A prospective one year comparative study of complications in laparoscopic surgeries in creation of pneumoperitoneum by verees needle(closed) versus hasson’s(open) technique”, in kle’s dr. Prabhakar kore charitable hospital, belagavi-590010:- a randomized controlled trial

Abstract

Background One of the challenges in laparoscopy is access into the abdomen, specifically insertion of surgical instruments through small incisions.In most cases major complications occur during insertion of primary umbilical trocar prior to commencement of intended surgery (about 50%).Finding a safe entry technique is a priority for the life of the patients. Two most commonly used techniques to create pneumoperitoneum is Closed (Verees needle) technique and Open (Hasson’s) technique. Objective: Primary-To evaluate safety, efficacy of two laparoscopic entry techniques Closed (Verees needle) and Open (Hasson’s) techniques, their associated complications. Secondary-Assess the access time to establish pneumoperitoneum by techniques. Materials and Method: It is a randomized controlled trial, done in patients undergoing any laparoscopic surgeries in department of general surgery at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehrunagar, Belagavi, between Jan 2014 to Dec 2014, with age group ≥16 years and ≤65 year’s patients and those with previous history of abdomen surgery included. The patients were randomized into two study groups. In group A, Verees needle was used, in group B Hasson’s cannula or 10mm trocar without blade was used. Variables comparing the safety and efficacy of the two methods and access time were studied. Results: The time to establish pneumoperitoneum was much less in the Hasson’s cannula technique (5.28 ± 1.1 minutes) as compared to the Verees needle technique (6.02 ± 0.7 minutes, P value <0.001). Pneumoperitoneum was achieved in 128 cases except in 2 cases in closed group. In the open group, gas leakage occurred in 14 (21.53%) cases, no patient had gas leak in closed group, bowel injury occurred in 2(1.53%) patients ,one(1.5%) in each group, extra-peritoneal insufflations in 3 patients(2.30%), with 2(3.1%) in closed group & one(1.5%) in open group, 3 (2.3%) patients had need for conversion,2(3.1%) closed group and one(1.5%) in open group, failure of technique in 2(3.1%) both in closed group, port-site hematoma occurred in 2(1.53%) ,one in each group case. There were no vascular injury, subcutaneous emphysema in either of the study group and there were no perioperative mortalities. Only access time and gas leakage had significance difference with P-value < 0.001, other complication had no significant difference between both groups and were comparable. In our present study we analyzed our results comparing patients with BMI< or >25 kg/m 2 and on patients with presence or absence of previous history of abdomen surgery irrespective of techniques used. In this analysis major and minor complication were more in patients with BMI> 25Kg/m2 and with previous history of abdomen surgery, but this finding was not statistically significant. Conclusion: The study concludes that there is still controversy exists to support the superiority of one technique over the other and this view is supported by the literature. Further studies are needed in multiple centers and on larger samples for conclusive evidence.