Effective, simple, easy procedure for laparoscopic port closure in difficult cases

Abstract

Background: Laparoscopic and rebotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial closure. Good fascial closure still represents problem, especially in difficult obese patients. This study reported simple technique is suitable in such cases.

Material and methods: We herein describe a simple technique for fascial closure after Laparoscopic surgery using percutaneous transabdominal approach by using two looped needles in 87 obese patients. This technique was done while the trocar sheath in its position.

Results: The procedure was used in 87 patients (69 females and 18 males) after laparoscopic cholecystectomy with mean body mass index 35.5 kg/m2 and mean age 47.1 years from May 2013 through June 2015. No intra-operative incidents and no port sites hernias were reported during a mean follow up of 18 months.

Conclusion: The procedure is easy to perform, safe, and effective for fascial port site closure in difficult obese (thick abdominal wall and oblique port wound) cases.

Keywords: External looped needles; Laparoscopic port site closure.

Figures

Fig. 1

Looped needle formed of Long needle (20 cm outer sheath) and metal stent (25 cm put inside the outer sheath needle) has large loop (plastic wire). The metal stent can be pushed or withdraw through the outer sheath needle to put the loop outside or inside the needle tip. On right, the metal stent removed from outer sheath needle. On left, the metal stent put inside the outer sheath needle.

Fig. 2

A: After of finish of laparoscopic procedure and the trocar sheath is in its position. The one looped needle holed the thread and passed at one side of port to appear at the peritoneal cavity. Fig. 2B: The other looped needle passed on the other side of port to appear from peritoneal cavity. The two looped needles were directed to put other thread end inside the loop of second needle and its stent was withdraw to hold the thread end inside the needle. Fig. 2C: Each thread end is holed by one looped needle. Fig. 2D: The two looped needles and thread (Vicryl No. 0) ends inside them were withdraw until the needles ends reached at the subcutaneous plane of abdominal wall. Fig. 2E: The trocar sheath at this point was removed and the plane of two needles made more horizontal with abdominal wall. Then, the two needles were pushed to appear their ends and both thread ends from the port wound. Fig. 2F: The both thread ends (Vicryl No. 0) were holed by tissue forceps and the looped needles removed by withdraw backward. Fig. 2G: The two looped needles were removed and both thread ends holed by tissue forceps outside the port wound. Fig. 2H: The suture strands were tied through the port site to produce good fascial closure, then closed the skin incision.

Fig. 3

a: The two looped needles were directed under direct vision to put the thread end from one needle to other needle, then the stent and loop withdraw to hole the thread end inside the needle. Fig. 3b: The thread ends were holed by two looped needles and withdraw until the needles tips reach at the subcutaneous plane of abdominal wall. Fig. 3c: At this point, the trocar sheath is removed and two needles end with thread ends bring to port wound.