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[Complications of the laparoscopic access]
G Di Vita1, M Frazzetta, E Cortese
1Dipartimento di Discipline Chirurgiche ed Anatomiche, Università degli Studi di Palermo.
Abstract:
The Authors analysed the complications observed during 156 laparoscopic accesses. In 38 cases following the classic closed technique, two pneumoderma, one pneumoscrotum, one pneumoepiploon and two laparoceles were observed in the umbilical area. In 30 patients the laparascopic access was performed according to the open technique, registering a significant loss of gas during the operation though not compromising it in 4 patients, and two infections of the umbilical incision. In 88 cases the modified closed technique was used and only one infection in the umbilical trocar insertion area was observed. After discussing the incidence, the etiopathogenesis, the diagnosis and the treatment of complications related to the laparoscopic access, the Authors emphasize the fact that in patients with surgical scars near the naval or patients who have already undergone laparascopy, or those with a positive history of affections causing abdominal adherence, the laparoscopic access must be performed using the open technique.
Insights
Laparoscopic access complications vary by technique. The open technique is recommended for patients with prior abdominal surgery or adhesions to minimize risks like gas embolism and infection.
Area of Science:
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Laparoscopic surgery relies on abdominal access, which carries potential complications.
- Different laparoscopic access techniques exist, each with varying risk profiles.
Purpose of the Study:
- To analyze and compare complications associated with different laparoscopic access techniques.
- To identify risk factors and recommend optimal access methods for specific patient groups.
Main Methods:
- Retrospective analysis of 156 laparoscopic procedures.
- Categorization of complications based on access technique: classic closed, open, and modified closed.
- Documentation of specific complications such as pneumoperitoneum, gas loss, and infections.
Main Results:
- The classic closed technique resulted in pneumoderma, pneumoscrotum, pneumoepiploön, and laparoceles.
- The open technique led to significant gas loss in some cases and umbilical incision infections.
- The modified closed technique showed a low incidence of infection.
Conclusions:
- The modified closed technique demonstrated a lower complication rate.
- The open technique is advised for patients with surgical scars, previous laparoscopy, or abdominal adhesions.
- Careful technique selection is crucial for safe laparoscopic access.