title: Trocar site hernia after bariatric surgery: our experience without fascial closure.
abstract: BACKGROUND
  The spreading of laparoscopic surgery has increased the occurrence of trocar site hernias, along with their related complications. Bariatric surgery combines two important risk factors in hernia formation: obesity and complexity of port-site closure. Several techniques and devices have been proposed to close the trocar wounds to minimize the risk of hernia occurrence.
  
  
  METHODS
  The records of 624 obese patients who underwent laparoscopic bariatric procedures between January 2006 and December 2012 were retrospectively reviewed. In no patient was performed the closure of the fascial layers of trocar incisions. Weight, BMI, E%WL and onset of complications were monthly collected for the first year after the procedure, then every six month.
  
  
  RESULTS
  10 patients showed trocar site hernia, for an overall prevalence of 1.6%. The mean time of occurrence was 15 months. None developed intestinal obstruction or other complications as a consequence of the hernia. The mean time of follow-up was 54 months. The mean weight and BMI before interventions were 136.3 ± 17.7 kg and 46.0 ± 4.6 kg/m² respectively. The mean percentage of excess weight loss (E%WL) at one year was 45.9%.
  
  
  CONCLUSIONS
  We avoided complicating the wound closure with fascia closure, accepting the risks related to the BMI. So far our procedure for port-site closure is relatively simple, safe, less invasive, less time-consuming and costless. These advantages could arise from the fact that our patients benefit from a remarkable weight loss after the intervention thus reducing one of the most important risk factors in the onset of trocar site hernia.
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pilone
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Micco
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy. Electronic address: ariolahasani@libero.it.
authors.forename: Ariola
authors.initials: A
authors.lastname: Hasani
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Celentano
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Monda
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitiello
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Izzo
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Leucio
authors.initials: L
authors.lastname: Iacobelli
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric surgery; Incisional hernia; Laparoscopy; Obesity; Trocar site