López-Negrete Cueto Emilio, Suárez Sánchez Aida, Rodicio Miravalles Jose Luis, Amoza Pais Sonia, Moreno Gijón María, Navarro Sandra Sanz, Vico Tamara Díaz, Noriega Menéndez Pablo, Montes García Ana, Sanz Álvarez Lourdes
Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
Division of General Surgery, Hospital Universitario de Cabueñes (HUCAB), Gijón, Spain.
J Abdom Wall Surg. 2025 Jul 28;4:15002. doi: 10.3389/jaws.2025.15002. eCollection 2025.
Patients undergoing bariatric surgery have comorbidities and risk factors which favour incisional hernias. Bladeless trocars are safe and not very harmful, being the preferred choice without port closure. The objective of this study is to evaluate the true occurrence of trocar hernias (trocar site hernia) in these patients in medium and long term.
We made an observational, descriptive, longitudinal, and retrospective study in patients who underwent bariatric surgery by laparoscopy with 12 mm bladeless trocars without fascial closure. We selected patients who agreed to participate in the study between January 2015 and July 2016. We also collected data on risk factors, pain scale, and ultrasound of port-site by an expert radiologist in 2018 and 2022.
In the first period 45 patients were included, with a mean age of 49.9 years and an initial BMI of 45.5 kg/m. Most of them (88.9%) were operated by gastric bypass. Forty-five abdominal wall ultrasounds were performed in 2018 with findings of 7 trocar site hernia for a total of 185 explored ports (3.8%), all of them in the epigastric port (p < 0.001) and asymptomatic. In 2022, 32 ultrasound detected 7 trocar site hernia (4.4%), 3 new and 4 knowns, with 2 symptomatic patients at the trocar site hernia with mild symptoms not consulted.
The incidence of trocar hernia in the medium and long term in postoperative bariatric surgery with 12 mm bladeless trocars without fascial closure is low, all of them being in the midline and paucity of symptoms. Our primary approach involves abstaining from closing the transmuscular accesses, deeming it unnecessary, while evaluating the closure or lateralization of the midline trocar.
接受减肥手术的患者存在共病和危险因素，这些因素易导致切口疝。无刀片套管针安全且危害不大，是不进行切口缝合时的首选。本研究的目的是评估这些患者中长期套管针疝（套管针穿刺部位疝）的实际发生率。
我们对接受腹腔镜减肥手术且使用12毫米无刀片套管针且未进行筋膜缝合的患者进行了一项观察性、描述性、纵向和回顾性研究。我们选取了2015年1月至2016年7月期间同意参与研究的患者。我们还收集了2018年和2022年的危险因素、疼痛评分以及由专业放射科医生进行的穿刺部位超声检查数据。
在第一阶段纳入了45例患者，平均年龄49.9岁，初始体重指数为45.5kg/m²。其中大多数患者（88.9%）接受了胃旁路手术。2018年对45例患者进行了腹壁超声检查，发现7例套管针穿刺部位疝，在总共185个探查穿刺孔中占3.8%，所有疝均位于上腹部穿刺孔（p<0.001）且无症状。2022年，32例超声检查发现7例套管针穿刺部位疝（4.4%），其中3例为新发病例，4例为已知病例，2例套管针穿刺部位疝患者有轻微症状但未咨询医生。
在使用12毫米无刀片套管针且未进行筋膜缝合的减肥手术后中长期套管针疝的发生率较低，所有疝均位于中线且症状较少。我们的主要方法是不进行肌层穿刺通道的缝合，认为没有必要，同时评估中线套管针的缝合或移位情况。
