Hata Shinro, Nakashima Shunsuke, Shinohara Mayuka, Shin Toshitaka, Mimata Hiromitsu
Department of Urology, Faculty of Medicine, Oita University, Yufu, JPN.
Cureus. 2023 Feb 13;15(2):e34915. doi: 10.7759/cureus.34915. eCollection 2023 Feb.
Most cases of port-site hernia were due to inadequate fascial closure of the port site. We experienced a rare case of hernia incarceration under the closed port-site fascia despite adequate closure of the fascia after robot-assisted laparoscopic radical cystectomy. In this case, the small intestine was incarcerated between the transversus abdominis and oblique abdominal muscles from the 12-mm trocar site for the assistant. We inserted forceps to release the incarceration, and the fascia and peritoneum of the port site were closed using a trocar site closure device under laparoscopy. We considered that all-layer suturing, including peritoneum and inner and outer oblique fascia suturing, was necessary for port-site closure, especially in patients with obesity, because hernias can occur with fascial closure alone.
大多数端口部位疝病例是由于端口部位的筋膜关闭不充分所致。我们遇到了一例罕见的病例，尽管在机器人辅助腹腔镜根治性膀胱切除术后筋膜已充分关闭，但在关闭的端口部位筋膜下仍发生了疝嵌顿。在该病例中，小肠从助手用的12毫米套管针穿刺部位被嵌顿在腹横肌和腹外斜肌之间。我们插入钳子以解除嵌顿，并在腹腔镜下使用套管针穿刺部位闭合装置关闭端口部位的筋膜和腹膜。我们认为，对于端口部位的闭合，尤其是肥胖患者，包括腹膜以及腹内、外斜筋膜缝合的全层缝合是必要的，因为仅进行筋膜闭合可能会发生疝。
