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Alternative site entry for laparoscopy in patients with previous abdominal surgery
K S Gersin1, B T Heniford, M J Arca
1Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Summary
Laparoscopic surgery in patients with prior abdominal operations is feasible. An alternative open Hasson technique in a new surgical site avoids adhesions, preventing visceral injuries and enabling safe entry.
Area of Science:
- Minimally Invasive Surgery
- Surgical Adhesions
- Abdominal Surgery
Background:
- Laparoscopic procedures are common in patients with prior abdominal surgery.
- Surgical adhesions can increase the risk of visceral injury during peritoneal entry.
- Identifying safe entry techniques is crucial for these patients.
Purpose of the Study:
- To describe an alternative entry technique for laparoscopic procedures in patients with prior abdominal surgery.
- To evaluate the safety and efficacy of this technique in avoiding adhesions and preventing injuries.
Main Methods:
- Utilized an open Hasson procedure in a previously unoperated abdominal field.
- Focused on avoiding potential adhesions from previous surgeries.
- Performed prospectively over 24 months in 95 patients.
Main Results:
- The alternative technique was performed successfully in 95 patients.
- No open conversions were required due to visceral or vascular injuries.
- Demonstrated a safe method for peritoneal entry in complex cases.
Conclusions:
- Previous abdominal surgery is not an absolute contraindication for minimally invasive procedures.
- The described alternative Hasson technique provides a safe approach to peritoneal entry.
- This method minimizes the risk of injury in patients with potential adhesions.