Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study | SpringerLink

Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study

  • Ioannis Karampinis
  • Eliette Lion
  • Svetlana Hetjens
  • Georgi Vassilev
  • Christian Galata
  • Christoph Reissfelder
  • Mirko OttoEmail author

Open Access

Original Contributions



The exact prevalence of trocar site hernias after bariatric procedures is not yet known. Recent metaanalysis data indicated concerning rates of up to 25%. We conducted a prospective cohort study to estimate the prevalence and analyze the role of fascia closure in the development of trocar hernias.


A total of 365 patients who were operated for obesity in our department between 2009 and 2018 were included. All patients were invited for a follow-up ultrasonography scan in order to detect abdominal wall defects. The role of intraoperative fascia closure in the development of trocar site hernias was evaluated, and a logistic regression analysis was performed to detect potential risk factors.


The overall prevalence of trocar hernias detected by ultrasonography was 34%. The prevalence of abdominal wall defects in patients who received a fascia closure was 37% compared with 34% in patients who did not receive a fascia closure (p = 0.37). The only factor that was associated with a higher risk for trocar site hernias was high excessive weight loss (p = 0.05).


Trocar site hernias are an underestimated complication of minimally invasive, multiportal bariatric surgery, and the prevalence of asymptomatic hernias is probably higher than initially expected. In this study, fascia closure did not protect against trocar hernias. However, opposing evidence from similar trials suggests closing the fascia. This clinical problem should therefore be further assessed in a prospective randomized setting.


Trocar site hernia Port site hernia Incisional hernia Bariatric surgery Surgical complications 

Copyright information

© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Authors and Affiliations

  1. 1.Department of SurgeryUniversitätsmedizin Mann heim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
  2. 2.Institute of Medical Statistic and Biomathematics, Universitätsmedizin Mannheim, Medical Faculty MannheimHeidelberg UniversityMannheimGermany

Source: Trocar Site HERnias After Bariatric Laparoscopic Surgery (HERBALS): a Prospective Cohort Study | SpringerLink

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