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05.06.2019 | Original Contributions

Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study

Zeitschrift:
Obesity Surgery
Autoren:
Lionel Rebibo, Marion Demouron, Jeanne Dembinski, Abdennaceur Dhahri, Thierry Yzet, Jean-Marc Regimbeau
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11695-019-03971-9) contains supplementary material, which is available to authorized users.

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Abstract

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.

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Zusatzmaterial
Video 1 Epigastric trocar site closure after SG using Weck® EFx Shield™. (MP4 44,857 kb)
11695_2019_3971_MOESM1_ESM.mp4
Literatur
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