Department of Surgery, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas 78229, USA.
J Surg Res. 2013 Sep;184(1):126-31. doi: 10.1016/j.jss.2013.05.025. Epub 2013 May 29.
The rate of hernia formation after closure of 10-12 mm laparoscopic trocar sites is grossly under-reported. Using an animal model, we have developed a method to assess trocar site fascial dehiscence and the strength of different methods of fascial closure.
Pigs (n = 9; 17 ± 2.5 lbs) underwent placement of 12 mm Hasson trocars with pneumoperitoneum maintained for 1 h. Three closure techniques (Figure-of-eight; simple interrupted; pulley) were compared with no fascial closure and to native fascia at five randomly allocated abdominal wall midline locations. Necropsy was performed on the fourth postoperative d. Statistical comparisons of tensile strength and breaking strength based on closure type and trocar location were made using ANOVA with Tukey's tests.
The mean (SD) force (Newtons) required for fascial disruption varied significantly with closure type [Native Fascia 170 (39), Figure-of-eight 169 (31), Pulley 167 (59), Simple Interrupted 151 (27), No Closure 108 (28)]; P = 0.007. The mean force required for fascial disruption was significantly increased for Native Fascia, Figure-of-eight, and Pulley relative to No Closure (P = 0.013, P = 0.015, P = 0.023, respectively). The mean (SD) force (in Newtons) required for fascial disruption also varied significantly with location of trocar [subxiphoid 181 (43), supraumbilical 151 (23), Umbilical 146 (23), infraumbilical 168 (62), suprapubic 120 (38)]; P = 0.03. The mean force for subxiphoid location was significantly increased relative to the suprapubic location (P = 0.021).
We have developed a novel assessment model that reliably detects differences in fascial integrity after laparoscopic trocar placement and closure. This model will allow for further testing of various trocars and closure techniques, and facilitate hernia prevention strategies.
闭合 10-12mm 腹腔镜套管部位后的疝形成率被严重低估。我们使用动物模型开发了一种评估套管部位筋膜裂开和不同筋膜闭合方法强度的方法。
猪（n=9；17±2.5 磅）进行 12mm Hasson 套管放置，维持气腹 1 小时。三种闭合技术（图 8 形；简单间断；滑索）与无筋膜闭合和五个随机分配的腹壁中线位置的天然筋膜进行比较。术后第 4 天进行尸检。根据闭合类型和套管位置比较拉伸强度和断裂强度的统计比较采用方差分析和 Tukey 检验。
筋膜破坏所需的平均（SD）力（牛顿）因闭合类型而异[天然筋膜 170（39），图 8 形 169（31），滑索 167（59），简单间断 151（27），无闭合 108（28）]；P=0.007。与无闭合相比，天然筋膜、图 8 形和滑索所需的筋膜破坏平均力显著增加（P=0.013，P=0.015，P=0.023）。套管位置的筋膜破坏所需的平均（SD）力（牛顿）也显著不同[剑突下 181（43），上脐部 151（23），脐部 146（23），下脐部 168（62），耻骨上 120（38）]；P=0.03。剑突下位置的平均力明显高于耻骨上位置（P=0.021）。
我们开发了一种新的评估模型，可可靠地检测腹腔镜套管放置和闭合后筋膜完整性的差异。该模型将允许进一步测试各种套管和闭合技术，并促进疝预防策略。
