Jacobs Volker R, Morrison John E, Paepke Stefan, Kiechle Marion
Frauenklinik, Department of Obstetrics and Gynecology, Technical University, Ismaninger Strasse 22, 81675 Munich, Germany.
J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):537-41. doi: 10.1016/s1074-3804(05)60089-8.
Piercing is an increasingly popular fashion trend mainly among adolescents. Umbilical piercing in particular can cause perioperative problems during laparoscopic procedures. We describe how to deal with this fashion trend in our institutions. First, any piercing needs to be documented during preoperative physical examination. During preoperative informed consent, patients are told that all pierced jewelry needs to be removed, preferably by the patient before the procedure. For the operation, patients may be offered the use of sterile "sleepers," which are substitutes made of plastic to avoid closure of the wound canal perioperatively. Postoperatively, most pierced jewelry can be put back into position after anesthesia has completely worn off. Only jewelry for piercings close to wounds (e. g., navel piercings) should not be reinserted until the skin is closed. Careful observation and increased hygienic effort to prevent local infection is necessary. To date, we have not seen any severe umbilical infection after laparoscopy. However, in several patients the umbilical pierced jewelry was back in the navel on the same day of surgery, sometimes immediately after waking from anesthesia. Hospital staff should know how to remove and substitute piercing jewelry as well as how to optimize hygienic care perioperatively to prevent umbilical wound infections. Time and effort for patient teaching and hygienic care are slightly increased.
穿孔是一种越来越流行的时尚潮流，主要在青少年中盛行。特别是脐部穿孔，在腹腔镜手术过程中可能会引发围手术期问题。我们描述了在我们机构中如何应对这种时尚潮流。首先，任何穿孔都需要在术前体格检查时记录下来。在术前知情同意过程中，要告知患者所有穿孔饰品都需要取下，最好在手术前由患者自行取下。对于手术，可为患者提供无菌“耳钉”使用，这是由塑料制成的替代品，以避免围手术期伤口通道闭合。术后，大多数穿孔饰品可在麻醉完全消退后重新佩戴。只有靠近伤口的穿孔饰品（如肚脐穿孔饰品）在皮肤闭合前不应重新插入。需要仔细观察并加强卫生措施以预防局部感染。迄今为止，我们在腹腔镜手术后尚未见到任何严重的脐部感染情况。然而，在几名患者中，脐部穿孔饰品在手术当天就重新戴回了肚脐，有时甚至在麻醉苏醒后立即就戴上了。医院工作人员应知道如何取下和替换穿孔饰品，以及如何在围手术期优化卫生护理以预防脐部伤口感染。用于患者教育和卫生护理的时间和精力会稍有增加。
