Objective: The creation of the pneumoperitoneum is the first surgical procedure in laparoscopic abdominal surgery. Morbid obesity is a risk factor for iatrogenic injuries due to the considerable thickness of the abdominal wall. The aim of this study was to assess the feasibility and the incidence of complications of the use of Veress needle (VN) in obese patients undergoing bariatric surgery. Methods: Between March 2004 and December 2010 a nonrandomized retrospective study was performed on 139 obese patients (mean BMI = 45,94 kg/m2). Blind VN insertion and insufflation followed by optical trocar insertion was the most widely used technique. Results: Of 139 patients, VN was successful used in 138 cases (99,28%), in one patient the procedure failed and an open laparoscopy was performed (0.72%). During the study period, there were 63 gastric bypass, 18 sleeve gastrectomy, 52 gastric banding and 8 reoperations. The VN was inserted at left upper quadrant in 46 cases and the midline above the umbilicus in 92 cases. A colonic perforation after VN insertion at the left upper quadrant occurred. The overall rate of complications was 0,72% (1/138). There were no access related complications when VN was inserted above the umbilicus; complications rate was 2.17% (1/46) at upper left quadrant VN placement. No cases of subcutaneous emphysema or extraperitoneal insufflation were observed. Conclusions: In our experience, the success rate was 98.28% and the overall rate of complications was 0.72%. The Veress needle technique can be considered feasible and safe even when used in obese population.
The creation of pneumoperitoneum in obese patients
KOSUTA, MARCO;GUERRINI, JACOPO;GIACOMEL, GRETA;GIURICIN, MICHELA;NAGLIATI, CARLO;PALMISANO, SILVIA;BALANI, ALESSANDRO;de Manzini, Nicolo'
2011-01-01
Abstract
Objective: The creation of the pneumoperitoneum is the first surgical procedure in laparoscopic abdominal surgery. Morbid obesity is a risk factor for iatrogenic injuries due to the considerable thickness of the abdominal wall. The aim of this study was to assess the feasibility and the incidence of complications of the use of Veress needle (VN) in obese patients undergoing bariatric surgery. Methods: Between March 2004 and December 2010 a nonrandomized retrospective study was performed on 139 obese patients (mean BMI = 45,94 kg/m2). Blind VN insertion and insufflation followed by optical trocar insertion was the most widely used technique. Results: Of 139 patients, VN was successful used in 138 cases (99,28%), in one patient the procedure failed and an open laparoscopy was performed (0.72%). During the study period, there were 63 gastric bypass, 18 sleeve gastrectomy, 52 gastric banding and 8 reoperations. The VN was inserted at left upper quadrant in 46 cases and the midline above the umbilicus in 92 cases. A colonic perforation after VN insertion at the left upper quadrant occurred. The overall rate of complications was 0,72% (1/138). There were no access related complications when VN was inserted above the umbilicus; complications rate was 2.17% (1/46) at upper left quadrant VN placement. No cases of subcutaneous emphysema or extraperitoneal insufflation were observed. Conclusions: In our experience, the success rate was 98.28% and the overall rate of complications was 0.72%. The Veress needle technique can be considered feasible and safe even when used in obese population.Pubblicazioni consigliate
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