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Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia.
J Laparoendosc Adv Surg Tech A. 2001 Jun; 11(3):171-3.JL

Abstract

BACKGROUND

The incidence of umbilical hernia following laparoscopic surgery varies from 0.02-3.6%. The incidence of pre-existing fascial defects, however, may be as high as 18% in patients undergoing abdominal laparoscopic surgery. Previous recommendations have been made to close any fascial defect greater than or equal to 10 mm. Reported here is a case of herniation through a 3-mm trocar site incision and the discovery of a pre-existing fascial defect.

CASE REPORT

A 32-year-old female underwent an uncomplicated laparoscopic tubal ligation using a 3-mm umbilical port. Prior to umbilical trocar removal at the completion of the case, the carbon dioxide was evacuated from the abdomen and the sleeve was withdrawn under direct vision. Neither the fascial nor skin incisions were sutured. On postoperative day two, the patient returned with omentum herniating from the 3-mm site. At surgery, a 1.5-cm pre-existing fascial defect was discovered adjacent to the trocar site. The hernia sac tracked laterally to the base of the umbilicus, and the omentum had slid into the sac and out the skin opening.

CONCLUSION

As this report illustrates, herniation associated with laparoscopic trocar sites can occur with incisions as small as 3 mm. The presence of pre-existing fascial defects can cause increased morbidity in any laparoscopic surgery, and as illustrated in this report, may predispose the patient to site herniation. The detection and management of these defects is crucial in preventing postlaparoscopic complications.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington 98431, USA. jbergie@gateway.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11441996

Citation

Bergemann, J L., et al. "Omental Herniation Through a 3-mm Umbilical Trocar Site: Unmasking a Hidden Umbilical Hernia." Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, vol. 11, no. 3, 2001, pp. 171-3.
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.
Bergemann, J. L., Hibbert, M. L., Harkins, G., Narvaez, J., & Asato, A. (2001). Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 11(3), 171-3.
Bergemann JL, 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 PMID: 11441996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. AU - Bergemann,J L, AU - Hibbert,M L, AU - Harkins,G, AU - Narvaez,J, AU - Asato,A, PY - 2001/7/10/pubmed PY - 2002/1/5/medline PY - 2001/7/10/entrez SP - 171 EP - 3 JF - Journal of laparoendoscopic & advanced surgical techniques. Part A JO - J Laparoendosc Adv Surg Tech A VL - 11 IS - 3 N2 - BACKGROUND: The incidence of umbilical hernia following laparoscopic surgery varies from 0.02-3.6%. The incidence of pre-existing fascial defects, however, may be as high as 18% in patients undergoing abdominal laparoscopic surgery. Previous recommendations have been made to close any fascial defect greater than or equal to 10 mm. Reported here is a case of herniation through a 3-mm trocar site incision and the discovery of a pre-existing fascial defect. CASE REPORT: A 32-year-old female underwent an uncomplicated laparoscopic tubal ligation using a 3-mm umbilical port. Prior to umbilical trocar removal at the completion of the case, the carbon dioxide was evacuated from the abdomen and the sleeve was withdrawn under direct vision. Neither the fascial nor skin incisions were sutured. On postoperative day two, the patient returned with omentum herniating from the 3-mm site. At surgery, a 1.5-cm pre-existing fascial defect was discovered adjacent to the trocar site. The hernia sac tracked laterally to the base of the umbilicus, and the omentum had slid into the sac and out the skin opening. CONCLUSION: As this report illustrates, herniation associated with laparoscopic trocar sites can occur with incisions as small as 3 mm. The presence of pre-existing fascial defects can cause increased morbidity in any laparoscopic surgery, and as illustrated in this report, may predispose the patient to site herniation. The detection and management of these defects is crucial in preventing postlaparoscopic complications. SN - 1092-6429 UR - https://www.unboundmedicine.com/medline/citation/11441996/Omental_herniation_through_a_3_mm_umbilical_trocar_site:_unmasking_a_hidden_umbilical_hernia_ L2 - https://www.liebertpub.com/doi/full/10.1089/10926420152389332?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -