Itoh Tsuyoshi, Fuji Nobuaki, Taniguchi Hiroki, Watanabe Taiji, Kosuga Toshiyuki, Kashimoto Kingo, Naito Kazuyo
Department of Surgery, Kyoto Prefectural Yosanoumi Hospital, Otokoyama Yosano-cho, Yosa-gun, Kyoto, Japan.
J Med Case Rep. 2008 Feb 14;2:48. doi: 10.1186/1752-1947-2-48.
Port-site herniation is a rare but potentially dangerous complication after laparoscopic surgery. Closure of port sites, especially those measuring 10 mm or more, has been recommended to avoid such an event.
We herein report the only case of a port site hernia among a series 52 consecutive cases of laparoscopy-assisted distal gastrectomy (LADG) carried out by our unit between July 2002 and March 2007. In this case the small bowel herniated and incarcerated through the port site on day 4 after LADG despite closure of the fascia. Initial manifestations experienced by the patient, possibly due to obstruction, and including mild abdominal pain and nausea, occurred on the third day postoperatively. The definitive diagnosis was made on day 4 based on symptoms related to leakage from the duodenal stump, which was considered to have developed after severe obstruction of the bowel. Re-operation for reduction of the incarcerated bowel and tube duodenostomy with peritoneal drainage were required to manage this complication.
We present this case report and review of literature to discuss further regarding methods of fascial closure after laparoscopic surgery.
切口疝是腹腔镜手术后一种罕见但潜在危险的并发症。建议关闭切口，尤其是那些直径达10毫米或更大的切口，以避免此类事件发生。
我们在此报告我们单位在2002年7月至2007年3月期间连续进行的52例腹腔镜辅助远端胃癌切除术（LADG）中唯一一例切口疝病例。在该病例中，尽管缝合了筋膜，但在LADG术后第4天，小肠仍通过切口疝出并发生嵌顿。患者最初的表现可能是由于梗阻，包括轻度腹痛和恶心，出现在术后第3天。基于与十二指肠残端渗漏相关的症状，在术后第4天做出了明确诊断，渗漏被认为是在肠道严重梗阻后发生的。需要再次手术以还纳嵌顿肠管并进行十二指肠造瘘及腹腔引流来处理这一并发症。
我们呈现此病例报告并回顾文献，以进一步探讨腹腔镜手术后筋膜缝合的方法。
