title: Trocar site hernia.
abstract: OBJECTIVE
  To review the relationship between the pathogenesis and clinical manifestations of trocar site hernias seeking to confirm the definition of trocar site hernias by classification.
  
  
  METHODS
  We searched this subject in English on MEDLINE by combining the words "trocar," "port," "hernia, and "laparoscopy."Data Extraction and
  
  
  METHODS
  We limited the main operations to cholecystectomy, colon and rectal surgery, fundoplication, and gastric surgery; finding 44 reports on these procedures. Of these, 19 were case reports, 18 were original articles (setting criteria; the incidence of the trocar site hernia was clarified, and involved >100 patients), and 7 technical notes on "how to do it" were collected. We obtained 19 additional reports using the references of those previously obtained. We, thus, reviewed 63 reports (24 case reports, 27 original articles, 7 technical notes, and 5 review articles).
  
  
  RESULTS
  Trocar site hernia was classified into 3 types. The early-onset type that occurred immediately after the operation, with a small-bowel obstruction, especially the Richter hernia, frequently developing. The late-onset type that occurred several months after the operation, mostly with local abdominal bulging with no small-bowel obstruction developing. The special type that occurred indicated the protrusion of the intestine and/or omentum. Trocar site hernias with fascial defects of 10 mm or larger should be closed, including the peritoneum. Opinion varied if a 5-mm trocar site defect should be closed.
  
  
  CONCLUSIONS
  It is useful to clearly classify trocar site hernias to improve management of laparoscopic procedures.
authors.affiliation: Departments of Innovative Surgery, Mie University School of Medicine, Mie, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tonouchi
authors.forename: Yukinari
authors.initials: Y
authors.lastname: Ohmori
authors.forename: Minako
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D013505:Digestive System Surgical Procedures / Q000295:instrumentation; D006547:Hernia / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D013525:Surgical Instruments / Q000009:adverse effects*