Failed pneumoperitoneum post abdominoplasty

Bisson, M.; Breeson, A. J.; Henderson, H.P.

doi:10.1007/s00238-007-0158-2

Cited by 5 publications

(3 citation statements)

References 3 publications

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“…Difficulties associated with performing laparoscopy in patients who have undergone prior abdominal wall surgery, such as abdominoplasty [ 1 , 2 , 4 , 25 ], umbilical hernia repair [ 26 ] and transverse rectus abdominis myocutaneous flap-based breast reconstruction [ 27 ], along with techniques to overcome such challenges, have been described previously. First, the altered abdominal wall anatomy resulting from previous surgery makes safe and proper trocar placement challenging.…”

Section: Discussionmentioning

confidence: 99%

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Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report

et al. 2016

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BackgroundLaparoscopic abdominal surgery may prove difficult in patients who have undergone previous abdominal procedures. No reports in the medical literature have presented an aborted laparoscopic procedure for failed pneumoperitoneum following autologous flap-based breast reconstruction.Case presentationA 55-year-old woman presented with recurrent invasive lobular carcinoma of the right breast as well as a history of ductal carcinoma in situ of the left breast. The patient desired to proceed with bilateral skin- and nipple-sparing mastectomies with right axillary lymph node biopsy, followed by immediate bilateral autologous deep inferior epigastric perforator (DIEP) flap-based breast reconstruction. Preoperatively, a computerized tomography angiogram was obtained for reconstructive preparation, which revealed a left adrenal mass. Ensuing work-up diagnosed a pheochromocytoma. Given the concern for breast cancer progression, the patient elected to proceed first with breast cancer surgery and reconstruction prior to addressing the adrenal tumor. Subsequently, 3 months later the patient was brought to the operating room for a laparoscopic left adrenalectomy for the pheochromocytoma. With complete pharmacologic abdominal relaxation, the abdomen proved too tight to accommodate sufficient pneumoperitoneum and the laparoscopy was aborted. The patient was evaluated in the outpatient setting for assessment of abdominal wall compliance at regular intervals. Five months later, the patient was taken back to the operating room where pneumoperitoneum was established without difficulty and the laparoscopic left adrenalectomy was performed without complications.ConclusionPneumoperitoneum for laparoscopic surgery subsequent to autologous DIEP flap-based breast reconstruction may prove difficult as a result of loss of abdominal wall compliance. Prior to performing laparoscopy in such patients, surgeons should consider the details of the patient’s previous reconstructive procedure and assess potential risk factors for difficulty with insufflation. Lastly, careful abdominal examination should be performed to indicate whether laparoscopy for elective procedures should be delayed until abdominal wall compliance normalizes.

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Section: Discussionmentioning

confidence: 99%

“…Second, trocar perforation can be difficult in patients with previous abdominal surgery if the abdominal wall is fibrotic or scarred [ 2 ]. Operative modifications for safe and effective port placement in this setting include providing counter traction with towel clamps and using sharp dissection to perforate fibrosis [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report

et al. 2016

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“…The limited publications about this problematic group of patients have underlined the importance of fibrosis secondary to wide dissection of abdominoplasty. Sometimes creation of a pneumoperitoneum can be impossible because of the thickened abdominal wall [ 3 ]. Among laparoscopic colorectal surgery patients who had previously undergone abdominoplasty surgery, the main technical problem was found to be the loss of abdominal wall compliance.…”

Section: Discussionmentioning

confidence: 99%

Difficulties of Bariatric Surgery after Abdominoplasty

Karıp

Altun

İşcan

et al. 2014

Case Reports in Surgery

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During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically.

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