A case of Port-site Hernia after Retroperitoneal Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer

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  • 早期子宮体癌に対する後腹膜鏡下傍大動脈リンパ節郭清術後に発症したポートサイトヘルニアの1例

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Retroperitoneal laparoscopic para-aortic lymphadenectomy is not yet a common technique in Japan. Perhaps for this reason, reports of complications associated with the procedure are rare. We present a case of a 69-year-old woman with a body mass index of 23.9kg/m2 who presented with irregular genital bleeding. She was diagnosed with endometrial cancer (endometrioid carcinoma grade 1, stage 1B) and underwent laparoscopic hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. Para-aortic lymphadenectomy was performed via a retroperitoneal approach. On the third postoperative day, the patient developed abdominal distension and vomited repeatedly. She was diagnosed with port-site hernia at the left iliac fossa based on enhanced abdominal computed tomography findings, and underwent laparotomy to relieve obstruction of the small bowel. This operation revealed herniation of the intestine into the peritoneal wall, which had been punctured during trocar insertion. Although the wound fascia had been kept sutured, the small bowel had entered into an extraperitoneal space under the fascia transversalis that had formed during retroperitoneal para-aortic lymphadenectomy. To avoid such complications in the future, closure of the peritoneal wall is mandatory after minimally invasive surgery for endometrial cancer including retroperitoneal laparoscopic para-aortic lymphadenectomy.

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