Top

Published in:

01-03-2019 | Obesity | Review Article

Trocar Site Hernias in Bariatric Surgery—an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis

Authors: Ioannis Karampinis, Eliette Lion, Maurizio Grilli, Svetlana Hetjens, Christel Weiss, Georgi Vassilev, Steffen Seyfried, Mirko Otto

Published in: Obesity Surgery | Issue 3/2019

Abstract

The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms ‘laparoscopy’ and ‘bariatric surgery’, ‘trocar/port’ and ‘hernia’. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0–39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.

Available only for authorised users

Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.PubMed

Welbourn R, Pournaras DJ, Dixon J, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the second IFSO global registry report 2013–2015. Obes Surg. 2018;28(2):313–22.PubMed

Anwar M, Collins J, Kow L, et al. Long-term efficacy of a low-pressure adjustable gastric band in the treatment of morbid obesity. Ann Surg. 2008;247(5):771–8.PubMed

Zehetner J, Holzinger F, Triaca H, et al. A 6-year experience with the Swedish adjustable gastric band prospective long-term audit of laparoscopic gastric banding. Surg Endosc. 2005;19(1):21–8.PubMed

Kadar N, Reich H, Liu CY, et al. Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol. 1993;168(5):1493–5.PubMed

Bergemann JL, Hibbert ML, Harkins G, et al. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. J Laparoendosc Adv Surg Tech A. 2001;11(3):171–3.PubMed

Ahlqvist S, Bjork D, Weisby L, et al. Trocar site hernia after gastric bypass. Surg Technol Int. 2017;30:170–4.PubMed

Scozzari G, Zanini M, Cravero F, et al. High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass. Surg Endosc. 2014;28(10):2890–8.PubMed

Mendoza D, Newman RC, Albala D, et al. Laparoscopic complications in markedly obese urologic patients (a multi-institutional review). Urology. 1996;48(4):562–7.PubMed

10.

Maietta P, Milone M, Coretti G, et al. Retrieval of the gastric specimen following laparoscopic sleeve gastrectomy. Experience on 275 cases. Int J Surg. 2016;28(Suppl 1):S124–7.PubMed

11.

Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid obesity. J Laparoendosc Adv Surg Tech A. 1999;9(1):23–30.PubMed

12.

Corcelles R, Boules M, Froylich D, et al. Laparoscopic three-port sleeve gastrectomy: a single institution case series. J Laparoendosc Adv Surg Tech A. 2016;26(5):361–5.PubMed

13.

Ternamian AM, Deitel M. Endoscopic threaded imaging port (EndoTIP) for laparoscopy: experience with different body weights. Obes Surg. 1999;9(1):44–7.PubMed

14.

Chakhtoura G, Zinzindohoue F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18(9):1130–3.PubMed

15.

Bonatti H, Hoeller E, Kirchmayr W, et al. Ventral hernia repair in bariatric surgery. Obes Surg. 2004;14(5):655–8.PubMed

16.

Scopinaro N, Marinari GM, Camerini G. Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg. 2002;12(3):362–5.PubMed

17.

Susmallian S, Ezri T, Charuzi I. Laparoscopic repair of access port site hernia after lap-band (R) system implantation. Obes Surg. 2002;12(5):682–4.PubMed

18.

Shoar S, Aboutaleb S, Karem M, et al. Comparison of two specimen retrieval techniques in laparoscopic sleeve gastrectomy: what is the role of endobag? Surg Endosc. 2017;31:4883–7.PubMed

19.

DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235(5):640–5. discussion 645–647PubMedPubMedCentral

20.

Mizrahi I, Alkurd A, Ghanem M, et al. Outcomes of laparoscopic sleeve gastrectomy in patients older than 60 years. Obes Surg. 2014;24(6):855–60.PubMed

21.

Chevallier JM, Zinzindohoue F, Douard R, et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg. 2004;14(3):407–14.PubMed

22.

Zinzindohoue F, Chevallier JM, Douard R, et al. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg. 2003;237(1):1–9.PubMedPubMedCentral

23.

Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8.PubMed

24.

Antanavicius G, Sucandy I. Robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch: the utility of the robotic system in bariatric surgery. J Robot Surg. 2013;7(3):261–6.PubMed

25.

Loy JJ, Youn HA, Schwack B, et al. Safety and efficacy of laparoscopic adjustable gastric banding in patients aged seventy and older. Surg Obes Relat Dis. 2014;10(2):284–9.PubMed

26.

Rubin M, Benchetrit S, Lustigman H, et al. Laparoscopic gastric banding with Lap-Band for morbid obesity: two-step technique may improve outcome. Obes Surg. 2001;11(3):315–7.PubMed

27.

Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.PubMed

28.

Marema RT, Perez M, Buffington CK. Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc. 2005;19(4):525–30.PubMed

29.

Wiesner W, Schob O, Hauser RS, et al. Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology. 2000;216(2):389–94.PubMed

30.

Derici S, Atila K, Bora S, et al. Simple, safe, and cost-effective technique for resected stomach extraction in laparoscopic sleeve gastrectomy. Gastroenterol Res Pract. 2016; Article ID 7090128, 4 pages, 2016.

31.

Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.PubMedPubMedCentral

32.

Casella G, Soricelli E, Fantini A, et al. A time-saving technique for specimen extraction in sleeve gastrectomy. World J Surg. 2010;34(4):765–7.PubMed

33.

Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.PubMed

34.

Gibson SC, Le Page PA, Taylor CJ. Laparoscopic sleeve gastrectomy: review of 500 cases in single surgeon Australian practice. ANZ J Surg. 2015;85(9):673–7.PubMed

35.

Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16(7):913–8.PubMed

36.

Bou Nassif G, Scetbun E, Lecurieux-Lafayette C, et al. “Hand-over-hand grasping technique”: a fast and safe procedure for specimen extraction in laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(5):1391.PubMed

37.

Sanchez-Pernaute A, Perez-Aguirre E, Botella AG, et al. Prophylactic closure of trocar orifices with an intraperitoneal mesh (ventralex((R))) in laparoscopic bariatric surgery. Obes Surg. 2008;18(11):1489–91.PubMed

38.

Arias E, Martinez PR, Ka Ming Li V, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19(5):544–8.PubMed

39.

Szold A, Abu-Abeid S. Laparoscopic adjustable silicone gastric banding for morbid obesity: results and complications in 715 patients. Surg Endosc. 2002;16(2):230–3.PubMed

40.

Coskun H, Bozbora A, Ogunc G, et al. Adjustable gastric banding in a multicenter study in Turkey. Obes Surg. 2003;13(2):294–6.PubMed

41.

Keidar A, Carmon E, Szold A, et al. Port complications following laparoscopic adjustable gastric banding for morbid obesity. Obes Surg. 2005;15(3):361–5.PubMed

42.

Hans PK, Guan W, Lin S, et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg. 2017 April 17; [Epub ahead of print]. Accessed on 07/06/2017. Available at: https://doi.org/10.1016/j.asjsur.2017.04.003.

43.

Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg. 2002;12(4):564–8.PubMed

44.

Patel S, Szomstein S, Rosenthal RJ. Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg. 2011;21(8):1209–19.PubMed

45.

Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we learned? Obes Surg. 2000;10(6):509–13.PubMed

46.

Armstrong J, O'Malley SP. Outcomes of sleeve gastrectomy for morbid obesity: a safe and effective procedure? Int J Surg. 2010;8(1):69–71.PubMed

47.

Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.PubMed

48.

Parikh MS, Fielding GA, Ren CJ. U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc. 2005;19(12):1631–5.PubMed

49.

Lakdawala M, Agarwal A, Dhar S, et al. Single-incision sleeve gastrectomy versus laparoscopic sleeve gastrectomy. A 2-year comparative analysis of 600 patients. Obes Surg. 2015;25(4):607–14.PubMed

50.

Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3003 patients: results at a high-volume bariatric center. Obes Surg. 2016;26(9):2045–50.PubMed

51.

Major P, Janik MR, Wysocki M, et al. Comparison of circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: a multicenter study. Wideochir Inne Tech Maloinwazyjne. 2017;12(2):140–6.PubMedPubMedCentral

52.

Balsiger BM, Ernst D, Giachino D, et al. Prospective evaluation and 7-year follow-up of Swedish adjustable gastric banding in adults with extreme obesity. J Gastrointest Surg. 2007;11(11):1470–6. discussion 1446–1447PubMed

53.

Lattuada E, Zappa MA, Mozzi E, et al. Injection port and connecting tube complications after laparoscopic adjustable gastric banding. Obes Surg. 2010;20(4):410–4.PubMed

54.

van Dielen FM, Soeters PB, de Brauw LM, et al. Laparoscopic adjustable gastric banding versus open vertical banded gastroplasty: a prospective randomized trial. Obes Surg. 2005;15(9):1292–8.PubMed

55.

Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.PubMed

56.

Frezza EE, Reddy S, Gee LL, et al. Complications after sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19(6):684–7.PubMed

57.

Aly MYF, Lee WJ. Letter to the editor: trocar site hernia prevention in laparoscopic bariatric surgery. Obes Surg. 2016;26(9):2227–8.PubMed

58.

Michalik M, Lech P, Bobowicz M, et al. A 5-year experience with laparoscopic adjustable gastric banding--focus on outcomes, complications, and their management. Obes Surg. 2011;21(11):1682–6.PubMed

59.

Coblijn UK, de Raaff CA, van Wagensveld BA, et al. Trocar port hernias after bariatric surgery. Obes Surg. 2016;26(3):546–51.PubMed

60.

Rosenthal RJ, Szomstein S, Kennedy CI, et al. Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(1):124–8.PubMed

61.

Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–82.PubMed

62.

Sucher R, Resch T, Mohr E, et al. Single-incision laparoscopic sleeve gastrectomy versus multiport laparoscopic sleeve gastrectomy: analysis of 80 cases in a single center. J Laparoendosc Adv Surg Tech A. 2014;24(2):83–8.PubMed

63.

Lee M, Nam EJ, Kim S, et al. Two-port access laparoscopic surgery in gynecologic oncology. Int J Gynecol Cancer. 2013;23(5):935–42.PubMed

64.

Rossi A, McLaughlin D, Witte S, et al. An expanded retrospective review of trocar site hernias in laparoscopic gastric bypass patients. J Laparoendosc Adv Surg Tech A. 2017;27(6):633–5.PubMed

65.

Dresel A, Kuhn JA, Westmoreland MV, et al. Establishing a laparoscopic gastric bypass program. Am J Surg. 2002;184(6):617–20. discussion 620PubMed

66.

Johnson WH, Fecher AM, McMahon RL, et al. VersaStep trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc. 2006;20(10):1584–6.PubMed

67.

Toouli J, Kow L, Collins J, et al. Efficacy of a low-pressure laparoscopic adjustable gastric band for morbid obesity: patients at long term in a multidisciplinary center. Surg Obes Relat Dis. 2008;4(3 Suppl):S31–8.PubMed

68.

Catheline JM, Fysekidis M, Bachner I, et al. Five-year results of sleeve gastrectomy. J Visc Surg. 2013;150(5):307–12.PubMed

69.

Pilone V, Di Micco R, Hasani A, et al. Trocar site hernia after bariatric surgery: our experience without fascial closure. Int J Surg. 2014;12(Suppl 1):S83–6.PubMed

70.

Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243(2):181–8.PubMedPubMedCentral

71.

Arru L, Azagra JS, Goergen M, et al. Three-port laparoscopic sleeve gastrectomy: feasibility and short outcomes in 25 consecutives super-obese patients. Cir Esp. 2013;91(5):294–300.PubMed

72.

Rebibo L, Dhahri A, Chivot C, et al. Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique. Surg Obes Relat Dis. 2015;11(4):791–6.PubMed

73.

Erdas E, Dazzi C, Secchi F, et al. Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: a long-term follow-up study. Hernia. 2012;16(4):431–7.PubMed

Title: Trocar Site Hernias in Bariatric Surgery—an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis
Authors: Ioannis Karampinis
Eliette Lion
Maurizio Grilli
Svetlana Hetjens
Christel Weiss
Georgi Vassilev
Steffen Seyfried
Mirko Otto
Publication date: 01-03-2019
Publisher: Springer US
Keywords: Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
Incisional Hernia
Published in: Obesity Surgery / Issue 3/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-03687-2

At a glance: The STEP trials

Springer Medicine

Trocar Site Hernias in Bariatric Surgery—an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2019

The First Report about the Laparoscopic Sleeve Gastrectomy-Induced Lactose Intolerance

Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients

Obstructive Sleep Apnoea Screening Preoperatively with the Epworth Questionnaire: Is It Worth It…?

Letter: Celiac Disease Presenting After a Single Anastomosis Duodeno-Ileal Bypass and Sleeve Gastrectomy

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors

Incidence of Diabetes Mellitus, Cardiovascular Diseases, and Cancer in Patients Undergoing Malabsorptive Surgery (Biliopancreatic Diversion and Biliointestinal Bypass) vs Medical Treatment