Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study.
Abdominal Wound Closure Techniques
/ adverse effects
Adult
Aged
Case-Control Studies
Female
Gastrectomy
/ adverse effects
Hernia, Abdominal
/ etiology
Humans
Incisional Hernia
/ etiology
Laparoscopy
/ adverse effects
Male
Middle Aged
Obesity, Morbid
/ surgery
Postoperative Period
Preoperative Period
Prospective Studies
Retrospective Studies
Risk Factors
Surgical Instruments
/ adverse effects
Suture Techniques
/ adverse effects
Young Adult
Abdominal CT scan
Open laparoscopy
Sleeve gastrectomy
Trocar site closure
Trocar site hernia
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
pubmed:
7
6
2019
medline:
27
5
2020
entrez:
7
6
2019
Statut:
ppublish
Résumé
Recent studies have reported trocar site hernia (TSH) rates after bariatric surgery ranging from 0 to 45.2% based on imaging assessment. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) comprising routine 12 mm epigastric trocar site closure (TSC). Prospective observational study with retrospective control cohort of a group of patients undergoing primary SG with routine 12 mm epigastric TSC. The "before" group (control group) was a previously published group of patients without 12 mm epigastric TSC and the "after" group (closure group) concerned patients with routine 12 mm epigastric TSC. Primary endpoint was the TSH rate after routine epigastric TSC. Secondary endpoints were comparison of the TSH rate, TSC feasibility and causes of failure, TSC-related morbidity, evaluation of TSC time and its course, and identification of risk factors for TSH. One hundred twenty-three patients were analyzed during the study period. Feasibility of epigastric TSC was 97.3% without related morbidity. Mean epigastric TSC time was 44.2 s (18-150). Epigastric TSC time was always less than 60 s after 10-15 procedures. At 1 year, 10 patients presented TSH (8.1%): epigastric in 6.5% (n = 8) cases and after open laparoscopy in 1.6% (n = 2) cases. Comparison of the two groups revealed a lower TSH rate in the closure group (8.1% vs. 17.0%; p = 0.02), due to a lower epigastric TSH rate (6.5% vs. 14.8%; p = 0.02). Routine epigastric TSC was a protective factor for TSH (p = 0.03; relative risk of 0.43). Routine epigastric TSC during SG is rapid and provides effective prevention of TSH.
Sections du résumé
BACKGROUND
Recent studies have reported trocar site hernia (TSH) rates after bariatric surgery ranging from 0 to 45.2% based on imaging assessment. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) comprising routine 12 mm epigastric trocar site closure (TSC).
MATERIAL
Prospective observational study with retrospective control cohort of a group of patients undergoing primary SG with routine 12 mm epigastric TSC. The "before" group (control group) was a previously published group of patients without 12 mm epigastric TSC and the "after" group (closure group) concerned patients with routine 12 mm epigastric TSC. Primary endpoint was the TSH rate after routine epigastric TSC. Secondary endpoints were comparison of the TSH rate, TSC feasibility and causes of failure, TSC-related morbidity, evaluation of TSC time and its course, and identification of risk factors for TSH.
RESULTS
One hundred twenty-three patients were analyzed during the study period. Feasibility of epigastric TSC was 97.3% without related morbidity. Mean epigastric TSC time was 44.2 s (18-150). Epigastric TSC time was always less than 60 s after 10-15 procedures. At 1 year, 10 patients presented TSH (8.1%): epigastric in 6.5% (n = 8) cases and after open laparoscopy in 1.6% (n = 2) cases. Comparison of the two groups revealed a lower TSH rate in the closure group (8.1% vs. 17.0%; p = 0.02), due to a lower epigastric TSH rate (6.5% vs. 14.8%; p = 0.02). Routine epigastric TSC was a protective factor for TSH (p = 0.03; relative risk of 0.43).
CONCLUSION
Routine epigastric TSC during SG is rapid and provides effective prevention of TSH.
Identifiants
pubmed: 31168720
doi: 10.1007/s11695-019-03971-9
pii: 10.1007/s11695-019-03971-9
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3500-3507Références
Surg Endosc. 2014 Oct;28(10):2890-8
pubmed: 24789133
Surg Endosc. 2013 Apr;27(4):1287-91
pubmed: 23232997
Surg Endosc. 2010 Aug;24(8):2053-5
pubmed: 20135178
J Visc Surg. 2010 Oct;147(5 Suppl):e39-46
pubmed: 20971049
Int J Surg. 2014;12 Suppl 1:S83-6
pubmed: 24862661
J Endourol. 2014 Jul;28(7):814-8
pubmed: 24588556
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):796-7
pubmed: 25698131
Obes Surg. 2015 Apr;25(4):712
pubmed: 25227920
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):791-6
pubmed: 25863538
Hernia. 2015 Feb;19(1):1-24
pubmed: 25618025
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
J Am Coll Surg. 2014 Mar;218(3):358-62
pubmed: 24559950
J Laparoendosc Adv Surg Tech A. 2014 Feb;24(2):83-8
pubmed: 24432970
Hernia. 2012 Aug;16(4):431-7
pubmed: 22714582
Obes Surg. 2019 Mar;29(3):1049-1057
pubmed: 30659465