Laparoscopic surgery is a minimally invasive technique that uses small incisions, specialized instruments, and a camera. This approach typically results in shorter recovery times and less scarring compared to traditional open surgery. However, these small cuts do not eliminate the risk of a hernia. A hernia can develop after laparoscopic surgery, specifically at one of the small incision sites used to access the abdominal cavity, occurring when the abdominal wall fails to close properly and allows internal tissue to protrude.
The Specific Hernia Risk After Laparoscopy
The hernia that occurs after this procedure is known as a port-site or trocar-site hernia, named after the instrument used to create the opening. A trocar is a sharp instrument housed within a cannula, inserted through the abdominal wall to create the entry point for surgical tools. Inserting and removing this device can damage or stretch the abdominal wall layers, including the fascia (a strong layer of connective tissue).
A port-site hernia develops when the fascial layer is weakened or not adequately closed, creating a defect through which abdominal contents, such as fat or a loop of bowel, can push outward. The incidence is low, generally estimated between 0.5% and 3% of laparoscopic procedures.
The size of the trocar is a major determinant of risk; ports 10 millimeters or larger carry a higher likelihood of herniation. For these larger openings, surgeons must close the fascia layer with sutures to minimize the defect. Even when the fascial layer is closed, a hernia can still occur if the suture fails or the tissue healing is compromised.
Recognizing the Signs of a Hernia
Patients should be aware of specific physical changes that indicate a port-site hernia has formed near a previous incision. The primary sign is a visible bulge or lump that appears at the scar site. This swelling may be more apparent when standing up, coughing, straining, or lifting heavy objects, as these activities increase intra-abdominal pressure.
Patients may also experience localized pain or discomfort, often described as a dull ache or a pulling sensation at the incision site. If the hernia contents become trapped (incarceration), symptoms become severe and require immediate medical attention. Signs of this complication include sudden, intense pain, nausea, vomiting, and an inability to pass gas or have a bowel movement, indicating a possible bowel obstruction.
The time frame for presentation varies widely. Early-onset hernias appear soon after surgery, often presenting with acute symptoms like bowel obstruction. Late-onset hernias appear weeks to months later, typically as a soft lump. Any new lump or discomfort at a surgical scar should be evaluated by a healthcare provider.
Patient and Procedural Risk Factors
The likelihood of developing a port-site hernia is influenced by factors that compromise the strength of wound healing. Patient factors include a high body mass index (BMI), which puts increased strain on the abdominal wall, and pre-existing conditions like diabetes, which impairs tissue repair.
Other risk factors include chronic coughing, poor nutritional status, and any condition that increases sustained intra-abdominal pressure. Post-operative surgical site infection is also a major risk, as it delays and weakens the healing process of the fascia. Older age is associated with a higher incidence of port-site hernias due to naturally weaker connective tissue.
Procedural factors relate directly to the surgeon’s technique and the tools used. The use of a large trocar (10 millimeters or more) necessitates formal fascial closure. Inadequate or absent closure of the fascia at these larger sites is a primary cause of herniation. Furthermore, the location of the incision matters, with umbilical and midline ports having a higher risk compared to more lateral placements.
What Happens If a Hernia Is Found
If a port-site hernia is suspected, the initial step is typically a physical examination to confirm the presence of a palpable mass at the incision site. Diagnosis may be aided by imaging, such as an ultrasound or a CT scan. Imaging confirms the contents of the hernia sac and assesses its severity.
Once a port-site hernia is confirmed, the definitive treatment is almost always surgical repair. For a small defect, the surgeon may simply close the opening with strong sutures. For larger defects (greater than two centimeters) or in patients with multiple risk factors, the repair often involves placing a surgical mesh to reinforce the weakened abdominal wall. Emergency surgery is required if the hernia becomes incarcerated or strangulated, as this can lead to tissue death. Elective repair of a non-complicated hernia is generally recommended to prevent the future risk of such emergency events.