Effect of internal ligation on the occurrence of trocar site hernia after laparoscopic sleeve gastrectomy

Aims: Nowadays, laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric surgical method. One of the complications seen after LSG is trocar site hernia (TSH). The aim of this study is to identify the risk factors for TSHs after LSG and to investigate the effect of internal ligation of the trocar entry site using energy-based vessel-sealing device (LigaSure™) on preventing TSH occurrence. Methods: The records of 841 patients who underwent LSG between January 2021 and October 2023 at Altınbaş University Faculty of Medicine Medicalpark Hospital were reviewed. A total of 244 patients were included in the study. All surgeries were performed by the same surgical team under identical conditions. In all patients, the right trocar site used to remove the stomach from the abdomen was expanded with a Kocher clamp. The right and left 12 mm trocar entry sites were ligated internally using LigaSure. The patients' age, gender, body-mass index (BMI), diabetes mellitus (DM), hypertension (HT), dyslipidemia, wound site infections, smoking status, chronic obstructive pulmonary disease (COPD), and constipation were evaluated. All patients were followed up at the 3rd, 6th, and 12th months following the LSG surgery. Physical examinations and ultrasound scans were performed to detect the presence of TSH. Results: In the analysis of 244 patients, 150 (61.5%) were female, 94 (38.5%) were male, and their ages ranged from 18 to 72 years old. The average age was 39.28±12.27 years old. The BMI ranged from 35.1 kg/m² to 63.9 kg/m², with an average of 43.16±5.40 kg/m². HT was present in 32% of the cases, diabetes in 35.2%, dyslipidemia in 38.9%, and COPD in 6.1%. Constipation was reported in 26.6% of the patients, and 41.4% were smokers. Wound infections were seen in 2 cases (0.8%). At the 3-month follow up, no TSHs were detected. At the 6-month post-surgical follow-up, one patient had a TSH, and one more was detected in an ultrasound scan performed after 1 year of the LSG surgery. The hernias identified were at the right trocar site, and none of them were symptomatic. There was no statistically significant correlation between gender, BMI, HT, diabetes, dyslipidemia, smoking, and the occurrence of hernia (p>0.05). The mean age of patients with a detected hernia (66.0±2.83 years) was statistically significantly higher than that of patients without hernia (39.06±12.07 years) (p:0.020; p