Abstract
Background
Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous.
Methods
In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall.
Results
The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes® (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done.
Conclusions
We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.
Similar content being viewed by others
References
Madan AK, Menachery S (2006) Safety and efficacy of initial port-site placement in morbidly obese patients. Arch Surg 141:300–303
Kiilholma P, Makinen J (1998) Incarcerated Richter’s hernia after laparoscopy. Eur J Obstet Gynecol Reprod Biol 28:75–77
Sauer M, Jarret JC (1984) Small bowel obstruction following diagnostic laparoscopy. Fertil Steril 42:653–654
Hogdall C, Roosen JU (1987) Incarcerated hernia following laparoscopy. Acta Obstet Gynecol Scand 66:735–736
Bourke JB (1977) Small intestinal obstruction from a Richter’s hernia at the site of insertion of a laparoscope. Br Med J 26:1393–1394
Berch BR, Torquati A, Lutfi RE, Richards WO (2006) Experience with the optical access port-site for safe and rapid entry in the performance of laparoscopic gastric bypass. Surg Endosc 20:1238–1241
Sanchez-Pernaute A, Garcia Botella E, García Botella A, Rodríguez L, Antona EM, Cabeza J, Valladolid DJ, Rubio MA, Delgado I, Torres A (2008) Prophylactic closure of port-site orifices with an intraperitoneal mesh (Ventralex®) in laparoscopic bariatric surgery. Obes Surg 18:1489–1491
Loriau J, Manaouil D, Verhaeghe P (2002) Laparoscopy: incisional hernias. Ann Chir 127:252–256
Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Dumont F, Riboulot M, Delcenserie R, Regimbeau JM (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145:106–113
Ahmad G, Duffy JMN, Phillips K, Watson A (2008) Laparoscopic entry techniques. Cochrane Database Syst Rev 2:CD006583. doi:10.1002/14651858.CD006583.pub2
Disclosures
Jean Baptiste Deguines, Quentin Qassemyar, Abdennaceur Dhahri, Olivier Brehant, David Fuks, Pierre Verhaeghe, and Jean-Marc Regimbeau have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Deguines, J.B., Qassemyar, Q., Dhahri, A. et al. Technique of open laparoscopy for supramesocolic surgery in obese patients. Surg Endosc 24, 2053–2055 (2010). https://doi.org/10.1007/s00464-009-0872-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0872-x