Srisombut Chartchai, Paktinun Nahathai, Timratana Poochong
Women Center, Bumrungrad International Hospital, Bangkok, Thailand (Srisombut and Paktinun).
Department of Obstetrics and Gynecology, Faculty of Medicine, Reproductive Endocrinology and Infertility Unit, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Srisombut).
AJOG Glob Rep. 2024 Jun 20;4(3):100368. doi: 10.1016/j.xagr.2024.100368. eCollection 2024 Aug.
Port-site herniation (PSH) is a rare complication observed postlaparoscopic surgery, typically associated with port sizes of 10 mm or larger, commonly occurred at umbilicus. While occurrences of extra-umbilicus with port size smaller than 10 mm are rare, we present a case detailing a lateral 7 mm PSH diagnosed on the 8th day following a total laparoscopic hysterectomy. The patient exhibited clinical symptoms indicative of partial small bowel obstruction, which became apparent on the third postoperative day. Computed tomography revealed significant small bowel dilatation and herniation through the previously employed 7 mm trocar site. Notably, this trocar site had been utilized with uterine screw. Prompt laparoscopic repair successfully addressed the herniation. The patient demonstrated satisfactory recovery and was subsequently discharged. While current practice recommends fascial incision closure for port size ≥10 mm. In light of our case, we propose considering fascial closure for small-size trocar subjected to any use of a manipulator.
穿刺孔疝(PSH)是腹腔镜手术后观察到的一种罕见并发症,通常与10毫米或更大的穿刺孔尺寸有关,常见于脐部。虽然脐外穿刺孔尺寸小于10毫米的情况很少见,但我们报告一例详细病例,一名患者在全腹腔镜子宫切除术后第8天被诊断为外侧7毫米穿刺孔疝。患者表现出提示部分小肠梗阻的临床症状,术后第三天变得明显。计算机断层扫描显示小肠明显扩张,并通过先前使用的7毫米套管针穿刺孔发生疝出。值得注意的是,该套管针穿刺孔曾用于子宫螺钉。及时的腹腔镜修复成功解决了疝出问题。患者恢复良好,随后出院。虽然目前的做法建议对穿刺孔尺寸≥10毫米的情况进行筋膜切口闭合。鉴于我们的病例,我们建议考虑对使用过任何操作器械的小尺寸套管针进行筋膜闭合。