Port site hernias: risk factors and prevention methods

Introduction. The widespread use of laparoscopic surgery has led to an increase in the incidence of port site hernias (PSH). The incidence of PSH can reach 40%, according to various studies. PSH not only reduce patients' quality of life but also require planned and sometimes emergency surgical treatment.

Aim of the study: To assess the incidence of PSH, identify the main risk factors, and determine the effectiveness of various trocar wound closure methods based on a literature review and our own clinical experience.

Materials and methods. The study consisted of several stages: Stage 1 was a retrospective analysis of 34 patients with trocar hernias after laparoscopic cholecystectomy (LC) and a prospective randomized study of 100 patients with acute calculous cholecystitis who underwent closure of either the aponeurosis alone (n=50) or all layers using the EndoClose device (n=50). Stage 2 was a multicenter, non-randomized study that included a retrospective analysis of 131 patients with postoperative ventral hernias and a prospective follow-up of 134 patients after various laparoscopic procedures with wound closure through all layers.

Results. The incidence of PSH in the retrospective group was 5,6 % (34 cases), while in the later cohort it was 15,27 % (20 of 131). Statistically significant risk factors included age over 60 years (p=0,011; r=0,82), obesity (BMI>30 kg/m², p=0,023; r=0,73), connective tissue dysplasia (p=0,037; r=0,56), and postoperative wound suppuration (p=0,042; r=0,64). In a prospective study, hernias developed in 5 patients (10 %) with laparoscopic-guided closure of only the aponeurosis, whereas no hernias were recorded in the group with laparoscopic-guided closure of all layers (p=0,028). With the EndoClose or Berci devices, the hernia incidence in the long-term period (3 years) did not exceed 1,49 % (2 of 134).

Conclusion. PSH remains a significant complication of laparoscopic surgery. Their development is facilitated by both general factors (age, obesity, connective tissue dysplasia) and local factors (infection, suturing technique). Suturing trocar wounds through all layers with intra-abdominal visual control using specialized devices significantly reduces the risk of hernia formation and should be considered the standard of care.

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