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Multicenter Study
. Apr-Jun 2019;23(2):e2019.00013.
doi: 10.4293/JSLS.2019.00013.

Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey

Free PMC article
Multicenter Study

Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey

Ali Wells et al. JSLS. .
Free PMC article


Background and objectives: Although trocar site hernias (TSHs) occur in only 1.5% to 1.8% of all laparoscopic procedures, TSHs can present serious postoperative complications. The purpose of this study was to survey surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) to elicit their experiences with TSHs, including fascial closure preferences.

Methods: After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based software. The survey link was emailed to all SLS members. Descriptive analyses included frequencies, percentages, and χ2 or Fisher's exact tests to assess statistical associations.

Results: There were 659 SLS members who completed the survey: 323 general surgeons, 242 gynecologists, 45 colorectal surgeons, 25 bariatric surgeons, and 24 urologists. Nearly 7 in 10 respondents (68.4%) reported at least 1 patient developing a TSH within the previous decade. Compared with other specialties, bariatric surgeons had the smallest proportion of respondents reporting fascial closure for 10- to 12-mm trocars (68%) and the largest proportion indicating no fascial closure for trocars of any size (28%) (P < .01). Among all respondents, 86.6%, 15.3%, and 2.4% close 10- to 12-mm, 8-mm, and 5-mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported no fascial closure for any size.

Conclusion: Port size remains one of the main risk factors for TSH development, with most respondents closing only 10- to 12-mm ports regardless of surgical volume or practice setting. The general trend for port closure for bariatric surgeons is significantly different from that of other surgeons.

Keywords: Laparoscopy; Trocar site hernia.

Conflict of interest statement

Conflicts of Interest: The authors declare that they have no conflict of interest.


Figure 1.
Figure 1.
Number of TSHs per monthly surgical volume. Although most surgeons reporting ≤ 2 TSHs in the past 10 years, the proportion of surgeons reporting this low incidence of TSHs was significantly different according to surgical volume (P < .01).

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