Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA.
Am Surg. 2023 Apr;89(4):1261-1263. doi: 10.1177/0003134821995063. Epub 2021 Feb 17.
Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH.
TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected.
241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia ( < .0001). Preoperative fascial defect on CT was predictive of TSH ( < .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI: .88-.92). Other major risk factors for TSH were: age greater than 59 years ( < .031, OR = 2.48); and obesity, BMI > 30 ( < .012, OR = 2.14).
The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.
研究表明，套管部位疝（TSH）是腹腔镜手术中一种被低估的并发症，其发生率高达 31%。我们确定了腹腔镜阑尾切除术前筋膜缺损的发生率，并研究了其与其他危险因素共同作用对 TSH 发生的影响。
腹腔镜阑尾切除术后，在腹部计算机断层扫描（CT）上，如果腹壁脐部区域的筋膜分离≥1cm，则定义为 TSH。我们回顾了 2010 年 5 月至 2018 年 12 月期间，因任何原因（术后 30 天以上）在我院接受术前和术后 CT 检查的患者的 TSH 发生情况。CT 扫描测量筋膜缺损，而调查人员对胶片时间（术前或术后）和患者身份均不知情。收集人口统计学信息。
241 例行腹腔镜阑尾切除术的患者均进行了术前和术后晚期 CT 检查。49 例（20.3%）患者发现 TSH。在未发生术后疝的患者中，术前筋膜间隙为 3.3 ± 4.3mm，而在发生术后疝的患者中为 14.8 ± 7.3mm（<0.0001）。CT 上术前筋膜缺损是 TSH 的预测因素（<0.001，OR=1.44），曲线下面积（AUC）为 0.921（95%CI：0.88-0.92）。TSH 的其他主要危险因素是：年龄大于 59 岁（<0.031，OR=2.48）；肥胖，BMI>30（<0.012，OR=2.14）。
腹腔镜阑尾切除术后套管部位疝的发生率为五分之一。术前筋膜缺损的存在、年龄较大和肥胖是套管部位疝发生的强有力预测因素。
