Safety of Veress needle insertion in laparoscopic bariatric surgery.
BACKGROUND
Creating the pneumoperitoneum is the first surgical procedure in laparoscopic abdominal surgery. Morbid obesity is a risk factor for iatrogenic injuries because of the considerable thickness of the abdominal wall. The aim of this study was to assess the feasibility and the incidence of complications when using Veress needles (VN) in obese patients undergoing bariatric surgery.


METHODS
Between March 2004 and December 2010, a retrospective analysis was performed on 139 obese patients (mean body mass index=45.94 kg/m). Blind VN insertion followed by optical trocar insertion was the most widely used technique.


RESULTS
Of the 139 patients, VN was successfully used in 138 cases (99.28%), and in 1 patient the procedure failed and an open laparoscopy was performed (0.72%). During the study period, there were 63 gastric bypasses, 18 sleeve gastrectomies, 50 gastric bandings, and 8 reoperations. The VN was inserted in the left upper quadrant in 46 cases and in the midline above the umbilicus in 93 cases. A colonic perforation after VN insertion at the left upper quadrant occurred. The overall rate of complications was 0.72%. There were no access-related complications when VN was inserted above the umbilicus; complication rate was 2.17% 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 VN technique can be considered feasible and safe even when used in obese population.
*General Surgery Department, University of Trieste, Trieste, Province of Trieste †Department of Biological Sciences and Human Oncology, Section of General and Oncologic Surgery, University Medical School of Bari, Policlinico, Bari, Italy.
Marco
M
Kosuta
Silvia
S
Palmisano
Giuseppe
G
Piccinni
Jacopo
J
Guerrini
Michela
M
Giuricin
Carlo
C
Nagliati
Biagio
B
Casagranda
Nicolò
N
de Manzini
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000295:instrumentation; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009339:Needles; D009767:Obesity, Morbid / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D055815:Young Adult