An Expanded Retrospective Review of Trocar Site Hernias in Laparoscopic Gastric Bypass Patients

Background: Trocar site hernias (TSH) are reported in 0.3% to 5.4% of laparoscopic cases, depending on diameter and type. Most occur with trocars over 10mm in diameter. Some recommend routine fascial closure, but this requires time, costs, pain, and increased infection rates. All prior series are based on clinical presentation alone. We examined the possibly underreported prevalence of asymptomatic TSH on postoperative computed tomography (CT) scans in a series of laparoscopic gastric bypass (LGBP) patients with unclosed port site fascia. Materials and Methods: After Institutional Review Board (IRB) approval, a retrospective review of all patients undergoing LGBP at our center from 2005 to 2014 was performed. All procedures were performed using dilating optical trocars up to 12mm diameter, placed above the arcuate line. No fascial closures were performed. Any patients undergoing abdominal CT scanning for any reason in the study period were included; patients who had undergone a separate laparoscopic operation after LGBP but before CT were excluded. Results: One thousand ninety-five patients were included; of these, 244 (22.3%) met study criteria, providing 732 port sites of 11 or 12mm diameter to study. Only two fascial defects (0.27%), one in an 11-mm site and one in a 12-mm site, each in different patients, were identified. Both were nonpalpable, asymptomatic, and plugged with fat. Conclusions: Incisional hernias in dilating or optical access trocar sites are extremely rare in LGBP patients using trocars up to 12mm, above the arcuate line. When found, they tend to be asymptomatic and at low risk for bowel strangulation. Routine closure of such fascial sites is likely unnecessary.