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VOLUME 4 , ISSUE 2 ( May-August, 2011 ) > List of Articles

REVIEW ARTICLE

Risk of Pneumoperitoneum in Obese: Old Myths and New Realities

Anaam Majeed Hasson

Citation Information : Hasson AM. Risk of Pneumoperitoneum in Obese: Old Myths and New Realities. World J Lap Surg 2011; 4 (2):97-102.

DOI: 10.5005/jp-journals-10007-1124

Published Online: 01-08-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective

To provide an overview of difficulties encountered during laparoscopic entries in obese patients and the contemporary methods used to establish the safest possible laparoscopic entry in obese.

Methods

Twenty-six articles related to laparoscopy procedures, in general, and associated difficulties in obese patient, in particular, were examined.

Results

Obesity imposes a challenge for the minimal access surgery procedures; particularly those related to the primary access of peritoneal cavity. However, closed and open peritoneal entry using blunt or optical instruments, through different sites, have been used to prevent entry failures or possible complications if difficulties are encountered whenever the surgeon cannot safely use his/her preferred entry procedure.

Conclusion

Induction of pneumoperitoneum can be a difficult, time-consuming and occasionally hazardous task in a morbidly obese patient. Different alternatives are possible according to differences in the method of entry, the site or the instruments used. The riskbenefit and the alternative options must be examined individually by the healthcare provider.


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  1. cdc.gov/obesity/defining.html).
  2. The physiologic effects of pneumoperitoneum in the morbidly obese. Annals of Surgery Feb 2005;241 (2).
  3. Textbook of practical laparoscopic surgery (2nd revised ed), McGraw-Hill Education-Europe 2010.
  4. Total laparoscopic hysterectomy in obese versus nonobese patients. Obstetrics and Gynecology April 2004;103(4):674-80.
  5. Abdominal access techniques used in laparoscopic surgery. http://www.uptodate.com/contents/abdominal-access-techniques-used-in-laparoscopic-surgery, 2010.
  6. Minimal access surgery and the future of interventional laparoscopy. Am J Surg 1991;161:404-07.
  7. Difficulties in laparoscopic access. In: Al-Kandari AM, Gill IS (Eds). Difficult conditions in laparoscopic urologic surgery, © Springer-Verlag London Limited 2011.
  8. Risks of the minimal access approach for laparoscopic surgery: Multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997;21:529-33.
  9. (OBG net, April 2003) Safety of laparoscopy in obese infertile women (http://www.obgyn.net/hysteroscopy/articles/el-tabbakh-lapobese.htm).
  10. Gynecologic laparoscopy. (http://emedicine.medscape.com/article/265201-overview).
  11. Non-umbilical entry sites for gynecologic laparoscopy. Epharmapedia (http://www.epharmapedia.com/news/details/11/52/Non Umbilical_ Entry_ Sites_for_Gynecologic_Laparoscopy.html?lang=en).
  12. org/sites/attachment.php?id=469)
  13. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: A systematic literature review. Surg Endosc http://(www.cirurgiaonline.med.br/METAsurgendosc.pdf).
  14. Laparoscopic access and instrument ergonomics (http://www.aagl.org/content/PDF/P1BrillB.pdf).
  15. Laparoscopic entry: A review of techniques, technologies, and complications (http://www.sogc.org/guidelines/documents/193E-CPG-May2007.pdf).
  16. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Vol 8, No 2, Winter 2006 (http://www.ranzcog.edu.au/publications/o-g_pdfs/OGWinter-2006/laparoscopic-surgery.pdf).
  17. Induction of pneumoperitoneum in morbidly obese patients. Obes Surg Aug 2003;13(4):601-04;discussion 604.
  18. Complications associated with optical access laparoscopic trocars, obstetrics and gynecology: April 2002;99(4):553-55 (http://journals.lww.com/greenjournal/Fulltext/2002/04000/Nicotine_Patches_for_Pregnant_Smokers__A.7.aspx).
  19. Laparoscopy in the massively obese female. Obstet Gynecol 1987;69:423-24.
  20. Access problems in laparoscopic cholecystectomy: Postoperative adhesions, obesity, and liver disorders. Semin Laparosc Surg 1998;5:92-106.
  21. Complications of laparoscopy: An inquiry about closed-versus open-entry technique. Am J Obsetet Gynecol 2004;190:634-38.
  22. Serious trocar accidents in laparoscopic surgery: A French survey of 103,852 operations. Surg Endosc 1996;6:367-70.
  23. How much gas is required for initial insufflation at laparoscopy? Gynaecol Endosc 1999;8:369-74Wiley online library.
  24. Transuterine insertion of Veress needle in laparoscopy. Obstet Gynecol Mar 1990;75(3 Pt1):456-57.
  25. Safe and effective laparoscopic entry technique in the obese woman undergoing gynaecological laparoscopic surgery—a systematic review (http://www.rcn.org.uk/_data/assets/pdf_file/0006/318777/2010_RCN_research_2.2.2.pdf).
  26. Veress needle related complications in laparoscopic surgery: Our experience APMC January-June 2010;4 (1).
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