Small bowel obstruction after hand-assisted laparoscopic sigmoid colectomy for cancer.

Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be relieved by laparoscopic exploration.