Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2023; 11(2): 357-365
Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.357
Is fascial closure required for a 12-mm trocar? A comparative study on trocar site hernia with long-term follow up
Santi Krittiyanitsakun, Chawisa Nampoolsuksan, Thikhamporn Tawantanakorn, Tharathorn Suwatthanarak, Nicha Srisuworanan, Voraboot Taweerutchana, Thammawat Parakonthun, Chainarong Phalanusitthepha, Jirawat Swangsri, Thawatchai Akaraviputh, Asada Methasate, Vitoon Chinswangwatanakul, Atthaphorn Trakarnsanga
Santi Krittiyanitsakun, Chawisa Nampoolsuksan, Thikhamporn Tawantanakorn, Tharathorn Suwatthanarak, Nicha Srisuworanan, Voraboot Taweerutchana, Thammawat Parakonthun, Chainarong Phalanusitthepha, Jirawat Swangsri, Thawatchai Akaraviputh, Asada Methasate, Vitoon Chinswangwatanakul, Atthaphorn Trakarnsanga, Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Trakarnsanga A conceived the study, revised the manuscript, and participated in its coordination; Krittiyanitsakun S and Nampoolsuksan C participated in the database collection and drafted the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This single-center retrospective study was approved by the Siriraj Institutional Review Board (SIRB Protocol No. 900/2562).
Informed consent statement: All of the patient consents give Associated Professor Atthaphorn Trakarnsanga MD. and his team at Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand permission to publish reproduce and distribute, the attached case study, regarding trocar site hernia. The authors aware that the case study does not mention patient name, address but it does reflect patient medical care, gender, age, and medical history. All of the patients will not be paid in any manner for use of the case study as described above. They will not receive any royalties or other compensation in connection with any suck publication or use. All of the patients are not required to sign the consent form, and they may refuse to do so. Their medical treatment and payment for healthcare will not be affected by whether or not they sign the consent form. They may withdraw these consents for any future sharing at any time by notifying the research team, but their withdrawal will not affect information that has already been shared or published. This authorization has no expired date.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset utilized during the current study is available within the institutional collected data system that was used under Siriraj’s institutional review board committee approval for this study. Data are available upon reasonable request with permission of Siriraj’s institutional review board committee.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Atthaphorn Trakarnsanga, MD, Associate Professor, Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok, Bangkoknoi, Bangkok 10700, Thailand. atthaphorn.tra@mahidol.ac.th
Received: September 2, 2022
Peer-review started: September 2, 2022
First decision: October 20, 2022
Revised: November 6, 2022
Accepted: January 5, 2023
Article in press: January 5, 2023
Published online: January 16, 2023
Processing time: 131 Days and 22.7 Hours
Abstract
BACKGROUND

Despite the infrequency of trocar site hernias (TSHs), fascial closure continues to be recommended for their prevention when using a ≥ 10-mm trocar.

AIM

To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.

METHODS

Between July 2010 and December 2018, all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed. All patients underwent cross-sectional imaging for TSH assessment. Clinicopathological characteristics were recorded. Incidence rates of TSH and postoperative results were analyzed.

RESULTS

Of the 254 patients included, 70 (111 ports) were in the fascial closure (closed) group and 184 (279 ports) were in the nonfascial closure (open) group. The median follow up duration was 43 mo. During follow up, three patients in the open group developed TSHs, whereas none in the closed group developed the condition (1.1% vs 0%, P = 0.561). All TSHs occurred in the right lower abdomen. Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain. The open group had a significantly shorter operative time and lower blood loss than the closed group.

CONCLUSION

Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed. However, further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

Keywords: Trocar site hernia; Port site hernia; Fascial closure; Laparoscopic colorectal surgery; Nonbladed trocar

Core Tip: The incidence of trocar site hernias (TSHs) varied from 0.1% to 2%. Previous studies and guidelines have also suggested fascial closure when using a > 10-mm trocar. The findings from this study demonstrated no significant difference in the incidence of TSHs between facial closure and nonclosure groups (0% vs 1.1%, P = 0.561) when the median clinical follow-up duration was 41 mo. Therefore, fascial closure may be selectively omitted when using a 12-mm nonbladed trocar.