Kawai Hironari, Misawa Takeyuki, Sasaya Kazuto, Aoyama Yoshishige
Department of Surgery, Aoyama Hospital, Funabashi, Japan.
Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
Asian J Endosc Surg. 2020 Jan;13(1):83-88. doi: 10.1111/ases.12690. Epub 2019 Jan 27.
Dual-hemostat techniques for port closure have previously been reported, but their safety and efficacy have not been evaluated. Here, we describe the dual-hemostat port closure technique employed at our institution, which uses a customized surgical suture for safe and certain port closure, and we assess the incidence rate of trocar-site hernia (TSH) after laparoscopic cholecystectomy.
From March 1999 to March 2017 at our institution, 316 patients underwent elective laparoscopic cholecystectomy performed by a single experienced surgeon. We routinely used a dual-hemostat technique with a customized surgical suture to achieve safe and certain port closure. We assessed the incidence rate of TSH after laparoscopic cholecystectomy (defined as a reoperation for a TSH or clinical hernia at the port site) based on follow-up data from patient questionnaires and clinical examinations.
After 67 patients were excluded because of death, unknown address, or conversion to open cholecystectomy, 249 eligible patients received questionnaires, of which 173 were returned (response rate, 69.5%). From these responses, TSH was suspected in three patients, but only one underwent reoperation for TSH after laparoscopic cholecystectomy. Thus, the incidence rate of TSH after laparoscopic cholecystectomy was 0.6% (1/173).
Our single-center experience demonstrated that our port closure technique using a dual-hemostat technique with customized surgical suture provides an appropriate option for laparoscopic cholecystectomy, especially given its ease and low incidence of TSH.
此前已有关于双止血器技术用于端口闭合的报道，但尚未对其安全性和有效性进行评估。在此，我们描述了我院采用的双止血器端口闭合技术，该技术使用定制的手术缝线实现安全可靠的端口闭合，并评估了腹腔镜胆囊切除术后套管针穿刺部位疝（TSH）的发生率。
1999年3月至2017年3月，我院316例患者接受了由一位经验丰富的外科医生进行的择期腹腔镜胆囊切除术。我们常规使用双止血器技术和定制的手术缝线来实现安全可靠的端口闭合。我们根据患者问卷和临床检查的随访数据评估了腹腔镜胆囊切除术后TSH的发生率（定义为因TSH或端口部位临床疝而进行的再次手术）。
67例患者因死亡、地址不明或转为开腹胆囊切除术而被排除后，249例符合条件的患者收到了问卷，其中173例回复（回复率为69.5%）。根据这些回复，3例患者疑似患有TSH，但只有1例在腹腔镜胆囊切除术后因TSH接受了再次手术。因此，腹腔镜胆囊切除术后TSH的发生率为0.6%（1/173）。
我们的单中心经验表明，我们采用双止血器技术和定制手术缝线的端口闭合技术为腹腔镜胆囊切除术提供了一种合适的选择，特别是考虑到其操作简便且TSH发生率低。
