Port-site hernias occurring after the use of bladeless radially expanding trocars

Objectives: To compare and review the incidence of port-site hernias after use of bladeless radially dilating trocars after noticing a unique hernia entity developing in some patients. A review of the relevant published data is presented.

Methods: We retrospectively identified patients who were diagnosed or treated for postoperative hernias at our institution between 2004 and 2007 using a departmental morbidity database. All patients had laparoscopic urologic surgery for malignant conditions using bladeless radially dilating trocars.

Results: Of 1055 consecutive patients who underwent laparoscopic urologic oncology surgery between 2004 and 2007, a total of 7 patients (0.66%) were identified with trocar-site hernias. All hernias occurred using 12-mm bladeless radially dilating trocars without fascial closure. All hernias were confirmed by computed tomography of the abdomen and 6 by surgical findings. Of the 7 patients, 4 had an intrafascial incisional hernia; the small bowel herniated through a defect in the transversalis and internal oblique fasciae, but the external oblique fascia was intact. The intrafascial hernias were not evident on physical examination owing to an intact external oblique fascia.

Conclusions: While rare, trocar-site herniation after use of bladeless radially dilating trocars is a potentially serious complication of laparoscopic surgery. A large proportion of these may be partial-wall or intrafascial hernias. It is important to increase awareness among laparoscopic surgeons of the possibility of intrafascial incisional hernias, as physical findings are subtle and early computed tomography diagnosis is necessary for timely surgical intervention.