Comparison of the Incidence of Complications among the Different Techniques of Laparoscopic Approach: Experience in a General Surgery Service in a Private Hospital

Abstract

Introduction: At least four techniques or approaches to minimize the risk of injury have been introduced. The correlation between techniques and the complication rate is controversial. The objective of the study is to report the incidence of laparoscopic entry associated injury, in relation to the used technique. Material and Methods: A retrospective study was conducted at the Hospital Espa? ol, in a 12-month period (2013). The medical records of all patients who underwent laparoscopic surgery were reviewed. Demographic and surgical variables were analyzed, comparing the results statistically through an analysis of variance (ANOVA). Results: A total of 792 cases were analyzed. The surgeries performed were: cholecystectomies (42%), appendectomies (26%), diagnostic laparoscopies (20%), ventral or inguinal hernioplasty (9%) and fundoplications (3%). The preferred approach was Hasson’s (79%) and Veres’s needle technique (14%), followed by classic closed (14%) and Palmer technique (2%). We documented six cases of laparoscopic entry associated injury (0.76%), four associated with the Hasson technique, one with Veress’s needle technique and one with direct approach technique were reported. The statistical analysis was performed considering the different techniques and their relation with the injuries. Analysis of variance did not reach statistical significance (p = 0.31). Conclusions: Among our data, the number of laparoscopic entry associated injuries, was less than 1%, and has a similar frequency to the reported literature. We did not find significant differences between the four laparoscopic entry techniques. There remains no clear evidence as to the optimal form of laparoscopic entry in the low-risk patient.