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Cited by 5Minimally Invasive Surgical TechniquesHernia repair and managementSurgical site infection prevention

Insights Into Laparoscopic Port Site Complications: A Comprehensive Review

Open access
Chandra J, Nemi, Manivasagam, Sri Saran, Choudhary, Sushila, Manocha, Paras, Reddy, B Harish·2024·Cureus
DOI 10.7759/cureus.63431PMC PMC11284342
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Abstract

Laparoscopic surgery has become a widely accepted standard of care for numerous procedures in the modern world. Nearly every major surgical procedure previously only possible by employing open techniques may now be completed laparoscopically, attributable to the quick advancement of technology and surgeons' abilities. There are several complications associated with the laparoscopic port site, either infective, non-infective, or neoplastic. This study aims to explore the morbidity associated with the port site following laparoscopic surgery and discuss the risk factors for complications. The umbilical port was most frequently associated with port-site hernia (PSH), followed by the epigastrium and the left and right hypochondrium. Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH. Port-site infection (PSI) is one avoidable adverse effect of laparoscopic surgery. Patients who have a history of diabetes, malnourishment, prolonged preoperative hospital stays, preoperative Staphylococcus aureus colonization of the nares, perioperative blood transfusions, and tobacco or steroid use are more likely to have PSI. Port-site hydatid cyst (PSHC) and port-site tuberculosis (PST) are rare but possible. While uncommon, a doctor should rule out endometriosis if a painful mass in the surgical scar, such as the trocar site, is discovered in a reproductive-age woman who has had pelvic or obstetric surgery in the past. Port-site metastasis (PSM) is the term for tumor-cell implantation at the trocar insertion site after a malignant tumor is removed laparoscopically. PSM has been reported in 1-2% of laparoscopic gynecologic surgical procedures. A few potential mechanisms for cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during long laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection. Nonetheless, the triggering mechanism is likely essentially multifaceted. Prevention is better than cure. Port-site hernia can be prevented using smaller trocars and meticulous rectus sheath defect closure at the end of surgery. The rest of the port site complications can be prevented by employing autoclavable laparoscopic hand instruments, utilizing autoclaved water to clean the instruments following disassembly, adhering to the recommended concentration, contact duration, and usage cycles when sterilizing instruments with liquid sterilizers, preventing bile or gut content from spilling into the operating room or the port site, using non-porous specimen retrieval bags for recovering the specimen, and thoroughly cleaning and irrigating the port site before closing the wound.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes infective, non-infective, and neoplastic complications at laparoscopic port sites, including hernia, infection, hydatid cyst, tuberculosis, endometriosis, and metastasis. It emphasizes prevention through meticulous fascial closure, sterile instrument handling, and specimen retrieval precautions.

Key findings

  • Port-site hernia (PSH) has reported incidences from 0.14% to 22%; a systematic review of laparoscopic cholecystectomy found an overall PSH frequency of 1.7% (range 0.3%–5.4%). The umbilical port was most frequently involved, followed by epigastrium and left/right hypochondrium. Risk factors include older age, higher BMI, preexisting hernia, trocar design/diameter, longer surgery, port-site extension, prolonged port manipulation/reinsertion, failure to close fascial defect, and wound infection.
  • Port-site infection (PSI) is described as avoidable; umbilical PSI rate in laparoscopic surgery is reported as 8%, with 89% after laparoscopic cholecystectomy and 11% after laparoscopic appendectomy. In one prospective study of 675 elective laparoscopic cholecystectomy patients, 6.7% had PSI, and Pseudomonas was the most common organism in 19 (42.2%) cases.
  • Port-site metastasis (PSM) has been reported in 1–2% of laparoscopic gynecologic surgical procedures. Proposed mechanisms include exfoliated-cell embolization, hematogenous spread, air turbulence during long operations, and direct implantation during unprotected retrieval or from contaminated instruments.
  • Rare port-site complications include hydatid cyst, tuberculosis, and endometriosis; prevention recommendations include smaller trocars, meticulous rectus sheath closure, autoclavable instruments, proper sterilization, avoiding spillage, using non-porous specimen retrieval bags, and irrigating the port site before closure.

Methods

  • Narrative review searching PubMed and Google Scholar for publications from 1996 to 2024 using keywords: port-site hernia, port-site infection, port-site tuberculosis, port-site endometriosis, port-site hydatid cyst, and port-site metastases.
  • Results were limited to English; abstracts, letters to the editor, and comments were excluded.
  • A total of 23 articles were analyzed, including case reports, case series, systematic reviews, randomized controlled trials, and original articles; the authors state the review was not suitable for statistical analysis.

Limitations

  • The paper states potential subjective bias in literature selection and interpretation, a non-exhaustive search strategy, and possible missed relevant studies.
  • The paper states only PubMed and Google Scholar were examined due to funding/resource limits, with most other databases inaccessible because they were paid for; conclusions are based on a selective set of studies, affecting generalizability.
  • The paper states a narrative rather than systematic review was conducted and may not cover all aspects in depth; evident from the text, the review relies heavily on case reports and case series for several rare complications, without formal quality appraisal or meta-analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.7759/cureus.63431

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 63 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Prolonged port manipulation and reinsertion are responsible for the development of port-site hernia.

    “Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH.”
    • Also stated in: § Review · hedged
      “It is believed that prolonged port manipulation and reinsertion, longer surgical times, failure to close the fascial defect, and wound infection effectively are responsible for the development of PSH [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Premisecitation

    Longer surgical times are responsible for the development of port-site hernia.

    “Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH.”
    • Also stated in: § Review · hedged
      “It is believed that prolonged port manipulation and reinsertion, longer surgical times, failure to close the fascial defect, and wound infection effectively are responsible for the development of PSH [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Premisecitation

    Failure to effectively close the fascial defect is responsible for the development of port-site hernia.

    “Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH.”
    • Also stated in: § Review · hedged
      “It is believed that prolonged port manipulation and reinsertion, longer surgical times, failure to close the fascial defect, and wound infection effectively are responsible for the development of PSH [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Premisenone given

    A history of diabetes, malnourishment, prolonged preoperative hospital stays, preoperative Staphylococcus aureus colonization of the nares, perioperative blood transfusions, and tobacco or steroid use are associated with a higher likelihood of port-site infection.

    “Patients who have a history of diabetes, malnourishment, prolonged preoperative hospital stays, preoperative Staphylococcus aureus colonization of the nares, perioperative blood transfusions, and tobacco or steroid use are more likely to have PSI.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Wound infection is responsible for the development of port-site hernia.

    “Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH.”
    • Also stated in: § Review · hedged
      “It is believed that prolonged port manipulation and reinsertion, longer surgical times, failure to close the fascial defect, and wound infection effectively are responsible for the development of PSH [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • May combine two claims. 32
  • Classified as probably not a substantial claim. 25

  • May combine two claims.

    Premisecitation

    The umbilical port is most frequently associated with port-site hernia, followed by the epigastrium and the left and right hypochondrium.

    “The umbilical port was most frequently associated with port-site hernia (PSH), followed by the epigastrium and the left and right hypochondrium.”
    • Also stated in: § Review · plain
      “The umbilical port was most frequently linked to incisional hernia, with the epigastrium and left and right hypochondrium coming next.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    A total of 23 articles were analyzed to prepare a comprehensive review and current consensus on port-site complications.

    “A total of 23 articles [4,6-27] were analyzed across the spectrum to prepare a comprehensive review and current consensus on this topic, as illustrated in Table 1.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4,6-27]

      Not checked in the free run.

    • Rests on an assumption: The 23 included articles provide a comprehensive review and current consensus on port-site complications.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Abstracts, letters to the editor, and comments were excluded from the review.

    “Abstracts, letters to the editor, and comments were excluded.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The search results were limited to the English language.

    “The results were limited to the English language.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The searches for relevant publications were conducted using the PubMed and Google Scholar databases.

    “The searches were conducted using the PubMed and Google Scholar databases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Advanced age, greater BMI, a prior hernia, trocar diameter and design, longer surgical duration, and extension of the gallbladder extraction port site are the most significant variables for port-site hernia.

    “The most significant variables included advanced age, greater BMI, a prior hernia, trocar diameter and design, longer surgical duration, and an extension of the gallbladder extraction port site.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sarcopenia and port extension were risk factors for umbilical port-site hernia.

    “Thus, the author concluded that sarcopenia and port extension were risk factors for umbilical PSH.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Ki HJ, Park JB, Sul JY. Umbilical port site hernia and diastasis recti. J Minim Invasive Surg. 2020, 23:80-5. 10.7602/jmis.2020.23.2.80 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The triggering mechanism for port-site metastasis is likely essentially multifaceted.

    “Nonetheless, the triggering mechanism is likely essentially multifaceted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hydatid cysts near the port site are an uncommon consequence of laparoscopic hydatid cystotomy, but they can develop when scolices become lodged there during removal of a daughter cyst during laparoscopy.

    “Hydatid cysts near the port site are an uncommon consequence of laparoscopic hydatid cystotomy; nonetheless, they can develop when scolices become lodged there during the removal of a daughter cyst during a laparoscopy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Swamy PT, Vagadia JG, Bhatt JG, Dave JP. Recurrent liver hydatid cyst and port site hydatid cyst in anterior abdominal wall in operated case of laparoscopic cystostomy for liver hydatid cyst: a rare complication. Int Surg J. 2021, 8:3495-3497.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pseudomonas is the most common organism causing port-site infection, accounting for 19 (42.2%) cases.

    “Pseudomonas is the most common organism causing PSI, accounting for 19 (42.2%) cases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Mir MA, Malik UY, Wani H, Bali BS. Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Int Wound J. 2013, 10:110-3. 10.1111/j.1742-481X.2012.00963.x source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A higher prevalence of hernias seems to be linked to the male gender.

    “He also claimed that a higher prevalence of hernias seems to be linked to the male gender [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997, 84:630-3.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Port-site metastasis has been reported in 1-2% of laparoscopic gynecologic surgical procedures.

    “PSM has been reported in 1-2% of laparoscopic gynecologic surgical procedures.”
    • Also stated in: § Review · plain
      “PSM has been reported in 1-2% of laparoscopic gynecologic surgical procedures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Potential mechanisms for tumor-cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during long laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection.

    “A few potential mechanisms for cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during long laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hernias have been associated with diabetes mellitus, acquired immune deficiency syndrome, renal failure, and chronic obstructive pulmonary disease.

    “Hernias have been associated with several medical conditions, such as diabetes mellitus, acquired immune deficiency syndrome, renal failure, and chronic obstructive pulmonary disease.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Port-site hernia can be prevented using smaller trocars and meticulous rectus sheath defect closure at the end of surgery.

    “Port-site hernia can be prevented using smaller trocars and meticulous rectus sheath defect closure at the end of surgery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A preexisting hernia with fascial closure at the time of surgery was present in 25% of patients, of whom 1.8% developed incisional port-site hernia.

    “A preexisting hernia with fascial closure at the time of surgery was present in 25% of patients, of whom 1.8% developed incisional PSH.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997, 84:630-3.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A preponderance of umbilical or paraumbilical defects predated laparoscopic cholecystectomy in 12% of patients, 83.7% of whom did not exhibit any symptoms.

    “Nassar et al. discovered that a preponderance of umbilical or paraumbilical defects predated laparoscopic cholecystectomy in 12% of patients, 83.7% of whom did not exhibit any symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997, 84:630-3.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Port-site hernia has been classified into three types: early, late, and special.

    “Though it has not been generally adopted, PSH has been classified into three types: early (dehiscence of fascial planes and peritoneum), late (dehiscence of the fascial plane with intact peritoneal hernia sac), and special (dehiscence of the entire abdominal wall) [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004, 139:1248-56. 10.1001/archsurg.139.11.1248 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pseudomonas isolates were 100% resistant to ampicillin + sulbactam + ceftriaxone, but susceptible to imipenem, amikacin, and vancomycin in 89.47%, 57%, and 52.63% of cases, respectively.

    “The majority of the isolates' strains were resistant to common antibiotics; for example, pseudomonas was found to be 100% resistant to ampicillin + sulbactam + ceftriaxone, but it was susceptible to imipenem, amikacin, and vancomycin in 89.47%, 57%, and 52.63% of cases, respectively [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Mir MA, Malik UY, Wani H, Bali BS. Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Int Wound J. 2013, 10:110-3. 10.1111/j.1742-481X.2012.00963.x source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prophylactic antibiotics, obesity, and drains have no bearing on the incidence of surgical site infections after laparoscopic cholecystectomy.

    “Prophylactic antibiotics, obesity, and drains have no bearing on the incidence of SSIs after laparoscopic cholecystectomy [33,34].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008, 70:3-10. 10.1016/S0195-6701(08)60017-1 source

      Not checked in the free run.

    • cites [34] Boni L, Benevento A, Rovera F, Dionigi G, Di Giuseppe M, Bertoglio C, Dionigi R. Infective complications in laparoscopic surgery. Surg Infect (Larchmt). 2006, 7 Suppl 2:S109-11. 10.1089/sur.2006.7.s2-109 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Port-site hydatid cyst and port-site tuberculosis are rare but possible.

    “Port-site hydatid cyst (PSHC) and port-site tuberculosis (PST) are rare but possible.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The umbilical port-site infection rate in laparoscopic surgery is 8%, with 89% of infections following laparoscopic cholecystectomy and 11% following laparoscopic appendectomy.

    “According to reports, the umbilical PSI rate in LS is 8%, with 89% of infections following laparoscopic cholecystectomy and 11% following laparoscopic appendectomy [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Hamzaoglu I, Baca B, Böler DE, Polat E, Ozer Y. Is umbilical flora responsible for wound infection after laparoscopic surgery?. Surg Laparosc Endosc Percutan Tech. 2004, 14:263-7. 10.1097/00129689-200410000-00007 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Following laparoscopic procedures, the most common complications or injuries are gastrointestinal (0.6 per 1,000), genitourinary (0.3 per 1000), vascular (0.1 per 1,000), and momentum (0.4 per 1,000).

    “Following laparoscopic procedures, the most common complications or injuries are gastrointestinal (0.6 per 1,000), genitourinary (0.3 per 1000), vascular (0.1 per 1,000), and momentum (0.4 per 1,000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Karthik S, Augustine AJ, Shibumon MM, Pai MV. Analysis of laparoscopic port site complications: a descriptive study. J Minim Access Surg. 2013, 9:59-64. 10.4103/0972-9941.110964 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The sole class of antimicrobials efficacious against Mycobacterium chelonae and M. abscessus are macrolides, which include clarithromycin.

    “The sole class of antimicrobials efficacious against Mycobacterium chelonae and M. abscessus are macrolides, which include clarithromycin.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Infection with atypical mycobacteria is typically restricted to the laparoscopic procedure because most laparoscopic equipment has a heat-sensitive outer insulating sheath.

    “Due to the heat-sensitive outer insulating sheath on most laparoscopic equipment, infection with atypical mycobacteria is typically restricted to the laparoscopic procedure [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: a review of its management. World J Clin Cases. 2015, 3:864-71. 10.12998/wjcc.v3.i10.864 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is no infection rate in surgeries lasting less than 30 minutes.

    “Additionally, he stated that there was no infection rate in surgeries lasting less than 30 minutes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005, 23:249-52. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Lambertz et al., there were no significant changes in mean hospital stay or hernia recurrence rate between the study groups.

    “Between the study groups, there were no significant changes in the mean hospital stay (3 ± 4 days; p=0.057) or the hernia recurrence rate (9%; p=0.653) [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Lambertz A, Stüben BO, Bock B, et al.. Port-site incisional hernia: a case series of 54 patients. Ann Med Surg (Lond). 2017, 14:8-11. 10.1016/j.amsu.2017.01.001 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Lambertz et al., the mesh repair group had significantly higher BMI and significantly higher rates of heart illnesses compared to the suture-only group.

    “Compared to patients in the suture-only group, individuals treated with mesh repair had considerably higher BMI and significantly higher rates of heart illnesses.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Lambertz A, Stüben BO, Bock B, et al.. Port-site incisional hernia: a case series of 54 patients. Ann Med Surg (Lond). 2017, 14:8-11. 10.1016/j.amsu.2017.01.001 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Port-site hernia can cause serious side effects such as intestinal blockage, strangling, and perforation, in addition to pain.

    “PSH can cause serious side effects such as intestinal blockage, strangling, and perforation, in addition to pain [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010, 14:490-7. 10.4293/108680810X12924466007728 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Smaller trocars and meticulous rectus sheath defect closure at the end of surgery can prevent port-site hernias.

    “Smaller trocars and meticulous rectus sheath defect closure at the end of surgery can prevent port-site hernias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Potential mechanisms for port-site metastasis include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during extended laparoscopic operations, and direct implantation onto the wound during forced unprotected organ or tissue retrieval or from contaminated instruments during tumor dissection.

    “A few potential mechanisms for cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during extended laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [45] Martinez J, Targarona EM, Balagué C, Pera M, Trias M. Port site metastasis. An unresolved problem in laparoscopic surgery. A review. Int Surg. 1995, 80:315-21.

      Not checked in the free run.

    • cites [46] Perrotta G. Port-site metastasis (PSM): definition, clinical contexts and possible preventive actions to reduce risk. J Surg Surg Res. 2021, 10.17352/2455-2968.000144 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Pus culture and sensitivity tests rule out primary port-site infection or related secondary infections in mycobacterial infections.

    “Pus culture and sensitivity tests rule out primary PSI or related secondary infections in mycobacterial infections.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Scar endometriosis can occur after cesarean sections, hysterectomy, episiotomy, and laparoscopic trocar port tracts.

    “While most cases of scar endometriosis occur following cesarean sections, it can also happen following hysterectomy, episiotomy, and laparoscopic trocar port tracts.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The review is unsuitable for statistical analysis because it covers all possible diverse complications around the laparoscopic port site.

    “Unlike most studies on individual port site complications, our study is a comprehensive review covering all possible diverse complications around the laparoscopic port site, making it unsuitable for any statistical analysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Heparin- or cytocidal-based peritoneal washing is used to stop adherence of free cells.

    “Heparin- or cytocidal-based peritoneal washing is used to stop the adherence of free cells.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a retrospective analysis of patients with solitary port-site metastasis, median overall survival was 37 months and post-port-site-metastasis disease-free survival was 20 months, with a median follow-up of 22 months.

    “Overall survival (OS) was 37 months, and post-PSM disease-free survival (DFS) was 20 months, with a median follow-up of 22 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Agarwala V, Ramaswamy A, Dsouza S, Pande N, Goel M, Patkar S, Ostwal V. Resection of isolated port site metastasis in gall bladder cancers-careful selection and perioperative systemic therapy may improve outcomes. Indian J Surg Oncol. 2018, 9:427-31. 10.1007/s13193-018-0809-8 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Port-site tuberculosis wounds may heal with anti-tubercular therapy alone or with anti-tubercular therapy and sinus tract excision together.

    “The patient's wound may heal with ATT alone or with ATT and sinus tract excision together [19,42].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Cunnigaiper ND, Venkatraman S. Port site tuberculosis: endogenous or exogenous infection?. Surg Infect (Larchmt). 2010, 11:77-8. 10.1089/sur.2007.089 source

      Not checked in the free run.

    • cites [42] Jain SK, Stoker DL, Vathianathan R. Port‑site tuberculosis following laparoscopic cholecystectomy: A case report and review of literature. Indian J Surg. 2005, 67:205.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In advanced ovarian cancer, post-laparotomy port-site excision increased the risk of wound complications and had no beneficial effect on survival.

    “They discovered that port-site excision increased the risk of wound complications and had no beneficial effect on survival [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Lago V, Gimenez L, Matute L, et al.. Port site resection after laparoscopy in advance ovarian cancer surgery: time to abandon?. Surg Oncol. 2019, 29:1-6. 10.1016/j.suronc.2019.01.007 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients undergoing laparoscopy or laparoscopic cholecystectomy with undiagnosed gallbladder adenocarcinoma have a high incidence of recurrences at the port site, and this incidence rises if gallbladder perforation occurs during the procedure.

    “According to Z'graggen et al., patients undergoing laparoscopy or laparoscopic cholecystectomy who have an undiagnosed gallbladder adenocarcinoma have a high incidence of recurrences at the port site. This incidence rises if a gallbladder perforation occurs during the procedure [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Z'graggen K, Birrer S, Maurer CA, Wehrli H, Klaiber C, Baer HU. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery. 1998, 124:831-8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    ZN staining can directly demonstrate AFB.

    “ZN staining can also directly demonstrate AFB.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The conclusions are based on a selective set of studies, which may affect the generalizability of the findings.

    “The conclusions drawn are based on a selective set of studies, which may affect the generalizability of the findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The review may not cover all aspects of the topic in depth due to the narrative approach.

    “Additionally, while the review aims to provide a comprehensive overview, it may not cover all aspects of the topic in depth due to the narrative approach.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The exact etiopathogenesis of endometriosis remains debated.

    “However, the exact etiopathogenesis of endometriosis is still up for debate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Various complications occur at the port site, such as port-site hernia, infection, hydatid cysts, tuberculosis, endometriosis, and metastatic deposits.

    “Various complications occur at the port site, such as port-site hernia, infection, hydatid cysts, tuberculosis, endometriosis, and metastatic deposits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Excision of port sites appears to be a viable strategy to prevent port-site metastasis given the substantial incidence of port-site metastasis, but doubts remain about the advantages of port-site resection.

    “Excision of port sites appears to be a viable strategy to prevent PSM, given the substantial incidence of PSM. Still, doubts remain about the advantages of port-site resection.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The review's search strategy was not exhaustive, and relevant studies may have been inadvertently missed.

    “First, the potential for subjective bias is inherent in the selection and interpretation of literature, as the search strategy was not exhaustive, and relevant studies may have been inadvertently missed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Ultrasound-guided fine-needle aspiration cytology is a quick and precise diagnostic method for abdominal wall masses linked to port-site endometriosis and helps rule out cancer and decide treatment.

    “When women have abdominal wall masses linked to port-site endometriosis, ultrasound-guided FNAC (fine-needle aspiration cytology) is a quick and precise diagnostic method that helps rule out cancer and decide on the best course of action [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Hensen JH, Van Breda Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006, 186:616-20. 10.2214/AJR.04.1619 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Scar endometriosis, also called abdominal wall endometriosis, is a very uncommon condition that primarily affects surgical scar sites.

    “Scar endometriosis, another name for abdominal wall endometriosis, is a very uncommon condition that primarily affects surgical scar sites.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A trocar port site endometrioma may arise from direct contact between the excised lesion and the port tract or by peritoneal seeding of cells due to pneumoperitoneum.

    “A trocar port site endometrioma may arise from direct contact between the excised lesion and the port tract or by peritoneal seeding of cells due to pneumoperitoneum [21,43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Emre A, Akbulut S, Yilmaz M, Bozdag Z. Laparoscopic trocar port site endometriosis: a case report and brief literature review. Int Surg. 2012, 97:135-9. 10.9738/CC124.1 source

      Not checked in the free run.

    • cites [43] Akbulut S, Sevinc MM, Bakir S, Cakabay B, Sezgin A. Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons. Acta Chir Belg. 2010, 110:303-7. 10.1080/00015458.2010.11680621 source

      Not checked in the free run.

49 of 49

  • The paper relies on this without support.

    Port-site issues are uncommon.

    “Since port site issues are uncommon, we have reviewed the available case reports, case series, systematic reviews, randomized control trials, and original articles currently available to analyze the subject comprehensively.”

  • The paper relies on this without support.

    The 23 included articles provide a comprehensive review and current consensus on port-site complications.

    “A total of 23 articles [4,6-27] were analyzed across the spectrum to prepare a comprehensive review and current consensus on this topic, as illustrated in Table 1.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The diagnosis of AWE is often difficult because it can mimic a variety of benign and malignant abdominal wall masses.

    “The diagnosis of AWE is often difficult, as it can mimic a variety of benign and malignant abdominal wall masses.”

    From Umbilical port-site endometriosis: a case presentation and narrative review of the literature (2026) · cites this paper as [15]

    The Review (page unavailable) says port-site endometriosis is frequently mistaken for conditions including benign cysts and malignant tumors, supporting the claim that it can mimic other abdominal wall masses. But the discussion concerns port-site endometriosis specifically, and it says diagnosis is typically not difficult when the characteristic mass, cyclic pain, and port-site scar are present. The broader statement that AWE is often difficult to diagnose omits that qualification. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • For extensive lesions, CT or MRI offers more precise evaluation of the involvement of fascia or rectus abdominis muscles and can help determine whether preoperative planning for abdominal wall reconstruction is necessary.

    “For extensive lesions, CT or MRI offers more precise evaluation of the involvement of fascia or rectus abdominis muscles and can help determine whether preoperative planning for abdominal wall reconstruction is necessary [15].”

    From Umbilical port-site endometriosis: a case presentation and narrative review of the literature (2026) · cites this paper as [15]

    The Review (page unavailable) says CT and MRI can be helpful in evaluating port-site endometriosis, though they cannot provide a conclusive preoperative diagnosis. It does not say they assess fascial or rectus muscle involvement in extensive lesions or guide planning for abdominal wall reconstruction. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • MRI provides superior contrast resolution compared to CT or ultrasound.

    “MRI, in particular, provides superior contrast resolution compared to CT or ultrasound [15].”

    From Umbilical port-site endometriosis: a case presentation and narrative review of the literature (2026) · cites this paper as [15]

    The Review section discusses CT, ultrasound and MRI for port-site endometriosis, but does not compare their contrast resolution. Searches for the claimed comparison and for MRI's diagnostic advantages found no supporting passage in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Treatment groups exceed the stated 13 patients

    Minor

    The seven patients receiving neoadjuvant chemotherapy, two receiving neoadjuvant chemoradiation, and six receiving upfront resection total 15, exceeding the stated cohort of 13 patients.

    Reported 13 · recomputed 15

  • Infection cohort described as both all infected and 6.7% infected

    Minor

    The first statement says all 675 included patients had postoperative port-site infection, while the second says only 6.7% of patients developed it.

2 of 2

Cites

Flagged first, then by citations

1 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Jain SK, Stoker DL, Vathianathan R. Port‑site tuberculosis following laparoscopic cholecystectomy: A case report and review of literature. Indian J Surg. 2005, 67:205.

Cited by

Sorted by citations

Related

Authors
Chandra J, N., Manivasagam, S. S., Choudhary, S., Manocha, P., & Reddy, B. H.
Affiliations
Vardhman Mahavir Medical College & Safdarjung Hospital (IN)
Corresponding author
Manivasagam, Sri Saran
ORCID
Venue
Cureus
Publisher
Springer Science and Business Media LLC
Published
2024-06-28
Volume
16
Issue
6
Pages
e63431-e63431
ISSN
2168-8184 (ISSN-L)
DOI
10.7759/cureus.63431
PMC
PMC11284342
OpenAlex
W4400156364
Semantic Scholar
448e9cc29fb5e7be150428928729c16c0c7aec71
Cited by
5
References
48
Citations by year
2026: 3 · 2025: 2
FWCI
0.55
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Cureus (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
  • Health Sciences › Medicine › Surgery › Hernia repair and management
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
Keywords
port site hernia, port site infection, port-site metastasis, endometriosis, risk factors, prevention, wound infection, trocar size, instrument sterilization, gynecologic laparoscopy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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