101.09 Trocar Site Hernia Is Common Following Laparoscopic Appendectomy

Posted on January 31, 2019

S. Hawkins1, G. Emmanuel2, L. Khoury1, S. Shams3, G. Yarmish2, V. Sim1, A. Gave1, M. Panzo1, S. M. Cohn1  1Staten Island University Hospital-Northwell Health,Surgery,Staten Island, NY, USA 2Staten Island University hospital-Northwell Health,Radiology,Staten Island, NY, USA 3Stanford Medical Center,Radiology,Stanford, CA, USA

Introduction:
Trocar site hernia (TSH) after laparoscopic cholecystectomy is found routinely (ie: >30% in the elderly) (1). The incidence of this complication after laparoscopic appendectomy (LA) is unknown but is reported to be extremely low. We sought to determine the incidence of TSH following LA.

Methods:
We reviewed abdominal CTs performed in patients >60 years old after LA and characterized them by the presence or absence of pre-operative hernia or TSH.

Results:
2475 patients underwent LA at our institution between 2006 and 2016. 166 (7%) were 60 years of age or older. In this high-risk age group, 49 (30%) underwent a CT of the abdomen for any indication following LA. 17 (35%) were found to have a TSH on their interval CT scan. Notably, 25 (51%) of this group were found to have umbilical hernia on the pre-operative CT, and of those patients 14 (56%) were found to have a TSH on their interval scan.

Conclusion:

We found that trocar site hernias after laparoscopic appendectomy are common (35%).  Umbilical hernias are very often present at baseline and represent a major risk factor for trocar site hernia after laparoscopic appendectomy. Further prospective studies to determine the potential benefit of prophylactic mesh placement (Ref 1) in the setting of laparoscopic appendectomy appear warranted.

Ref: 1: Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg. 2014 May;218(5):960-8. doi: 10.1016/j.jamcollsurg.2014.01.049. Epub 2014 Feb 18. PubMed PMID: 24680572.