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Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: A long-term follow-up study
Hernia, 07/11/2012
Erdas E et al. – After long–term follow–up, the incidence of TSH following LC was higher than expected. The insertion of large trocars at the umbilical site plays a key role in the development of TSH. Other conditions such as obesity and large gallstones can be additional risk factors since the umbilical defect must often be widened in these cases.
Methods- A total of 313 patients submitted to LC between 2000 and 2004 were included in the study.
- The pneumoperitoneum was always performed by means of Hasson’s technique at the umbilical site and the operative trocars were positioned using either the American technique or the French technique.
- Closure of the fascial defect was performed only at the umbilical site.
- The effects of several variables, including age, gender, size of gallstones, co–existing umbilical hernia, complexity of operation, diabetes, obesity, malnutrition, smoking, and heavy manual work on the development of TSH were assessed by univariate and multivariate models.
- Thirteen cases of TSH (4.1 %) were detected over a mean follow–up period of 89.8 months (range: 60–128).
- Of these, 11 (84.6 %) developed at the umbilicus and 2 at the 10 mm subxiphoid site (15.4 %).
- At univariate and multivariate analysis, gallstones ≥2 cm (p = 0.030; OR = 9.95, p = 0.01) and obesity (p = 0.002; OR = 22.93, p < 0.01) were found to increase the likelihood of TSH development.
