Laparoskopik kolesistektomi sonrasi port yeri fıtığı: retrospektif klinik deneyim

Yıl 2023, Cilt: 16 Sayı: 3, 362 - 367, 01.07.2023

Fatih Büyüker , Mehmet Acar , Mehmet Sait Özsoy , Medeni Sermet , Hakan Baysal

https://doi.org/10.31362/patd.1207388

Öz

Amaç: Kolesistektomi planlanan hastalarda laparoskopik kolesistektomi altın standarttır. Laparoskopik kolesistektomi esnasında veya sonrasında laparoskopiye bağlı komplikasyonlar görülebilir. Bu çalısmada port yeri hernisi insidansı ve predispozan faktörlerinin incelenmesi amaçlanmaktadır.
Gereç ve yöntem: Ocak 2016-Mart 2021 tarihleri arasında hastanemiz genel cerrahi kliniğinde yapılan laparoskopik kolesistektomi operasyonları retrospektif olarak incelendi. Pnömoperitoneum oluşturmak için hasson tekniği kullanıldı. Tüm kolesistektomiler 4 port tekniği ile yapıldı. Tüm hastalarda umbilical trokar fasyası kapatıldı. Demografik veriler retrospektif olarak değerlendirildi.
Bulgular: Port yeri hernisi insidansı %0,5 olarak bulundu. 15 hastada umblikal herni saptandı. 11 hasta erkek 4 hasta kadın idi. Ortalama yaş 55,4 idi. Ortalama herni tespit süresi 14,3 ay idi. Ortalama BMI 30,11 olarak bulundu. 4 hastada kronik hastalık mevcut idi. 14 hasta opere edildi. 1 hasta acil strangülasyon gelişmesi üzerine acil opere edildi. 3 hastada nüks saptandı. Mortalite gözlenmedi.
Sonuç: Obezite, yaş kadın cinsiyet önemli risk faktörleri olarak degerlendirilmektedir. Serimizde umblikal port yerine tüm olgularda fasiyal kapama yapılmakta ancak en çok port hernisi umblikus portundan kaynaklanmaktadır.

Anahtar Kelimeler

port yeri hernisi, fasiyal kapama, risk faktörleri, laparoskopik kolesistektomi

Port-site hernia after laparoscopic cholecystectomy: retrospective clinical experience

Öz

Purpose: Laparoscopic cholecystectomy is the gold standard in patients scheduled for cholecystectomy. Complications related to laparoscopy may occur during or after laparoscopic cholecystectomy. This study is aimed to examine the incidence of port-site hernia and its predisposing factors.
Materials and methods: Laparoscopic cholecystectomy operations performed in the general surgery clinic of our hospital between January 2016 and March 2021 were reviewed retrospectively. The pneumoperitoneum was created by entering the abdomen with a mini-incision from the umbilicus using the Hasson technique. All cholecystectomies were performed using the 4-port technique. The umbilical trocar fascia was closed in all patients. Demographic data were evaluated retrospectively.
Result: The incidence of port-site hernia was determined as 0.5%. The umbilical hernia was detected in 15 patients: 11 male and four female. The mean age was 55.4 years. The mean hernia detection time was 14.3 months. The mean body mass index [BMI] was found to be 30.11. Four patients had a chronic disease. Fourteen of the patients underwent surgery. One of the patients was operated on a mini-incision urgently due to the development of strangulation. Recurrence was detected in three patients. No mortality was observed.
Conclusion: Obesity, age, and female gender are considered important risk factors. In our series, fascial closure was performed instead of the umbilical port in all cases, but most of the port site hernias originate from the umbilicus port.

Anahtar Kelimeler

Port-site hernia, fascial closure, risk factor, laparoscopic cholecystectomy

Kaynakça

• 1. Mühe E. Laparoscopic cholecystectomy--late results. Langenbecks Arch Chir Suppl Kongressbd 1991:416-423. https://doi.org/10.1007/978-3-642-95662-1_189
• 2. Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 1998;2:341-346.
• 3. Litynski GS. Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe (1987-1988). JSLS 1999;3:163-167.
• 4. Périssat J. Laparoscopic surgery: a pioneer's point of view. World J Surg 1999;23:863-868. https://doi.org/10.1007/s002689900590
• 5. Polychronidis A, Karayiannakis AJ, Simopoulos C. 'Laparoscopic cholecystectomy' or simply 'cholecystectomy’? Med Princ Pract 2003;12:276. https://doi.org/10.1159/000072299
• 6. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165:9-14. https://doi.org/10.1016/s0002-9610(05)80397-6
• 7. Sanz López R, Martínez Ramos C, Núñez Peña JR, Ruiz de Gopegui M, Pastor Sirera L, Tamames Escobar S. Incisional hernias after laparoscopic vs open cholecystectomy. Surg Endosc 1999;13:922-924. https://doi.org/10.1007/s004649901135
• 8. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15:113-121. https://doi.org/10.1007/s10029-010-0757-x
• 9. Ciscar A, Badia JM, Novell F, Bolívar S, Mans E. Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC Surg 2020;20:330. https://doi.org/10.1186/s12893-020-01000-6
• 10. Golash V, Rahman S. Railroading removal of gall bladder in laparoscopic cholecystectomy. J Minim Access Surg 2006;2:31-32. https://doi.org/10.4103/0972-9941.25676
• 11. Overby DW, Apelgren KN, Richardson W, Fanelli R. Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010;24:2368-2386. https://doi.org/10.1007/s00464-010-1268-7
• 12. Coda A, Bossotti M, Ferri F, et al. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 1999;9:348-352.
• 13. Alimoğlu O, Kaya B, Şahin M, Eryılmaz R, Akçakaya A. Trocar site herniation following laparoscopic cholecystectomy. Laparosc Endosc Surg Sci 2004;11:76-79.
• 14. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207:1-6. https://doi.org/10.1016/j.amjsurg.2013.05.010
• 15. Nofal MN, Yousef AJ, Hamdan FF, Oudat AH. Characteristics of trocar site hernia after laparoscopic cholecystectomy. Sci Rep 2020;10:2868. https://doi.org/10.1038/s41598-020-59721-w
• 16. Comajuncosas J, Vallverdú H, Orbeal R, Parés D. Trocar site incisional hernia in laparoscopic surgery. Cir Esp 2011;89:72-76. https://doi.org/10.1016/j.ciresp.2010.08.007
• 17. Uslu HY, Erkek AB, Cakmak A, et al. Trocar site hernia after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2007;17:600-603. https://doi.org/10.1089/lap.2006.0182
• 18. Voiculescu S, Jitea N, Burcoş T, Cristian D, Angelescu N. Incidents, accidents and complications in laparoscopic surgery. Chirurgia (Bucur) 2000;95:397-399
• 19. Nacef K, Chaouch MA, Chaouch A, Khalifa MB, Ghannouchi M, Boudokhane M. Trocar site post incisional hernia: about 19 cases. Pan Afr Med J 2018;29:183. https://doi.org/10.11604/pamj.2018.29.183.14467
• 20. Sharma R, Mehta D, Goyal M, Gupta S. The earliest presenting umbilical port site hernia following laparoscopic cholecystectomy: a case report. J Clin Diagn Res 2016;10:18-19. https://doi.org/10.7860/JCDR/2016/20460.8205
• 21. Chatzimavroudis G, Papaziogas B, Galanis I, et al. Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience. Hernia 2017;21:925-932. https://doi.org/10.1007/s10029-017-1699-3
• 22. Al Haijar N, Duca S, Molnár G, Vasilescu A, Nicolescu N. Incidents and postoperative complications of laparoscopic cholecystectomies for acute cholecystitis. Rom J Gastroenterol 2002;11:115-119.
• 23. Mayol J, Garcia Aguilar J, Ortiz Oshiro E, De Diego Carmona JA, Fernandez Represa JA. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997;21:529-533. https://doi.org/10.1007/pl00012281
• 24. Singal R, Zaman M, Mittal A, Singal S, Sandhu K, Mittal A. No need of fascia closure to reduce trocar site hernia rate in laparoscopic surgery: a prospective study of 200 non-obese patients. Gastroenterology Res 2016;9:70-73. https://doi.org/10.14740/gr715w
• 25. Kulkarni AA, Sharma G, Deo KB, Jain T. Umbilical port versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Surgeon 2022;20:26-35. https://doi.org/10.1016/j.surge.2021.02.009
• 26. Sood S, Imsirovic A, Sains P, Singh KK, Sajid MS. Epigastric port retrieval of the gallbladder following laparoscopic cholecystectomy is associated with the reduced risk of port site infection and port site incisional hernia: an updated meta-analysis of randomized controlled trials. Ann Med Surg (Lond) 2020;55:244-251. https://doi.org/10.1016/j.amsu.2020.05.017