BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm ...BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.METHODS Between July 2010 and December 2018,all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed.All patients underwent cross-sectional imaging for TSH assessment.Clinicopathological characteristics were recorded.Incidence rates of TSH and postoperative results were analyzed.RESULTS Of the 254 patients included,70(111 ports)were in the fascial closure(closed)group and 184(279 ports)were in the nonfascial closure(open)group.The median follow up duration was 43 mo.During follow up,three patients in the open group developed TSHs,whereas none in the closed group developed the condition(1.1%vs 0%,P=0.561).All TSHs occurred in the right lower abdomen.Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain.The open group had a significantly shorter operative time and lower blood loss than the closed group.CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed.However,further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.展开更多
This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-r...This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.展开更多
BACKGROUND Trocar site hernia(TSH)is a rare but potentially dangerous complication of laparoscopic surgery,and the drain-site TSH is an even rarer type.Due to the difficulty to diagnose at early stages,TSH often leads...BACKGROUND Trocar site hernia(TSH)is a rare but potentially dangerous complication of laparoscopic surgery,and the drain-site TSH is an even rarer type.Due to the difficulty to diagnose at early stages,TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences.Herein,we report an unusual case of drain-site TSH,followed by a brief literature review.Finally,we provide a novel,simple,and practical method of prevention.CASE SUMMARY A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital.She was admitted to our hospital with a 2-d history of intermittent abdominal pain,nausea,vomiting,and abdominal enlargement with an inability to pass stool and flatus.The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision,which was used as a drainage port,with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines.She was diagnosed with drain-site strangulated TSH.The emergency exploratory laparotomy confirmed the diagnosis.A herniorrhaphy followed by standard intestinal resection and anastomosis were performed.The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.CONCLUSION TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction,especially after the removal of the drainage tube,to avoid the serious consequences caused by delayed diagnosis.Furthermore,all abdomen layers should be carefully closed under direct vision at the trocar port site,especially where the drainage tube was placed.Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.展开更多
目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、...目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、分型、临床表现进行分析,探讨该病的CT诊断特点。结果 2例患者CT像上均表现为左下腹壁小肠局部疝出并高位小肠梗阻,结合患者手术史,CT均拟诊为TSH;手术也均证实部分小肠嵌顿于Trocar切口内,近端小肠扩张积液。结论 CT对腹腔镜术后TSH的早期诊断和鉴别诊断具有重要价值,对TSH的早期手术治疗也具有很好的指导意义。展开更多
近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来...近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来越多的类似病例被报道,穿刺孔疝导致的术后安全问题逐渐引起注意。穿刺孔疝的发生是由于穿刺部位存在缺损,腹腔内组织或脏器通过缺损突出皮下间隙所致。穿刺孔疝一旦发生,不仅会降低患者生活质量,而且如果伴发肠道嵌顿将危及患者生命。因此,腹腔镜术后穿刺孔疝应当引起重视,识别相关危险因素,做好必要的预防措施具有重要的临床意义。本文就穿刺孔疝的发生及预防作一综述,以期为临床提供参考。展开更多
文摘BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.METHODS Between July 2010 and December 2018,all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed.All patients underwent cross-sectional imaging for TSH assessment.Clinicopathological characteristics were recorded.Incidence rates of TSH and postoperative results were analyzed.RESULTS Of the 254 patients included,70(111 ports)were in the fascial closure(closed)group and 184(279 ports)were in the nonfascial closure(open)group.The median follow up duration was 43 mo.During follow up,three patients in the open group developed TSHs,whereas none in the closed group developed the condition(1.1%vs 0%,P=0.561).All TSHs occurred in the right lower abdomen.Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain.The open group had a significantly shorter operative time and lower blood loss than the closed group.CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed.However,further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.
文摘This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.
基金Supported by National Key Research and Development Program of China,No.2016YFC0906000.
文摘BACKGROUND Trocar site hernia(TSH)is a rare but potentially dangerous complication of laparoscopic surgery,and the drain-site TSH is an even rarer type.Due to the difficulty to diagnose at early stages,TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences.Herein,we report an unusual case of drain-site TSH,followed by a brief literature review.Finally,we provide a novel,simple,and practical method of prevention.CASE SUMMARY A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital.She was admitted to our hospital with a 2-d history of intermittent abdominal pain,nausea,vomiting,and abdominal enlargement with an inability to pass stool and flatus.The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision,which was used as a drainage port,with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines.She was diagnosed with drain-site strangulated TSH.The emergency exploratory laparotomy confirmed the diagnosis.A herniorrhaphy followed by standard intestinal resection and anastomosis were performed.The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.CONCLUSION TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction,especially after the removal of the drainage tube,to avoid the serious consequences caused by delayed diagnosis.Furthermore,all abdomen layers should be carefully closed under direct vision at the trocar port site,especially where the drainage tube was placed.Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.
文摘目的:通过病例报告并结合文献复习,分析腹腔镜术后Trocar 部位疝(TSH)的发生原因、分型、临床表现、诊断、治疗及预防措施,提高对腹腔镜术后TSH 的诊疗水平.方法:报告1例泌尿外科腹腔镜术后发生TSH患者的诊治经过及随访结果,并结合文献复习对TSH的发生原因、分型、临床表现、诊断、治疗及预防措施进行分析.结果:51岁女性患者因'左侧脓肾切除术后,切口疼痛伴流脓,左肾区肿物'行腹腔镜下左侧肾区肿物切除术、窦道切除术,术后第4天出现左下腹12 mm Trocar部位疝并发肠梗阻,急诊剖腹探查,行肠管松解术和切口缝合术,术后7天患者痊愈出院,术后随访至今,无复发.结论:TSH是一种少见的腹腔镜手术并发症,发生率为0.18%~2.80%,多见于普外科和妇产科等经腹腔入路腹腔镜手术,我国泌尿外科腹腔镜手术多采用后腹腔入路,故极少发生,TSH临床上主要分为早发型、迟发型和特殊型三种,其发生涉及多种因素,一旦发生,无自愈可能,多需手术治疗.预防TSH的方法包括逐层严格关闭切口、改进Trocar外形、控制腹压等.
文摘目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、分型、临床表现进行分析,探讨该病的CT诊断特点。结果 2例患者CT像上均表现为左下腹壁小肠局部疝出并高位小肠梗阻,结合患者手术史,CT均拟诊为TSH;手术也均证实部分小肠嵌顿于Trocar切口内,近端小肠扩张积液。结论 CT对腹腔镜术后TSH的早期诊断和鉴别诊断具有重要价值,对TSH的早期手术治疗也具有很好的指导意义。
文摘近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来越多的类似病例被报道,穿刺孔疝导致的术后安全问题逐渐引起注意。穿刺孔疝的发生是由于穿刺部位存在缺损,腹腔内组织或脏器通过缺损突出皮下间隙所致。穿刺孔疝一旦发生,不仅会降低患者生活质量,而且如果伴发肠道嵌顿将危及患者生命。因此,腹腔镜术后穿刺孔疝应当引起重视,识别相关危险因素,做好必要的预防措施具有重要的临床意义。本文就穿刺孔疝的发生及预防作一综述,以期为临床提供参考。
