Abstract
<h3>Study Objective</h3> To provide clinical direction on laparoscopic abdominal entry techniques in women with known history of laparoscopic Roux-en-Y Gastric Bypass (RYGB) undergoing gynecologic surgery and to identify any associated complications. <h3>Design</h3> Retrospective Chart Review and Case Series. <h3>Setting</h3> Community-based tertiary care medical center. <h3>Patients or Participants</h3> All patients who underwent RYGB between 2013 and 2020 and had a subsequent gynecologic procedure. <h3>Interventions</h3> Abdominal access. <h3>Measurements and Main Results</h3> Thirty-one patients were identified, of which 18 had an adnexal surgery and 13 a hysterectomy. At time of surgery, the mean age was 44 years and body mass index was 32 kg/m<sup>2</sup>. The average interval time from RYGB to gynecologic surgery was 29 months. The majority of women (71%) had additional abdominal surgeries, among them 82% had prior laparotomies. Three entry sites were identified at the initial attempt to access the abdominal cavity; umbilical (71%), left upper quadrant (LUQ, 26%) and left lower quadrant (LLQ, 3%). Closed entry technique using the Veress needle was the most commonly used entry technique (68% versus 29% for optical trocar entry and 3% for open entry). There were no injuries resulting from abdominal access irrespective of the entry site or technique chosen. However, access was unsuccessful in 25% (2 out of 8) of the cases when attempted in the LUQ, resulting in conversion to alternative entry sites. <h3>Conclusion</h3> Successful and safe abdominal access in the bariatric patient can sometimes be challenging and preoperative surgical planning is essential. While no injuries during entry were reported regardless of site chosen, closed entry at the umbilicus using the Veress needle was the technique the most practiced and was associated with fewer attempts and conversions to alternative sites as compared to LUQ entry.
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