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Objective: To assess the incidence of trocar hernias using a radial dilating trocar system. Introduction: Obese patients are at increased risk of trocar-related hernias, but port closure in these patients is difficult. A radially dilating trocar system has a theoretical advantage of reducing hernia incidence, but this is unproven. The current study was undertaken to determine the incidence of trocar site herniation using a commercially available radially dilating trocar system without routine closure of fascial defects. Methods: We retrospectively evaluated 2,780 laparoscopic RYGB patients enrolled in a prospectively collected database at 3 centers. All patients underwent RYGB using dilating trocars between January 2003 and March 2008. A total of 15,443 dilating trocars were used. Trocar configurations were based upon surgeon preference. In sites where a Hasson port or a 15mm trocar was used, or an EEA stapler was passed transabdominally, the fascial defects were closed. Dilating trocar sites were not routinely closed. Prospectively collected data included demographics, location, type, size, and number of access ports, history of prior hernia, steroid use, diabetes, respiratory disorder, port-site infection, and specimen extraction. All patients were followed at 3-12 month intervals postoperatively and for the presence of trocar site hernias. Descriptive statistics, Chi-square and Fisher’s exact tests were used to characterize and compare patients with and without trocar site hernias.Results: A total of 2,780 patients were followed for a median of 12.6 months. There were 17, 147 trocar sites. Of these, 1,305 were Hasson and 399 were 15mm trocars. Dilating ports included 6,658 12mm and 8,785 5mm sites. Overall, 46 (0.3%) patients developed a trocar site hernia. The incidence of hernia with each trocar type is: 35/1305 (2.7%) Hasson, 2/399 (0.5%) 15mm ports, 5/6658 (0.075%) 12mm dilating ports, and 2/8785 (0.023%) 5mm dilating ports. The majority (93%) of port site hernias were located in the midline position. Specimens were extracted through 8 port sites which went on to herniate (17%). Specimen extraction resulted in a hernia incidence of 2.7% (8/293) compared to a hernia incidence of 1.5% (38/2,487) without extraction for any size port, p=0.127. Trocar site hernia was not associated with any pre-operative predictor. Conclusion: A low incidence of trocar hernias was found after laparoscopic RYGB surgery using a radially dilating trocar system. Port site hernias are more frequent with larger trocars, at Hasson sites, when specimens are retrieved at the site, and at trocars positioned in the mid-line of the abdomen.