Chandra J Nemi, Manivasagam Sri Saran, Choudhary Sushila, Manocha Paras, Reddy B Harish
General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Surgery, Maulana Azad Medical College, New Delhi, IND.
Cureus. 2024 Jun 28;16(6):e63431. doi: 10.7759/cureus.63431. eCollection 2024 Jun.
Laparoscopic surgery has become a widely accepted standard of care for numerous procedures in the modern world. Nearly every major surgical procedure previously only possible by employing open techniques may now be completed laparoscopically, attributable to the quick advancement of technology and surgeons' abilities. There are several complications associated with the laparoscopic port site, either infective, non-infective, or neoplastic. This study aims to explore the morbidity associated with the port site following laparoscopic surgery and discuss the risk factors for complications. The umbilical port was most frequently associated with port-site hernia (PSH), followed by the epigastrium and the left and right hypochondrium. Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH. Port-site infection (PSI) is one avoidable adverse effect of laparoscopic surgery. Patients who have a history of diabetes, malnourishment, prolonged preoperative hospital stays, preoperative Staphylococcus aureus colonization of the nares, perioperative blood transfusions, and tobacco or steroid use are more likely to have PSI. Port-site hydatid cyst (PSHC) and port-site tuberculosis (PST) are rare but possible. While uncommon, a doctor should rule out endometriosis if a painful mass in the surgical scar, such as the trocar site, is discovered in a reproductive-age woman who has had pelvic or obstetric surgery in the past. Port-site metastasis (PSM) is the term for tumor-cell implantation at the trocar insertion site after a malignant tumor is removed laparoscopically. PSM has been reported in 1-2% of laparoscopic gynecologic surgical procedures. A few potential mechanisms for cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during long laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection. Nonetheless, the triggering mechanism is likely essentially multifaceted. Prevention is better than cure. Port-site hernia can be prevented using smaller trocars and meticulous rectus sheath defect closure at the end of surgery. The rest of the port site complications can be prevented by employing autoclavable laparoscopic hand instruments, utilizing autoclaved water to clean the instruments following disassembly, adhering to the recommended concentration, contact duration, and usage cycles when sterilizing instruments with liquid sterilizers, preventing bile or gut content from spilling into the operating room or the port site, using non-porous specimen retrieval bags for recovering the specimen, and thoroughly cleaning and irrigating the port site before closing the wound.
在现代社会，腹腔镜手术已成为众多手术广泛认可的标准治疗方式。几乎所有以前只能通过开放手术完成的 major 外科手术，如今都可以通过腹腔镜完成，这得益于技术的快速发展和外科医生能力的提升。腹腔镜穿刺孔部位存在多种并发症，包括感染性、非感染性或肿瘤性。本研究旨在探讨腹腔镜手术后穿刺孔部位相关的发病率，并讨论并发症的危险因素。脐部穿刺孔与穿刺孔疝（PSH）的关联最为常见，其次是上腹部以及左右季肋部。长时间的穿刺孔操作与重新插入、手术时间延长、未能有效闭合筋膜缺损以及伤口感染是导致 PSH 发生的原因。穿刺孔感染（PSI）是腹腔镜手术一种可避免的不良后果。有糖尿病史、营养不良、术前住院时间延长、术前鼻腔金黄色葡萄球菌定植、围手术期输血以及吸烟或使用类固醇的患者更易发生 PSI。穿刺孔包虫囊肿（PSHC）和穿刺孔结核（PST）虽罕见但有可能发生。虽不常见，但对于既往有盆腔或产科手术史的育龄女性，如果在手术瘢痕（如套管针穿刺部位）发现疼痛性肿块，医生应排除子宫内膜异位症。穿刺孔转移（PSM）是指在腹腔镜下切除恶性肿瘤后，肿瘤细胞在套管针插入部位植入。在 1% - 2%的腹腔镜妇科手术中曾报道过 PSM。穿刺孔部位细胞植入的一些潜在机制包括肿瘤切除过程中脱落细胞的栓塞或血行播散、长时间腹腔镜手术期间的空气湍流，以及在强行、无保护地取出器官/组织过程中直接植入伤口或肿瘤切除期间来自被污染的手术器械。然而，触发机制可能本质上是多方面的。预防胜于治疗。使用较小的套管针并在手术结束时细致地闭合腹直肌鞘缺损可预防穿刺孔疝。其余穿刺孔部位并发症可通过使用可高压灭菌的腹腔镜手持器械、拆卸后用高压灭菌水清洁器械、使用液体灭菌剂对器械进行灭菌时遵循推荐的浓度、接触时间和使用周期、防止胆汁或肠内容物溢入手术室或穿刺孔部位、使用无孔标本回收袋回收标本以及在关闭伤口前彻底清洁和冲洗穿刺孔部位来预防。
