Page 4 - WJOLS - Laparoscopic Journal

Muzzafar Zaman et al
and opening of the peritoneum under direct vision, and MATERIALS AND METHODS
direct trocar insertion. After reviewing the two methods The study was carried out in the Department of General
available and surveying the existing data concerning the Surgery, MMIMSR Medical College and Hospital,
rates of failure and complications, we conclude that no Ambala, Haryana from August 2013 to December 2015.
single technique can claim to be overwhelmingly supe-
rior, and that laparoscopic surgeons should, therefore, INCLUSION CRITERIA
acquaint themselves with both of these two techniques.
The umbilical port (10 mm) is also known as primary • Cholelithiasis (uncomplicated)
port, through which laparoscope is introduced. The • Age 18 to 70 years
majority of visceral or vessel injury is due to entry of • No history of previous laparotomy
primary umbilical port. 1 • Normal umbilicus.
The open technique was first described by Hasson
in 1970. This technique consists of creating a small EXCLUSION CRITERIA
umbilical incision under direct visualization to enter • Age < 18 and > 80
the abdominal cavity followed by the introduction • Pregnancy
of a blunt trocar. Pneumoperitoneum is then rapidly • Past history of laparotomy
created. Hasson proposed its potential benefits to be • Umbilical hernia or granuloma/abscess
the avoidance of blind insertion of the Veress needle • Severe systemic illnesses.
and bladed trocar, prevention of visceral and vascular
injuries, preperitoneal insufflation and gas embolism, OBSERVATION AND RESULTS
guaranteed pneumoperitoneum, and a more anatomical
repair of the abdominal wall. 2 The study was conducted at MMIMSR Medical College
Under usual circumstances, the Veress needle is and Hospital, Ambala, Haryana. A total of 200 patients
inserted in the umbilical area, in the midsagittal plane, were studied out of which 170 underwent laparoscopic,
with or without stabilizing or lifting the anterior 20 laparoscopic hernia repair and 10 laparoscopic
abdominal wall. In patients known or suspected to have appendectomy (Table 1). All the patients underwent
periumbi lical adhesions, or after failure to establish laparoscopic procedures were divided into two groups
pneumoperitoneum after three attempts, alternative sites A and B. In group A, pneumoperitoneum was created
for Veress needle insertion may be sought. 3 using closed technique and in group B it was created
Both of these techniques are associated with vascular using open technique. The two groups had different
as well as visceral injury, but extensive literature reviews parameters regarding time of consumption of entry
have not proved the superiority of one technique to the technique for pneumoperitoneum, safety of viscera
others, largely due to the lack of large, randomized, vessels and bladder, air leakage, port site hernia and
controlled trial data. Today, some 30 years on, the failure of both techniques in two groups (Tables 2 and 3).
debate continues as to which method is the safest to use.
Various unreliable available body of facts indicates that DISCUSSION
the younger generation of General surgeons prefer the Minimal access surgery has become the method of choice
open technique. 4-6 for management of symptomatic and uncomplicated
gallbladder stones, appendectomies and hernia repair
AIMS AND OBJECTIVES
Table 1: Type of procedure carried out in two groups
The aim of the study is to see the difference between open Group A Group B
and closed methods of creation of pneumoperitoneum Procedure (n = 100) (n = 100)
for performing any laparoscopic procedure in terms of Laparoscopic cholecystectomy 85 85
operating time, safety, failure of technique and time for Laparoscopic appendectomy 5 5
creation of pneumoperitoneum. Laparoscopic hernia repair 10 10

Table 2: Time analysis in two groups
Variable Group A Group B
p-value Range Mean SD Range Mean SD
Time required to induce pneumoperitoneum 0.044 6–17 9.17 ± 2.86 6–10 8.11 ± 1.02
Total operating time 0.005 55–130 78.34 ± 21.59 45–110 67 ± 15.11
Hospital stay 0.034 36–72 49.71 ± 8.30 36–56 45.1 ± 6.76
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