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Trocar site hernia after laparoscopic surgery: a qualitative systematic review

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Abstract

Purpose

There is a risk of developing a trocar site hernia (TSH) after laparoscopic surgery, but data is sparse and based mostly on retrospective studies with a short and poorly defined follow-up period. Surgical approaches and patient-related co-morbidity have also been suggested as risk factors for development of TSH. The aim of the present review was to perform a qualitative systematic analysis to estimate the incidence of TSH and to discuss the surgical and patient-related risk factors for development of TSH.

Methods

The literature search was until 19 May 2010. Studies with TSH, defined as either operation for TSH or a hernia found during clinical follow-up, were included. We included randomised controlled trials, prospective non-controlled studies including >200 patients, and retrospective studies including >200 patients. The review was completed according to the PRISMA guidelines.

Results

We included 19 studies in adults and 3 studies in paediatric patients (<18 years), and a total of 30,568 adults and 1,098 children were analysed. The overall incidence of TSH was 0–5.2%. TSH occurred most often (96%) in trocar sites of a minimum of 10 mm, located mostly in the umbilicus region (82%). Data supported a higher incidence of TSH when the trocar site fascia was not sutured, and in pre-school children undergoing a laparoscopic procedure.

Conclusions

Current data suggests a relatively low incidence of TSH but that all trocar incisions of a minimum of 10 mm should be closed. In pre-school children undergoing laparoscopic surgery, all port sites should be closed.

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Acknowledgments

This study was funded by the foundation for Health Research in Region Zealand, Denmark.

Conflict of interest

F.H. received support from Baxter Healthcare A/S. J.R. has received research grants regarding laparoscopic surgery from Johnson & Johnson, Covidien, and Baxter Healthcare A/S, and had travel/accommodations expenses for international meetings covered or reimbursed from Johnson & Johnson, and Baxter Healthcare A/S. T.B. has received support from Johnson & Johnson, Covidien, and Baxter Healthcare A/S.

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Authors and Affiliations

  1. Department of Surgery, Køge Sygehus, University of Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark

    F. Helgstrand & T. Bisgaard

  2. Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark

    J. Rosenberg

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  1. F. Helgstrand
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Correspondence to F. Helgstrand.

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Helgstrand, F., Rosenberg, J. & Bisgaard, T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15, 113–121 (2011). https://doi.org/10.1007/s10029-010-0757-x

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