and posterior rectus sheathes, with retraction of the rectus abdominis muscle laterally.
authors.affiliation: Department of Surgery, University of Southern California, HCC Suite 514, 1510 San Pablo St, Los Angeles, CA 90033-4612, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Bowrey
authors.forename: D
authors.initials: D
authors.lastname: Blom
authors.forename: P F
authors.initials: PF
authors.lastname: Crookes
authors.forename: C G
authors.initials: CG
authors.lastname: Bremner
authors.forename: J L
authors.initials: JL
authors.lastname: Johansson
authors.forename: R V
authors.initials: RV
authors.lastname: Lord
authors.forename: J A
authors.initials: JA
authors.lastname: Hagen
authors.forename: S R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: J H
authors.initials: JH
authors.lastname: Peters
mesh_terms: D000005:Abdomen / Q000601:surgery; D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects*; D016896:Treatment Outcome