Proper closure of trocar sites is key to avoiding hernias. (Laparoscopic Surgery).

WASHINGTON -- Trocar site hernias after laparoscopic surgery occur in about only 0.5%-3% of cases, but one's index of suspicion should be high, and CT scans should be done early as delays in hernia diagnosis can lead to bowel necrosis, Dr. Michelle Wolfe said.

To prevent hernias in the first place, all trocar sites larger than 5 mm, regardless of location, should be closed at both the peritoneum and fascia under direct laparoscopic visualization, she said at a meeting on gynecologic surgery sponsored by the Washington Hospital Center.

According to the literature, hernia risk increases along with the number of port sites and the complexity of the procedure, she said.

"As a general rule patients should feel better within hours of laparoscopy. If not, one should be suspicious of complications," said Dr. Wolfe of the Washington Hospital Center.

Signs and symptoms of port-site hernias include abdominal pain, nausea, vomiting, and a palpable mass. Time to recognition can take anywhere from hours to months to years.

CT scans are the best modality for diagnosing trocar hernias because abdominal x-rays may be normal. At the same time, peritoneal signs and leukocytosis are often absent initially making diagnosis difficult.

To prevent hernias, Dr. Wolfe suggested using ports smaller than 5 mm whenever possible and removing trocars and [CO.sub.2] cannulas under direct visualization to avoid sucking bowel into defects.