The Analysis of Bowel Hernia Following Laparoscopic Surgery in Gynecology

doi:10.3877/cma.j.issn.1673-5250.2013.06.005

Objective

To explore the characteristic of trocar site hernia following gynecological laparoscopic surgery and the preventive methods.

Methods

A total of 1 891 cases of clinical data after laparoscopic surgery in our hospital from July 2008 to April 2013 were analyzed retrospectively. The characteristics and high risk factors of bowel hernia were discussed. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Navy General Hospital of PLA. Informed consent was obtained from each participating patient.

Results

Two cases of bowel hernia were both occurred in the left lower abdominal port site, by which specimens were taken. The diameter of trocar site were 15 mm and 10 mm. Five and four days delayed after surgery. The incidence of bowel hernia after laparoscopic surgery was 0. 1 % (2/1 891) in our department, that was 0. 3 % (1/367) after laparoscopic myomectomy and 1. 9 % (1/52) in elderly women patients.

Conclusions

The key to prevent intestinal hernia after laparoscopic surgery is that suturing peritoneum carefully, especially in elderly women patients and the patients with trocar site bigger than 10 mm. Suturing peritoneum under laparoscopic visualization would prevent the hernia effectively.

Key words: laparoscopy, hernia, paracentesis, complications

图1 病例1左下腹穿刺孔肠管嵌顿

Figure 1 Trocar site hernia in left lower abdomen of the case 1

图2 病例2左下腹穿刺孔肠管嵌顿

Figure 2 Trocar site hernia in left lower abdomen of the case 2

图3 病例2解除肠管嵌顿后腹腔镜下缝合腹膜

Figure 3 Laparoscopic suturing peritoneum after relieving bowel impaction of the case 2

表1 本院妇科腹腔镜术后肠疝危险因素分析

Table 1 The risk factors of bowel hernia following laparoscopic surgery in our department

危险因素	年龄>60岁	穿刺孔直径(mm)			左下腹穿刺孔	取物操作	穿刺方式		缝合腹膜	腹压增加
危险因素	年龄>60岁	15	10	5	左下腹穿刺孔	取物操作	气腹针	套管针	缝合腹膜	腹压增加
病例1	-	+	-	-	+	+	+	-	-	+
病例2	+	-	+	-	+	+	-	+	-	+

表1 本院妇科腹腔镜术后肠疝危险因素分析

Table 1 The risk factors of bowel hernia following laparoscopic surgery in our department

危险因素	年龄>60岁	穿刺孔直径(mm)			左下腹穿刺孔	取物操作	穿刺方式		缝合腹膜	腹压增加
危险因素	年龄>60岁	15	10	5	左下腹穿刺孔	取物操作	气腹针	套管针	缝合腹膜	腹压增加
病例1	-	+	-	-	+	+	+	-	-	+
病例2	+	-	+	-	+	+	-	+	-	+

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