title: 5-millimeter Trocar-site Hernias After Laparoscopy Requiring Surgical Repair.
abstract: Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and predisposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, 17 (5.76%) of which met the inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age (interquartile range) for all adult patients with trocar-site hernias was 63 years (interquartile range, 39.5-66.5 years). Eight of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous although details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients [84%]) was used more often compared with exploratory laparotomy (4 patients [16%], p < .001) to manage trocar-site hernias. There was no statistical difference in the location of trocar-site hernias (i.e., umbilical [14 patients, 56%] vs nonumbilical/lateral [11 patients, 44%], p = .12). Findings of this review suggest that increased operative times and excessive manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions although prospective data are required to validate the overall generalizability of this management strategy.
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York. Electronic address: nip9060@med.cornell.edu.
authors.forename: Nigel
authors.initials: N
authors.lastname: Pereira
authors.affiliation: Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Hutchinson
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Irani
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Chung
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Jovana P
authors.initials: JP
authors.lastname: Lekovich
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Pak H
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Department of Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.affiliation: The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Zev
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D000328:Adult; D000368:Aged; D005205:Fascia; D000071938:Fasciotomy / Q000379:methods; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects; D014472:Umbilicus
keywords: 5-mm; Fascial defects; Incisional hernia; Laparoscopy; Management; Trocar-site hernia