A 5-mm Port-Site Hernia Following a Laparoscopic Myomectomy Resulting in Bowel Obstruction

Abstract

Abstract

Background: Royal College of Obstetricians and Gynaecologists guidelines advise closure of 7-mm or larger lateral ports and 10-mm or larger midline ports. Herniation through 5-mm port sites has been shown, particularly when drains have been left in situ, and this case demonstrates the serious risk of bowel strangulation. Case: A 41-year-old woman underwent laparoscopic myomectomy for a 15-cm pedunculated fibroid. Four ports, 2×10–mm and 2×5–mm ENDOPATH® XCEL® Bladeless trocars were used for access and 1:20 vasopressin was used for hemostasis. The fibroid was then morcelated with a PKS™ PlasmaSORD™ Bipolar Morcellator. The rectus sheath for the 10-mm umbilical and right lateral ports were closed with Vicryl,™ using a J needle, and the skin was closed with MONOCRYL.™ The surgical time was 194 minutes, and surgery was complicated by recurrent reinsertion of a trocar because of the patient's high body mass index. No drains were used and the patient was discharged 2 days later. She was readmitted to the hospital 10 days later with intractable vomiting and abdominal pain. A plain X-ray revealed the presence of air under her diaphragm and computed tomography of her abdomen revealed a loop of small bowel present within the abdominal wall at the 5-mm left lateral port site. An emergency laparotomy confirmed that she had an incarcerated, strangulated small bowel within the port site and a straightforward resection anastomosis was performed. Results: The patient was discharged 9 days later and made a full recovery. Conclusions: Elective closure of the rectus irrespective of port size should be considered in cases of prolonged manipulation through the port or repeated reinsertion of a trocar, both of which may lead to an extension of an initial incision. (J GYNECOL SURG 30:247)