腹腔鏡下付属器摘出術後に発症した臍部5mmポートサイト大網ヘルニアの1例

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  • Five-millimeter Umbilical Trocar Site Hernia Following Laparoscopic Salpingo-oophorectomy: Case Report

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The incidence of trocar site hernia is reported to be about 0.2% after gynecological laparoscopic surgery. A 44-year-old woman underwent laparoscopic right salpingo-oophorectomy for endometrial cyst of the right ovary. Her body mass index was 19.1 kg/m2. After a 5-mm incision was made with a scalpel at the umbilical area, a 5-mm trocar was inserted by using a Veress needle. This umbilical port was used as the camera port. The postoperative period was uneventful and the patient was discharged on the 5th operative day. At home, the patient noticed a watery discharge from the umbilical trocar wound on the 6th postoperative day. At presentation, she was afebrile and her blood counts were normal. A viable portion of the omentum was prolapsed through the umbilical trocar site. Trocar site hernia was diagnosed, and an urgent laparoscopic surgery was performed. The omentum was reduced laparoscopically and the prolapsed omentum was excised. She was discharged the day after the reoperation, and had an uneventful postoperative course. Trocar site hernia less than 10 mm is a rare complication after gynecological laparoscopic surgery. Recent systematic reviews have suggested that umbilical trocar port, obesity, and fascial closure are not associated with a higher risk of trocar site hernia. However, the depth of the abdominal wall of the umbilicus should be noted in regard to umbilical trocar site hernia. We believe that attention should be paid to patients with thin and fragile abdominal wall of the umbilicus even if the BMI is high.

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