Verification of Fascial Fissure Direction at the Port-site: the Search for a Reliable Closure Method

Abstract

Background: One of the complications of endoscopic surgery is port-site hernia. The risk of port-site hernia is minimized by proper port-site closure, which relies on appropriate characterization of the fascia, particularly the direction of fascial fissures. Methods: The following 4 procedures were examined to identify the fascial fissure direction: mobility of the port, observation from the lumen of the port, palpation for fascia, and visual confirmation. The match rate of each procedure with visual confirmation was verified. Results: 51 port-sites without fasciotomy were examined. The direction of the fissure was from 12 to 6 o’clock in 11 cases and 3 to 9 o’clock in 40 cases. The match rate between mobility and the fissure was 45.1%. The match rate of observation from the lumen was 96.1%. Comparing the suturing time, the average time was significantly shortened to 327 seconds in the second half compared to 494 seconds in the first half of our study period with the VersaOneTM fascial closure system. Conclusion: Treatment of port-site hernia can be done by suture or mesh repair, although ideally it is best to prevent the hernia in the first place. The fissure direction was almost always identifiable via observation from the lumen of the port. Closure of the port-site using modified Z-sutures allowed for full fascial closure, particularly in cases of patients with obesity.