Title: Laparoscopic Surgery: Is it Essential to Close the Trocar Site Fascial Defects of 5 and 10 Millimeters in Diameter?
Authors: Dr Jawad Kadhim S. Al-Dhahiry MD, Dr Hassan Khalil Melek MD, Dr Tareq Khalid Abduljabbar MD
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.34
Abstract
Background: Port Site Hernia (PSH) is potentially a serious complication of laparoscopic surgery. Many surgeons close the fascia, especially in those sites where a trocar diameter ≥10 mm is inserted. Suturing the fascia may lead to damage of other tissues, such as the bowel, hence, some surgeons prefer not to close the fascia.
Objective: to clarify whether non-closure of 5 and 10 millimeters (mm) laparoscopic trocar site fascial defects is actually a risk factor for development of port site hernia.
Design and Setting of the study: This study was a prospective cross-sectional one performed in AL-Karama Teaching Hospital/ Kut/ Wasit /Iraq.
Patients and Methods: a total of 570 patients, laparoscopically cholecystectomised for symptomatic cholelithiasis during period from April 2011 to December 2016, were included in this study. The port site fasciae were not closed .Skin only was closed with 2/0 Nylon .The incidence rate of PSH was calculated . All patients were followed up by outpatient clinic visits.
Results: statistical analysis of the study data revealed that, out of 570 laparoscopically cholecystectomised patients, only two patients developed PSH at the 10mm umbilical port site during the follow-up period range between 1 - 68 months. No major complications nor mortality were reported.
Conclusion: This study revealed that closure of 5 and 10 mm laparoscopic port site fasciae is not essential because non-closure was associated with very low incidence of PSH. Also, closure of the laporoscopic port site fascia prolongs time of surgery and unnecessarily uses suture material thus, it economically increases cost of surgery.
Keywords: Port site hernia , laparoscopic cholecystectomy , umbilical hernia .
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