Kosuta Marco, Palmisano Silvia, Piccinni Giuseppe, Guerrini Jacopo, Giuricin Michela, Nagliati Carlo, Casagranda Biagio, de Manzini Nicolò
*General Surgery Department, University of Trieste, Trieste, Province of Trieste †Department of Biological Sciences and Human Oncology, Section of General and Oncologic Surgery, University Medical School of Bari, Policlinico, Bari, Italy.
Surg Laparosc Endosc Percutan Tech. 2014 Feb;24(1):e1-4. doi: 10.1097/SLE.0b013e31828f6cfd.
Creating the pneumoperitoneum is the first surgical procedure in laparoscopic abdominal surgery. Morbid obesity is a risk factor for iatrogenic injuries because of the considerable thickness of the abdominal wall. The aim of this study was to assess the feasibility and the incidence of complications when using Veress needles (VN) in obese patients undergoing bariatric surgery.
Between March 2004 and December 2010, a retrospective analysis was performed on 139 obese patients (mean body mass index=45.94 kg/m). Blind VN insertion followed by optical trocar insertion was the most widely used technique.
Of the 139 patients, VN was successfully used in 138 cases (99.28%), and in 1 patient the procedure failed and an open laparoscopy was performed (0.72%). During the study period, there were 63 gastric bypasses, 18 sleeve gastrectomies, 50 gastric bandings, and 8 reoperations. The VN was inserted in the left upper quadrant in 46 cases and in the midline above the umbilicus in 93 cases. A colonic perforation after VN insertion at the left upper quadrant occurred. The overall rate of complications was 0.72%. There were no access-related complications when VN was inserted above the umbilicus; complication rate was 2.17% at upper left quadrant VN placement. No cases of subcutaneous emphysema or extraperitoneal insufflation were observed.
In our experience, the success rate was 98.28% and the overall rate of complications was 0.72%. The VN technique can be considered feasible and safe even when used in obese population.
建立气腹是腹腔镜腹部手术的第一步。病态肥胖是医源性损伤的一个危险因素，因为腹壁相当厚。本研究的目的是评估在接受减肥手术的肥胖患者中使用韦雷氏针（VN）的可行性和并发症发生率。
2004年3月至2010年12月，对139例肥胖患者（平均体重指数=45.94kg/m）进行回顾性分析。最常用的技术是先盲目插入VN，然后插入光学套管针。
139例患者中，138例（99.28%）成功使用了VN，1例手术失败，改行开放式腹腔镜手术（0.72%）。研究期间，进行了63例胃旁路手术、18例袖状胃切除术、50例胃束带术和8例再次手术。VN插入左上方象限46例，脐上中线93例。在左上方象限插入VN后发生结肠穿孔。并发症总发生率为0.72%。在脐上插入VN时无与穿刺通道相关的并发症；左上方象限插入VN时并发症发生率为2.17%。未观察到皮下气肿或腹膜外充气的病例。
根据我们的经验，成功率为98.28%，并发症总发生率为0.72%。即使在肥胖人群中使用，VN技术也可被认为是可行和安全的。
