Manigrasso M, Anoldo P, Milone F, De Palma G D, Milone M
Department of Surgical Specialties and Nephrology, University "Federico II" of Naples, Italy.
Department of Surgery and Advanced Technologies, University "Federico II" of Naples, Italy.
Int J Surg Case Rep. 2018;53:500-503. doi: 10.1016/j.ijscr.2017.12.041. Epub 2018 Jan 9.
trocar site herniation is a rare but potentially serious complication of laparoscopic surgery. Data about drain site hernia after laparoscopic surgery is scarce and anecdotal.
we report an uncommon case of drain site hernia in a man undergone laparoscopic left colectomy for a colonic adenocarcinoma who developed small bowel herniation in a 10 mm port site, in which a 24 FR drain was inserted leaving a real free space of 2 mm.
laparoscopic approach has gained widespread acceptance in each surgical fields because of the perceived better postoperative outcomes in terms of less pain, faster recovery, and lower risk of incisional hernia. However, the risk of trocar site hernia has been known since 1967. Different risk factors for the development of trocar site hernia are described in literature: the trocar diameter and design, preexisting fascial defects, enlargement of a port site to remove a specimen, high blood glucose levels, obesity, increase intra-abdominal pressure as in chronic obstructive airway disease or extensive manipulation of the trocar during surgical intervention, which may enlarge the trocar site and thus induce small bowel herniation. However, the most important recognized risk factor for trocar site hernia is the size of the trocar.
waiting for further studies, the lesson to be learnt from this case report is that, even if the free space after drain positioning is minimal, drain should not be positioned through the 10 mm trocar to allow the closure of fascial defect in order to avoid any herniation.
套管针穿刺部位疝是腹腔镜手术罕见但可能严重的并发症。关于腹腔镜手术后引流部位疝的数据稀少且多为个案报道。
我们报告一例罕见的引流部位疝病例，一名因结肠腺癌接受腹腔镜左半结肠切除术的男性患者，在10毫米的穿刺部位发生小肠疝，该部位曾插入一根24F引流管，仅留下2毫米的实际自由空间。
由于腹腔镜手术在减轻疼痛、恢复更快和切口疝风险更低等方面被认为术后效果更好，因此在各个外科领域已得到广泛认可。然而，自1967年以来就已知道存在套管针穿刺部位疝的风险。文献中描述了套管针穿刺部位疝发生的不同风险因素：套管针的直径和设计、先前存在的筋膜缺损、为取出标本而扩大穿刺部位、高血糖水平、肥胖、慢性阻塞性气道疾病等导致的腹内压升高或手术干预期间对套管针的广泛操作，这些可能会扩大套管针穿刺部位，从而导致小肠疝。然而，公认的套管针穿刺部位疝最重要的风险因素是套管针的尺寸。
在等待进一步研究的过程中，从本病例报告中吸取的教训是，即使引流管放置后的自由空间很小，也不应通过10毫米的套管针放置引流管，以便关闭筋膜缺损，从而避免任何疝的发生。
