Effective, simple, easy procedure for laparoscopic port closure in difficult cases

Abstract

BackgroundLaparoscopic and rebotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial closure. Good fascial closure still represents problem, especially in difficult obese patients. This study reported simple technique is suitable in such cases.Material and methodsWe herein describe a simple technique for fascial closure after Laparoscopic surgery using percutaneous transabdominal approach by using two looped needles in 87 obese patients. This technique was done while the trocar sheath in its position.ResultsThe procedure was used in 87 patients (69 females and 18 males) after laparoscopic cholecystectomy with mean body mass index 35.5 kg/m2 and mean age 47.1 years from May 2013 through June 2015. No intra-operative incidents and no port sites hernias were reported during a mean follow up of 18 months.ConclusionThe procedure is easy to perform, safe, and effective for fascial port site closure in difficult obese (thick abdominal wall and oblique port wound) cases.

Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia.

“…However, all these procedures are unsuitable in obese cases because of the thick abdominal wall and oblique wound necessitating assistance from inside; the suture is placed from the port site, which requires an increased skin incision, and the suture passes close to the edges of the fascia defect. Lasheen et al reported percutaneous transabdominal technique for closure of the port site with no port site herniation [ 10 , 11 ]. However, this technique cannot be used in obese patients.…”

“…It was reported that laparoscopic port site hernias can occur with incisions as small as 3 mm [ 8 ]. It is recommended that the fascia of 10 mm or wider trocar sites in adults and 5 mm or wider port sites in children must be closed [ 9 – 11 ]. Complete closure of fascia at the port site can be complicated and frustrating, often requiring blind suturing of the fascial defect, with the risks of incomplete closure and injury to the intraperitoneal organs or larger skin incisions.…”

Laparoscopic Port Closure Techniques and Incidence of Port-site Hernias: A Review and Recommendations

“…19 • Ports which are 10 mm and higher, either midline or lateral, must be closed at the level of fascia. 29,56 • The use of minimal necessary ports. Neudecker et al…”