Risks of blind versus open approach to celiotomy for laparoscopic surgery.
Patients undergoing laparoscopic cholecystectomy had celiotomy either by a blind (Veress needle) approach (n = 781) or by fascial and peritoneal incision with insertion of a 10-mm sheath under direct vision (n = 247). The blind approach was associated with three small bowel injuries and one tear of the left common iliac artery. No intestinal or vascular injuries occurred in the open insertion group. The difference was not statistically significant. The mean duration of surgery was 81.4 +/- 1.3 min in the blind group compared with 72.6 +/- 2.0 min in the open group (p < 0.001). There was no significant difference in postoperative stay or in return to normal activity between the two groups. It is recommended that blind access to the peritoneal cavity for laparoscopy be abandoned in favor of an open approach because the blind approach confers no advantages and places the patient at risk for unrecognized visceral or vascular injury even though these injuries may not occur at a statistically significant frequency.
Sigman
H H
HH
Division of General Surgery, McGill University, Montréal, Québec, Canada.
Fried
G M
GM
Garzon
J
J
Hinchey
E J
EJ
Wexler
M J
MJ
Meakins
J L
JL
Barkun
J S
JS
D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications / Q000453:epidemiology*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D012307:Risk Factors; D013525:Surgical Instruments; D013997:Time Factors