The role of microlaparoscopy for safer wall entry: incidence of umbilical adhesions according to past surgical history

Wiley - Tập 8 Số 6 - Trang 363-367 - 1999
A Audebert1
1Institut Greenblatt France, Bordeaux, France

Tóm tắt

ObjectiveTo determine the incidence of umbilical adhesions related to previous surgical history.DesignA prospective single‐centre study with a single operator.SettingClinique Saint‐Sernin and Polyclinique de Bordeaux, Bordeaux, France.Subjects900 patients undergoing diagnostic or operative laparoscopy, classified into four groups: group I, 419 patients with no previous surgical surgery (control group); group II, 140 patients with previous major operative laparoscopy; group III 145 patients with previous laparotomy with a horizontal suprapubic incision; group IV, 96 patients with a previous laparotomy with a midline incision.InterventionInspection of the umbilical area for the presence of adhesions, with a microlaparoscope passed through a Veress needle at Palmer's point.Main outcome measuresIncidence and severity of umbilical adhesions and their potential risk in case of blind insertion of the umbilical trocar.ResultsUmbilical adhesions were noticed in 9.77% of the 900 patients. The incidence was different in the four groups: group I, 0.77%; group II, 1.42%; group III, 21.37%; group IV, 53.12%. Severe adhesions, with a potential risk in case of blind insertion of the umbilical trocar, were encountered in 0.38%, 0.71%, 6.89% and 31.25%, respectively, in the patients in the four groups.ConclusionsWomen with previous laparotomy have a higher incidence of umbilical adhesions, especially in the case of midline incisions. Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended in these high risk patients, in order to reduce complications of trocar insertion.

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Wiley

Tập 8 Số 6

363-367

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