Page 38 - World Journal of Laparoscopic Surgery

Different Port Closure Techniques in Laparoscopy Surgery

Fig. 14M Fig. 14N
Figs 14A to N: Veress needle technique for port closure

potentially dangerous. The usual presentation involves remaining lateral ports, further ensuring that the bowel is
crampy abdominal pain with nausea and vomiting. Treatment not implicated in the repair, and that homeostasis has been
35
is by reduction of the bowel that is incarcerated, followed achieved, at the end the perfiction of the clouser technique
by repair of the fascial defect. Although some authors have proliferated and improvements are continuously being
advocate open repair or local exploration combined with made. Practising surgeon should be congnisant of the full
laparoscopy, the laparoscopic approach is acceptable range of techniques while familiarizing themselves with the
treatment at the time of diagnosis, as long as the incarcerated useful ones deemed simple, safe and effective. 36
30
bowel is not compromised or frankly ischemic. The The comparisons among these techniques are beyond the
following risk factors for the development of trocar-site aim of this illustrative review, applying a tighter closure of the
hernias have been identified: The trocar diameter, the trocar skin incision may control the leak of the ascetic fluid in patient
design, pre-existing fascial defects, and some operation and with ascitis, but for a short-time. The tight closure of fascia will
11
6
patient-related factors. Many authors believe that prevent ascitic fluid leak. For closure of the skin, transcutaneous
inserting the 10 mm lateral trocar in an oblique fashion or as closure with absorbable material seems to be the most suitable
a Z-tract will reduce hernia formation by putting the external technique. 37
and internal fascias at different levels, 8-31 so It is
recommended that all 10 and 12 mm trocar must be closed. REFERENCES
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Technology today July-sept 2003;10:3.
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especially in children. Some authors insist that all 3. Earle DB. A simple and inexpensive technique for closing trocar
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mm, should be closed at the fascial level in infants. 1999;9:81-85.
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Kulacoglu, Reardon et al, and Nezhat et al agree that 4. Brody F, Rehm J, Ponsky J, Holzman M. A reliable and efficient
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World Journal of Laparoscopic Surgery, September-December 2009;2(3):29-38 37