腹腔鏡攝護腺切除手術後傷口疝氣
盧則宏 歐建慧
國立成功大學醫學院附設醫院泌尿部
Trocar site hernia after laparoscopic prostatectomy
Ze-Hong Lu, Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, College of
Medicine, National Cheng Kung University, Tainan, Taiwan
Purpose:
Prostate cancer is one of the leading cause of cancer death in males in Taiwan and in the world. For prostate cancer, minimal invasive operation such as robotic assisted laparoscopic or laparoscopic prostatectomy is the mainstream method. Compared with open prostatectomy, smaller operation wound, shorter hospital stay, and less pain severity are reported. However, trocar site hernia had been reported from previous studies. Here, we announced a case report and literature reviews about trocar site hernia after laparoscopic prostatectomy.
Materials and Methods:
We retrospectively collected clinical course including symptoms, signs, physical examination, image studies and further management and final outcomes to find out possible mechanism of herniation and how to early detection. Besides, we reviewed literature for post laparoscopy trocar site herniation.
Results:
66 y/o male with hyperlipidemia received laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection for prostate cancer. The final pathologic results was adenocarcinoma, T2bN0M0. After operation, wound condition and drainage amount was non-remarkable. However, persisted nausea and vomiting with abdominal fullness was recorded during postoperative period. Besides, one bulging mass below one trocar wound was detected. Sonography of this bulging mass revealed distended bowel loop, but hernia can not be sure. Further computed tomography of abdomen confirmed trocar site hernia. Emergency operation was arranged. Small bowel loop herniation from previous trocar site was impressed. General surgeon was consulted to exam strangulated bowel loop. Some ecchymosis was found, and it improved after warm water rinse and we pushed bowel loop back into abdominal cavity and closed wound by layers. Postoperative course was uneventful.
Conclusion:
Postoperative persistent nausea or vomiting or abdominal fullness may indicate bowel obstruction which may be related to trocar herniation. Abdominal CT scan should be considered for suspicious trocar site hernia patients. Early surgical intervention should be arranged as soon as possible after trocar site hernia confirmed.