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Hitoshi Tonouchi, MD, PhD; Yukinari Ohmori, MD; Minako Kobayashi, MD, PhD; Masato Kusunoki, MD, PhD

Arch Surg. 2004;139:1248-1256.

Objective  To review the relationship between the pathogenesis and clinical manifestations of trocar site hernias seeking to confirm the definition of trocar site hernias by classification.

Data Sources  We searched this subject in English on MEDLINE by combining the words "trocar," "port," "hernia, and "laparoscopy."

Data Extraction and Study Selection  We limited the main operations to cholecystectomy, colon and rectal surgery, fundoplication, and gastric surgery; finding 44 reports on these procedures. Of these, 19 were case reports, 18 were original articles (setting criteria; the incidence of the trocar site hernia was clarified, and involved >100 patients), and 7 technical notes on "how to do it" were collected. We obtained 19 additional reports using the references of those previously obtained. We, thus, reviewed 63 reports (24 case reports, 27 original articles, 7 technical notes, and 5 review articles).

Data Synthesis  Trocar site hernia was classified into 3 types. The early-onset type that occurred immediately after the operation, with a small-bowel obstruction, especially the Richter hernia, frequently developing. The late-onset type that occurred several months after the operation, mostly with local abdominal bulging with no small-bowel obstruction developing. The special type that occurred indicated the protrusion of the intestine and/or omentum. Trocar site hernias with fascial defects of 10 mm or larger should be closed, including the peritoneum. Opinion varied if a 5-mm trocar site defect should be closed.

Conclusion  It is useful to clearly classify trocar site hernias to improve management of laparoscopic procedures.

Author Affiliations: Departments of Innovative Surgery (Drs Tonouchi, Ohmori, Kobayashi, and Kusunoki) and Surgery II, Mie University School of Medicine, Mie, Japan (Dr Kusunoki).

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