A case report of a 5 mm trocar-site evisceration after transabdominal preperitoneal (TAPP) hernia repair

Background: The incidence of trocar hernias in large published series ranges between 0.18% and 2.8%. Only a few cases are reported at trocar sites smaller than 10 mm in adult surgery, being even more uncommon in 5 mm incisions with an estimated incidence of 0.0005%. Case Description: We present a case report of an evisceration through a 5 mm laparoscopic trocar incision after transabdominal preperitoneal (TAPP) inguinal hernioplasty. The patient is a 75-year-old woman with multiple abdominal surgeries. TAPP hernioplasty was performed as a scheduled surgery, with placement of two laparoscopic 5 mm balloon trocars in both flanks. The patient was discharged the following day. On the third postoperative day, the patient arrived to the emergency room with diffuse abdominal pain and vomiting. It was initially managed conservatively, but an abdominal computed tomography (CT) scan was performed that showed a small intestine herniation through a 5 mm laparoscopic trocar incision in the left flank. An urgent intervention was performed, using a laparoscopic approach. The herniated ileal loop was identified through the hole of the previous trocar. The incarcerated intestine was reduced and the abdominal defect was closed with barbed suture. Conclusions: The presence of hernias in 5 mm trocars is very rare and can go unnoticed, therefore, we must keep this clinical suspicion in mind. In cases with high risk and excessive manipulation of the 5 mm trocar, we must try to close these trocars. This complication, although rare, can appear in the transabdominal approach to inguinal hernia; however, it does not with the extraperitoneal approach. The use of a laparoscopic approach for the repair of incarcerated/incisional hernias is increasing, as it is a safe technique with the advantage of being a minimally invasive surgery. Barbed sutures allow us to close the defect in the abdominal wall more easily than with other types of sutures.