High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass

BACKGROUND: Trocar Site Hernia (TSH) seems to represent a rare surgical complication, but available data are based only on symptomatic patients and clinically diagnosed cases; moreover, no data are available concerning TSH incidence after robotic-assisted procedures. Aims of the study were to asses TSH incidence in obese patients who underwent Roux-en-Y gastric bypass (RYGB) and to compare it between robotic-assisted and standard laparoscopy. METHODS: Patients who underwent RYGB between November 2007 and June 2012 underwent a clinical examination and an ultrasonography study of the abdominal wall by a single operator. RESULTS: 150 patients entered the study, 102 in the laparoscopic and 48 in the robotic group. Mean pre-operative weight and BMI were 129.3 kg and 47.4 kg/m2, respectively; both were higher in the laparoscopic group (134.7 vs 117.6 kg, p < 0.001; 49.2 vs 43.8 kg/m2, p < 0.001), while pre-operative comorbidities were not significantly different between groups. Operative time was lower in the laparoscopic group (182.7 vs 284.0 min, p < 0.001), while post-operative complications were not different between groups. The overall incidence of TSH was 39.3 % (59/150); incidence was 35.3 % (36/102) in the laparoscopic and 47.9 % (23/48) in the robotic group (p = 0.195). There were no significant differences between patients with and without TSH, except for higher post-operative wound complication in patients without TSH (22 vs 6.8 %, p = 0.024; OR 0.26). CONCLUSIONS: TSH revealed a high incidence in a bariatric surgery population, suggesting that it represents a strongly underestimated complication; furthermore, the present study showed a trend towards a higher incidence of TSH in patients who underwent robotic-assisted bariatric surgery.