title: Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique.
abstract: BACKGROUND
  Obesity is recognized as a risk factor for trocar site hernia (TSH) after laparoscopic surgery. Some recent studies have reported a TSH rate after bariatric surgery ranging from 0% to 1.6% using clinical evaluation and may underestimate the TSH rate. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) by abdominal computed tomography (CT) scan.
  
  
  METHODS
  A retrospective review of all patients who underwent first-line SG and abdominal CT scan between March 2004 and February 2014 was performed. The primary endpoint was the incidence of TSH. Secondary endpoints were the site of TSH, the TSH rate with open laparoscopy using the authors' technique, and risk factors for TSH after SG.
  
  
  RESULTS
  During the period study, 1108 patients underwent first-line SG, including 10 cases of conversion to laparotomy (excluded from the present analysis). Of the remaining patients, 228 had abdominal CT scan (20.7%), with a mean age of 45.1 years (18-68 yr) and a mean BMI of 47.6 kg/m(2) (33-75.4 kg/m(2)). The median time interval between SG and CT scan was 27 months (3-92 mo). CT scan revealed 44 TSH in 43 patients (18.8%). The site of the TSH was epigastric (16.6%), open laparoscopy (1.7%), right subcostal margin (0.8%), with no TSH in the left subcostal margin. In patients with>1 year of follow-up, the TSH rate was 19.7%.
  
  
  CONCLUSIONS
  The TSH rate after bariatric surgery is underestimated. The authors' open laparoscopy technique is a reliable technique with a low TSH rate. In the light of these results, the epigastric trocar site is systematically closed at the end of SG.
authors: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
authors: Lionel
authors: L
authors: Rebibo
authors: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
authors: Abdennaceur
authors: A
authors: Dhahri
authors: Department of Radiology, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
authors: Cyril
authors: C
authors: Chivot
authors: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
authors: Cosse
authors: C
authors: Cyril
authors: Department of Radiology, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
authors: Thierry
authors: T
authors: Yzet
authors: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors: Jean-Marc
authors: JM
authors: Regimbeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000009:adverse effects* / Q000295:instrumentation; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Abdominal CT scan; Open laparoscopy; Sleeve gastrectomy; Trocar site hernia