Open AccessIncidence and Treatment of Incarcerated Trocar-Site Hernias After Robotic Surgery: Presentation of Three Cases
Author(s) -
Mariangela Mancini,
Marialaura Righetto,
Fabrizio Dal Moro,
Filiberto Zattoni
Publication year - 2020
Publication title -
journal of endourology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.123
H-Index - 1
ISSN - 2379-9889
DOI - 10.1089/cren.2020.0110
Subject(s) - medicine , surgery , bowel resection , perforation , laparoscopy , presentation (obstetrics) , abdominal surgery , laparoscopic surgery , general surgery , port (circuit theory) , incidence (geometry) , complication , abdominal wall , materials science , physics , optics , electrical engineering , punching , metallurgy , engineering
Background: Trocar-site hernias (TSHs) are an uncommon but potentially severe complication of robot-assisted urologic surgery, with an incidence of incarcerated hernias varying from 0.4% to 0.66%. Currently, there are no standardized guidelines on trocar site fascial closure. Although it is widely recommended to close the midline 12-mm port site, there is no agreement on the need for fascial closure of lateral port sites, especially if ≤12 mm. Cases Presentation: We report three cases of incarcerated intestinal TSHs in the past 10 years in our institution. All were from lateral abdominal ports (two 12 and one 8 mm), after robot-assisted radical prostatectomy. Patients were Caucasian and from 60 to 71 years; symptoms varied widely from obstinate hiccups, abdominal distention with fever, to acute abdomen. In all cases reduction of the herniated loop from the outside, using a minilaparotomy over the port site, was safe and effective. However, in one case bowel resection for bowel ischemic necrosis was necessary. No specific clinical risk factors could be identified in our cases. Conclusion: Incarcerated TSH after robotic urologic surgery may arise from any trocar site, regardless of size and location. This could be treated effectively with a minilaparotomy over the trocar site, to avoid more serious life-threatening consequences such as bowel necrosis and perforation. No risk factor seems to be predictive of TSHs.