Umbilical Trochar Site Is The Usual Suspect For Trocar Hernia After Laparoscopic Cholecystectomy: A Prospective Study

INTRODUCTION: Trocar site hernia (TSH) is a rare but clinically significant complication of laparoscopic cholecystectomy (LC). This study aimed to evaluate the association between gallbladder retrieval site selection and postoperative TSH incidence.
METHODS: In this prospective, randomized study, 110 patients undergoing LC were allocated to either umbilical (n = 55) or epigastric (n = 55) gallbladder retrieval groups. Surgical techniques and postoperative management were standardized. Patients were followed for one year, with routine ultrasonography performed at 6 and 12 months regardless of symptoms. The primary outcome was the incidence of TSH. Secondary outcomes included postoperative pain and retrieval time.
RESULTS: Fifty patients in each group were included in the final analysis. TSH occurred in 6 patients (12%) in the umbilical group and 5 patients (10%) in the epigastric group (P = 1.00); all hernias were located at the umbilical site. Gallbladder retrieval time was significantly shorter in the epigastric group (P = 0.013), whereas umbilical retrieval was associated with significantly lower pain at 6 hours postoperatively (P = 0.027). Multivariate analysis identified extraction site widening as the only independent risk factor for TSH (OR = 4.08, P = 0.05).
DISCUSSION AND CONCLUSION: The site of extraction did not significantly influence TSH rates, which consistently occurred at the umbilical site. Epigastric extraction shortened retrieval time but was associated with slightly higher early postoperative pain. Standardizing technique and minimizing fascial dilation appear critical for reducing TSH risk. Future studies should explore the role of 5-mm umbilical trocars to further mitigate hernia development.