8-mm Port Site Hernia After Robotic Right Hemicolectomy in a Dialysis Patient: Is 8-mm Closure Necessary? A Case Report

Port site hernia (PSH) is a rare but important complication of minimally invasive surgery. While fascial closure is generally recommended for ports 10 mm or larger, the necessity of closing 8mm robotic ports remains controversial. We report a case of PSH at an 8 mm port site following robot-assisted right hemicolectomy in a dialysis patient. An 83-year-old man with ascending colon cancer and a history of chronic hemodialysis underwent robotic right hemicolectomy, with an operative time of 353 minutes. The initial postoperative course was uneventful, but on postoperative day 21 he developed abdominal pain. Computed tomography (CT) imaging revealed small bowel herniation through the 8-mm port site in the right lower abdomen, with signs of incarceration and obstruction. Laparoscopic exploration showed a 10- mm fascial defect, which was closed with 0-Vicryl sutures using an Endo Close™ (Medtronic, Minneapolis, MN, USA). The patient recovered without recurrence.The PSH in this case was likely caused by multiple factors, including prolonged operative time, tissue fragility associated with advanced age and long-term dialysis, and increased intra-abdominal pressure. Dialysis-related loss of collagen and elastic fibers may have further reduced tissue elasticity. A review of 21 reported PSH cases at 8-mm robotic ports showed that most occurred in the lower abdomen and frequently required bowel resection. Although PSH at 8-mm ports is rare, its potential for incarceration and emergency surgery underscores laparoscopic inspection of port sites before completing the procedure. Fascial closure should be considered for high-risk patients, particularly those with tissue fragility, such as individuals on chronic dialysis.