Official publication of Rawalpindi Medical University
Comparison Between Veress Needle (Closed)Technique and Open Technique in Laparoscopic Cholecystectomy
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1.
Tariq Nawaz, Muhammad Waqas Ayub, Amjad Umair, Atif Khan, Qasim Ali , Faisal Murad, Idrees Anwar. Comparison Between Veress Needle (Closed)Technique and Open Technique in Laparoscopic Cholecystectomy. JRMC [Internet]. 2016 Jun. 30 [cited 2024 Mar. 28];20(2). Available from: http://journalrmc.com/index.php/JRMC/article/view/193

Abstract

Background: The aim of this study is to compare
open cholecystectomy with needle (closed)
technique in laparoscopic cholecystectomy in
terms of outcomes and complications.
Methods : In this comparative study patients
undergoing cholecystectomy were randomized to be
in either of the two groups. Each containing 70
patients. Inclusion criteria was, patients with age 20
to 50 years with symptomatic gall stones disease, and
without any other general contraindication for
laparoscopic surgery . All patients were diagnosed
by history ultrasound abdomen. All patients having
contraindications to laparoscopic procedure like
respiratory compromise, malignancy or any other comorbidities
were excluded from the study.Group A
constituted 70 patients and all those were
randomized for open technique while group B also
contained the same number of patients and they
were randomized for Veress needle technique. Open
technique was performed through skin incision and
then dissecting the fascia for gaining access to
abdomen by inserting trocar while the closed
technique involves direct insertion of Veress needle
into abdominal cavity for pneumoperitoneum
creation and then trocar placement. The parameters
compared were access time , gas leak, visceral injury,
vascular injury, need for conversion, umbilical port
site hematoma, umbilical port site infection,
umbilical port site hernia. Patients were assessed
after discharge at the first post operative day,
seventh day then after 2 months, 6 months, and after
1 year and last visit on 18 months for assessment of
complications.
Results: Out of 140 patients, 90 were females and
50 patients were males. Age ranged from 22 to 55
years with mean age of 40 years. The mean time
needed to create pneumoperitoneum was 4±1
minutes in veress needle technique and 5±1 in open
method (p-value = 0.000) . Gas leak was observed in
15 patients in group A where as no patient had a gas
leak in group B (p-value=0.000). Pneumoperitoneum
was achieved in all 150 cases. There was one case of
visceral injury in which ileal mesentery was
damaged while inserting trocar (p-value = 0.316). It
was managed laparoscopically. No vascular injury
was noted in both groups. Neither open nor closed
techniques were associated with conversion to open
cholecystectomy regarding access to peritoneal
cavity. Two (1,3%) patients had post operative
hematoma at the umbilical port site in group A
whereas no one developed this complication in
group B (p-value = 0.154) . Four (2.6 %) patients
presented with surgical site infection at the
umbilical trocar site(p-value=0.042). No
complications were noted in the veress needle
technique. No patient presented with umbilical port
site hernia after 18 months of follow up.
Conclusion: Both the open and closed method for
gaining access into peritoneal cavity are safe but the
veress needle method has advantage of less time
taken to enter into the abdominal cavity as compared
to open method and port site complications like port
site hematoma formation and infection are more in
open technique.

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