de Beaux A C, East B
Spire Murrayfield Hospital, The University of Edinburgh, Edinburgh, United Kingdom.
3rd Department of Surgery, Motol University Hospital, Prague, Czechia.
J Abdom Wall Surg. 2022 Dec 21;1:11034. doi: 10.3389/jaws.2022.11034. eCollection 2022.
Laparoscopic and robot-assisted surgery is now common place, and each trocar site is a potential incisional hernia site. A number of factors increase the risk of trocar site hernia (TSH) at any given trocar site. The aim of this paper is to explore the literature and identify the patients and the trocar sites at risk, which may allow target prevention strategies to minimise TSH. A pub med literature review was undertaken using the MeSH terms of "trocar" OR "port-site" AND "hernia." No qualifying criteria were applied to this initial search. All abstracts were reviewed by the two authors to identify papers for full text review to inform this narrative review. 961 abstracts were identified by the search. A reasonable quality systematic review was published in 2012, and 44 additional more recent publications were identified as informative. A number of patient factors, pre-operative, intra-operative and post-operative factors were identified as possibly or likely increasing the risk of TSH. Their careful management alone and more likely in combination may help reduce the incidence of TSH. Clinically symptomatic TSH is uncommon, in relation to the many trocars inserted every day for "keyhole" surgery, although it is a not uncommon hernia to repair in general surgical practice. There are patients inherently at risk of TSH, especially at the umbilical location. It is likely, that a multi-factored approach to surgery, will have a cumulative effect at reducing the overall risk of TSH at any trocar site, including choice of trocar type and size, method of insertion, events during the operation, and decisions around the need for fascial closure and how this is performed following trocar removal.
腹腔镜手术和机器人辅助手术如今已很常见，每个套管针穿刺部位都是潜在的切口疝发生部位。在任何给定的套管针穿刺部位，多种因素会增加套管针穿刺部位疝（TSH）的风险。本文旨在探究文献并确定有风险的患者和套管针穿刺部位，这可能有助于制定针对性的预防策略以将TSH降至最低。使用“套管针”或“穿刺孔部位”以及“疝”的医学主题词（MeSH）在PubMed上进行了文献综述。对此次初步检索未应用限定标准。两位作者对所有摘要进行了审阅，以确定需全文审阅的论文，从而为这篇叙述性综述提供资料。检索共识别出961篇摘要。2012年发表了一篇质量尚可的系统综述，另外还识别出44篇更新的有参考价值出版物。一些术前、术中和术后的患者因素被确定为可能或很可能增加TSH的风险。单独对这些因素进行仔细管理，更有可能是综合管理，可能有助于降低TSH的发生率。与每天为“钥匙孔”手术插入的众多套管针相比，临床上有症状的TSH并不常见，尽管在普通外科手术中这是一种并不罕见的需修复的疝。有些患者本身就有发生TSH的风险，尤其是在脐部位置。很可能，一种多因素的手术方法在降低任何套管针穿刺部位TSH的总体风险方面将产生累积效应，包括套管针类型和尺寸的选择、插入方法、手术中的事件，以及关于是否需要筋膜闭合以及在拔除套管针后如何进行筋膜闭合的决策。
