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Trocar Injuries in 17,446 Laparoscopic Gastric Bypass—a Nationwide Survey from the Scandinavian Obesity Surgery Registry

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Abstract

Background

Although, the vast majority of bariatric procedures worldwide are performed laparoscopically, there is no consensus on the best technique to enter the first trocar, a potentially dangerous maneuver. Three principally different techniques exist: initial pneumoperitoneum by Verres needle, open Hasson technique, and direct placement of an optical trocar. In this nationwide survey, we have studied the presently used technique to place the first trocar and identified any intraabdominal injuries in 2012–2014.

Methods

A questionnaire concerning techniques for placing the first trocar and identified intraabdominal injuries was sent to all 41 centers performing laparoscopic Roux en-Y gastric bypass (LRYGB) in Sweden. Total number of procedures were collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), also searched for reports on intraabdominal injuries.

Results

During the present study period, 17,446 LRYGBs were performed. Twelve intraabdominal injuries (0.07 %) were found: bleedings from the omentum, small bowel mesentery and liver (n = 8), and gastric or small bowel perforation (n = 4). The injuries were evenly distributed between the Veress technique and direct placement of an optical trocar, while no injuries occurred with the Hasson technique. Concerning placement of the first trocar, initial pneumoperitoneum with Veress needle was most common (59 %), followed by direct placement of an optical trocar (30 %). This indicates a switch from 2009–2010 (Veress 45 % and optical trocar 45 %, p < 0.001).

Conclusions

Twelve intraabdominal injuries (0.07 %) were found in this nationwide survey. The most common technique for placing the first trocar had switched from directly placing an optical trocar to prior establishment of pneumoperitoneum.

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Authors and Affiliations

  1. Deparment of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Magnus Sundbom

  2. Deparment of Surgery, Örebro University Hospital, Örebro, Sweden

    Johan Ottosson

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  1. Magnus Sundbom
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  2. Johan Ottosson
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Correspondence to Magnus Sundbom.

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Compliance with Ethical Standards

The survey was approved by the regional ethical review board at Uppsala University, Sweden.

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

At baseline visit, patients give informed consent to be included in the Scandinavian Obesity Surgery Registry (SOReg).

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Sundbom, M., Ottosson, J. Trocar Injuries in 17,446 Laparoscopic Gastric Bypass—a Nationwide Survey from the Scandinavian Obesity Surgery Registry. OBES SURG 26, 2127–2130 (2016). https://doi.org/10.1007/s11695-016-2080-9

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