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Laparoscopy HerniationFrom: Arthur W. Curtis, Jr. (artcurtis@juno.com)Fri Nov 8 19:35:18 1996
A week ago, I performed a laparoscopic tubal ligation on a healthy 30+yo thin muscular patient. All went well for the brief procedure. I used a disposable 8mm trocar and sleeve for the non video laparoscopy. The fascia was not cut prior to the insertion of the trocar and was not sutured at the conclusion of the procedure. Two days later she called saying there was fat protruding from the umbilical incision. She denied any except minimal non exertional activity. It was an obvious knuckle of omentum about 3-4 cm. There was no pain, no inflammation and no evidence of any peritoneal irritation. Perfusion of the omentum seemed normal with no strangulation. Manual reduction of the omentum was unsuccessful in the ER. Under general anesthesia, I extended the incision inferiorly in the midline about 5-7 mm and easily reduced the omentum. Ligating the herniated omentum was considered (the omentum was exteriorized for several hours), but the general surgeon advised merely replacing the entire omentum. She was discharged as soon as she recovered from anesthesia and given Doxycycline for 7days. I repair the fascia of 10mm and larger trocar incisions, but always thought that smaller punctures never needed suturing. I thought I'd ask the list if others repair incisions smaller than 10mm. Some of our laparoscopists do not repair 10mm incisions, but only 12mm incisions. Thanks _________________ Arthur Curtis _________________ Worcester MA ArtCurtis@juno.com
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