title: Trocar Injuries in 17,446 Laparoscopic Gastric Bypass-a Nationwide Survey from the Scandinavian Obesity Surgery Registry.
abstract: Although, the vast majority of bariatric procedures worldwide are performed laparoscopically, there is no consensus on the best technique to enter the first trocar, a potentially dangerous maneuver. Three principally different techniques exist: initial pneumoperitoneum by Verres needle, open Hasson technique, and direct placement of an optical trocar. In this nationwide survey, we have studied the presently used technique to place the first trocar and identified any intraabdominal injuries in 2012-2014.
  
  
  
  A questionnaire concerning techniques for placing the first trocar and identified intraabdominal injuries was sent to all 41 centers performing laparoscopic Roux en-Y gastric bypass (LRYGB) in Sweden. Total number of procedures were collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), also searched for reports on intraabdominal injuries.
  
  
  
  During the present study period, 17,446 LRYGBs were performed. Twelve intraabdominal injuries (0.07 %) were found: bleedings from the omentum, small bowel mesentery and liver (n = 8), and gastric or small bowel perforation (n = 4). The injuries were evenly distributed between the Veress technique and direct placement of an optical trocar, while no injuries occurred with the Hasson technique. Concerning placement of the first trocar, initial pneumoperitoneum with Veress needle was most common (59 %), followed by direct placement of an optical trocar (30 %). This indicates a switch from 2009-2010 (Veress 45 % and optical trocar 45 %, p < 0.001).
  
  
  
  Twelve intraabdominal injuries (0.07 %) were found in this nationwide survey. The most common technique for placing the first trocar had switched from directly placing an optical trocar to prior establishment of pneumoperitoneum.
authors.affiliation: Deparment of Surgical Sciences, Uppsala University, Uppsala, Sweden. magnus.sundbom@surgsci.uu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.affiliation: Deparment of Surgery, Örebro University Hospital, Örebro, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Ottosson
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology* / Q000209:etiology; D015390:Gastric Bypass / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation; D009767:Obesity, Morbid / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012042:Registries; D013525:Surgical Instruments; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
keywords: Complication; Gastric bypass; Intraabdominal injury; Laparoscopy; Pneumoperitoneum; Trocar
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