Page 116 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
Closure of trocar incisions
There are no good quality comparative studies investigating di erent suture materials or techniques for closure of trocar fascia defects. Armananzas et al.(113) reported in a recently published RCT a bene t for prophylactic intraperitoneal placement of a ventral patch at the umbilical site in high-risk patients to reduce the incidence of trocar-site hernia from 18.5% to 4.4% (OR 10.1: CI 2.15-47.6; p< 0.001). Larger sample-sized studies with a good risk- bene t assessment and longer follow-up are needed to con rm and support a stronger recommendation.
Single incision laparoscopic surgery and incisional hernia
The incidence of trocar-site hernia after single port surgery has been mostly investigated as a secondary outcome measure in the setting of RCTs and 3 High Quality MAs were found(137-139). Two MAs of RCTs have found no di erence in the incidence of trocar-site hernia between single port and multiple port surgery, although a trend in favour of multiple port surgery was demonstrated(137, 139). The most recent MA included 19 RCTs involving 676 patients and found a higher incidence of trocar site hernia following single port surgery(138).
Statement
For laparoscopic procedures a mesh- augmented closure may be applied in patients at high risk for trocar-site hernia.
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weak
Statement
Emerging evidence suggests an increased incidence of trocar-site hernia for single-incision surgery as compared to conventional surgery; therefore meticulous closure of the incised fascia in single-port surgery is recommended.
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weak
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