Trocar-wound in laparoscopic operations; novel approach to prevent hernia

Background: Fascial wound dehiscence and incisional hernia after abdominal surgery is a reported complication. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. However, laparoscopic surgery may still be followed by trocar-wound herniation. Various methods have been advocated for its prevention.
Methods: The records of 109 patients who underwent laparoscopic operations (12 gastric bypass, 18 gastroplasty, 15 gastric banding and 64 cholecystectomies) in obese patients between November 2004 and December 2006, with regular follow-up, were retrospectively reviewed. In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel plug was inserted into the muscle layer of trocar wounds.
Results: 2 male patients in the gastric bypass group developed a trocar wound hernia, for an overall prevalence of 1.83% (2/109). The intervals between surgery and diagnosis were 1 and 3 months respectively. These 2 patients have not developed intestinal obstruction as a consequence of the hernia, and have not undergone hernia repair.  No patient in the other groups has been found to develop a hernia.
Conclusion: With Surgicel pluging technique, the prevalence of trocar-wound hernia after laparoscopic procedures has been very rare.