Laparoscopic Management of Port Site Richter’s Hernia Following Gastric Bypass.

Michel Gagner, MD, Davit Sargsyan, MD, Moataz Bashah, Mohammed Al Kuwari, MD, Mohammed Rizwan, MD

Hamad General Hospital, Doha, Qatar

We present a case of port site Richter’s hernia following gastric bypass successfully managed laparoscopically. A 28 year old lady with BMI of 44 without comorbidities underwent laparoscopic Roux-en-Y antecolic gastric bypass with stapled anastomosis performed with EEA 25mm introduced through the left midclavicular port site. All port sites greater that 10mm were closed with vicryl 0/0 sutures. Postoperative period was uneventful and patient was discharged on 2nd postop day tolerating fluid diet. Seven days later patient presented to emergency department complaining of fever, pain and purulent discharge from the left midclavicular port. Abdominal CAT scan demonstrated a small bowel loop entrapped in the left port site wound. Patient was taken for laparoscopic exploration which revealed a loop of alimentary limb eventerating through the dehisced left midclavicular port site wound with signs of infection. The loop was bluntly dissected by finger from outside and atraumatic forceps from inside, reduced to the abdomen and found to be viable and non-perforated. The wound was closed by suture passer with interrupted prolene 1/0 stitches. Postoperative period was uneventful and patient was discharged on day 7 with clean and granulating wound. Outpatient follow up on day 21st showed healed wound with no apparent facial defects. Despite port site closure some patients might develop wound dehiscence or hernias especially in presence of infection. Therefore port sites greater than 10mm should be closed properly and special precautions should be taken at sites of contact with GI staplers and GI specimens.

Session: Video Channel Day 1

Program Number: V056

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