Herniation at the site of cannula insertion after laparoscopic cholecystectomy
Letter 1
Sir
We read with interest the recent Case Report by Messrs McMillan and Watt (Br J Surg 1993; 80: 915). We have previously reported the complication of small bowel herniation through the umbilical wound from a 10-mm port, resulting in obstruction that required small bowel resection'. In this case the gallbladder had also been removed through the epigastric cannula, suggesting that a wound of 10 mm is sufficient for this problem to arise. We believe that the complication has not been encountered following gynaecological laparoscopy as nearly all procedures use 5-or 8-mm cannulas. We had attempted closure of the defect with a 2/0 polyglactin suture, and feel this illustrates the difficulties encountered in closure of the fascial layer through such a small incision. We have found the use of a J shaped needle facilitates closure of the wound. The report of small bowel obstruction secondary to suturing of the small bowel to the abdominal wall demonstrates the need for adequate exposure for the placement of sutures under direct vision'. Although the wounds are small and some believe closure to be unnecessary, further reports of this nature may help settle the debate of whether to close fascial defects after laparoscopic surgery.