Small bowel obstruction in a lateral trocar site following laparoscopic bariatric surgery

Introduction

One of the complications of laparoscopic surgery is incisional hernia at the port trocar site. It is a rare complication, with a reported incidence varying between 0.65% and 2.8%, and it is documented in both adults and children.

Case presentation

An obese 62-year-old woman underwent a laparoscopic mini gastric bypass for body weight reduction at another hospital. On the third post-operative day, she developed abdominal pain with vomiting and was admitted to our hospital. Imaging studies confirmed a small bowel loop obstruction at the lateral 12mm trocar site and the patient was operated on immediately. The viability of the entrapped bowel was confirmed at the trocar site opening, the bowel loop was returned into the abdominal cavity and the defect was closed. Two days later, the patient was discharged in good condition.

Discussion

Trocar site or port site hernia is defined as an incisional hernia which occurs after minimal invasive surgery, at the trocar site incision. Following bariatric surgery its reported incidence is 1% - 1.6%. Its cause is multi-factorial, including obesity and old age, the size and site of the inserted trocar and the angle of insertion, and excessive manipulations. Although there is no clear consensus on closure at port sites, it is recommended that fascial defects of larger than 10mm in adults and 5mm in children should be closed.

Conclusion

Trocar site hernia is a rare complication of laparoscopic procedures, and one that can be minimized. Viscus entrapment in a port site hernia should be suspected during the post-operative period whenever the patient presents with abdominal distension, pain and vomiting since, particularly in the case of bariatric surgery, the findings on physical examination may be inconclusive, due to obesity.