Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Keyhole surgery reduces the size of the cuts. It does not abolish them. Each port, the small opening through which a camera or instrument passes, goes through the full thickness of the abdominal wall.
Occasionally the muscle layer at one of those sites does not heal securely, and a hernia forms. That is a port-site hernia. It is a type of incisional hernia, and a small one, but it has features worth knowing.
The navel is the commonest site. It is the usual entry point for the camera. It is often the port through which a gallbladder or other specimen is removed. The tissue there is naturally weaker.
Larger ports carry more risk than the narrow 5 mm ones, and a port that had to be widened carries more still. Patient factors add to that.
What raises the risk at a port site
| Factor | Why it matters |
|---|---|
| The navel port | The usual camera entry, often widened to remove a specimen, and naturally the weakest point of the wall. |
| Port size | A 10 mm or 12 mm port carries more risk than a 5 mm one. A port that had to be stretched carries more still. |
| Wound infection at that site | Healing of the muscle layer is poorer where the wound became infected. |
| Obesity and diabetes | Both slow healing of the muscle layer and both raise pressure or reduce tissue quality. |
| Smoking | Reduces the strength of the scar that forms in the muscle layer. |
| Chronic cough, constipation, straining | Repeated pressure on a healing port site before the layer is strong. |
A bulge at an old keyhole scar deserves an examination rather than a wait-and-see.
Most appear within the first year or two after the original operation. A bulge at or near the old scar that comes out on standing or coughing, sometimes with a local ache.
A small number present much earlier, sometimes within days, with bowel caught in the small opening.
Warning signs that need to be seen urgently
Bowel trapped in a narrow port-site defect does not settle on its own.
A port-site defect is often only a centimetre or two across. Narrow openings trap bowel more readily than wide ones, because what goes through cannot easily come back.
For that reason a port-site hernia causing symptoms is generally repaired rather than watched.
The repair follows the defect. A small one can be closed directly, usually with a small piece of mesh to reinforce it. Larger or multiple defects, or a port-site hernia sitting inside a wider weakness along the midline, are treated like any ventral or incisional hernia.
Where the navel is involved, the repair overlaps with that of an umbilical hernia. The same factors that caused it, weight, sugar control and smoking, are worked on before a planned repair, so the chance of it coming back is lower.
It may well be a port-site hernia. An examination, and an ultrasound if it is unclear, will confirm it.
Most appear within the first one to two years, but they can present earlier or later.
Its narrow neck makes trapping of bowel more likely than in a wide hernia. Symptomatic ones are usually repaired.
It can be open, laparoscopic or robotic depending on the size, the site and whether there are other defects.
The risk is reduced by closing larger port sites and controlling risk factors, but it cannot be removed entirely.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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