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Updated: Jul 18, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Laparoscopy after previous laparotomy
Zulfo Godinjak1, Edin Idrizbegović, Kerim Begić
1Obstetrics and Gynecology Hospital, University of Sarajevo Clinics Center, Bolnicka 10, 71000 Sarajevo, Bosnia and Herzegovina.
Abstract:
Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previous laparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.
Insights
Creating pneumoperitoneum with Veres needle insertion in the umbilicus is safe for laparoscopic surgery after prior laparotomy. This method avoids complications, even with extensive adhesions, facilitating safe laparoscopic procedures in previously operated patients.
Area of Science:
- Abdominal Surgery
- Minimally Invasive Procedures
Background:
- Extensive adhesions commonly form after abdominal surgery, complicating subsequent laparoscopic operations.
- Previous laparotomy is often a concern for laparoscopic entry, but not an absolute contraindication.
Purpose of the Study:
- To evaluate the safety and efficacy of Veres needle insertion at the umbilicus for creating pneumoperitoneum in patients with a history of laparotomy.
- To demonstrate that closed laparoscopy is a viable option for patients with prior abdominal surgeries.
Main Methods:
- A retrospective analysis of 144 laparoscopic operations performed over three years.
- Patients had undergone one or two prior laparotomies for various reasons (digestive, gynecological, C-section, war injuries).
- Veres needle insertion and trocar placement were performed in the umbilical region using a closed laparoscopy technique.
Main Results:
- No intraoperative complications were recorded during Veres needle or trocar insertion in the umbilical region.
- No adhesions were found at the umbilicus, and no abdominal organs were injured in any of the 144 patients.
- Conversion to open laparotomy was necessary in 7 patients following diagnostic laparoscopy, not due to entry complications.
Conclusions:
- Umbilical Veres needle insertion is a safe and effective method for establishing pneumoperitoneum in laparoscopic surgery following previous laparotomy.
- This technique minimizes the risk of injury and complications, even in the presence of adhesions from prior surgeries.
- Closed laparoscopy via umbilical entry is a feasible approach for patients with a history of abdominal surgery.
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