TROCAR SITE HERNIA AFTER LSG
Condition: Obesity, Morbid; Hernia Incisional
MeSH terms: Obesity, Morbid; Hernia; Incisional Hernia
Study type: Interventional

Summary: 
      Today, laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed
      bariatric surgical method. One of the complications seen after LSG is trocar site hernia
      (TSH). There is no clear information about the rate of TSH detected radiologically after LSG.
      Thick abdominal wall and failure to adequately expose the facial defect related to this,
      mobility limitations due to excessive subcutaneous fatty tissue are the reasons accused for
      increased incidence of TSH.

      Demographic characteristics and postoperative weight loss of patients who underwent LSG
      procedure in our clinic between January 2015 and June 2017 and whose facial defects in the
      trocar region were repaired with the Carter-Thomason Suture Passer (CTSP) were evaluated. TSH
      evaluation was made both by physical examination and superficial USG by a general surgeon who
      had radiological training on concurrent superficial abdominal ultrasonography (USG). Detected
      TSHs were divided into two groups as symptomatic and asymptomatic.
    

Detailed description: 
      This study included 61 patients who applied to the obesity follow-up outpatient clinic for
      any complaints or routine control over a 3-month period or who were called by telephone for
      control and who underwent laparoscopic sleeve gastrectomy for morbid obesity between January
      2015- June 2017. Patients with symptoms associated with trocar site hernia were also included
      in the study, while patients with multiple bariatric surgical procedures or abdominal
      operations were excluded. Physical examinations to detect hernias were performed both in
      standing and supine positions for all patients and also during increased abdominal pressure
      by the Valsalva maneuver. All abdominal incision sites were examined. On physical
      examination, a hernia was defined as a bulging during the Valsalva maneuver and palpation of
      the fascial defect. USG was performed (Figure I,II) by a clinician who had previously
      received superficial USG evaluation training for trocar site hernia with a GE pro 500, 3 MHz
      and abdominal incision sites were investigated for the presence of hernias.

      The trocar entry localizations of the patients were all the same and are as follows: one
      15-mm camera trocar (supraumbilical) , one 10-mm working trocar (left upper quadrant), two
      5-mm working trocars (right and left upper quadrant) and one 5-mm liver retractor. Trocar
      entry localizations are shown in Figure III. During fascia closure procedure, No. 0
      absorbable suture (PolyglactinYü-ce Vicryl Ⓡ, Tekirdag, Turkey ) was used with the CTSP
      (Figure IV). The collected data were recorded in a pre-established database with age, gender,
      Diabetes Mellitus (DM), postoperative follow-up period, BMI at the time of operation and BMI
      during superficial USG.

      This study was approved by the Ethics Committee of University of Health Sciences Istanbul
      Fatih Sultan Mehmet Training and Research Hospital (12.09.2019 / 80).
    

Intervention name(s): CTSP
Intervention type(s): Procedure
Intervention description(s): In all patients Carter Thomasson Suture Passer (CTSP) were used for closing fascial defect peroperatively
Intervention model: Single Group Assignment
Intervention model description: 61 patients who underwent Laparoscopic Sleeve Gastrectomy are included. USG was performed (Figure I,II) by a clinician who had previously received superficial USG evaluation training for trocar site hernia and abdominal incision sites were investigated for the presence of hernias.
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Laparoscopic Sleeve Gastrectomy; Morbid obesity; Trocar site hernia; Carter Thomasson Suture Passer