Jain Point: To Study the Efficacy and Safety in Previous Upper Abdominal Scars

Abstract

Study Objective To study the safety of Jain Point, the left lateral port, in previous surgery cases especially upper abdomen scars. Design All laparoscopic entries made through the Jain Point, which has already been established to be free of adhesions and data analyzed retrospectively for previous surgery cases, especially scars in upper quadrant of abdomen. Setting Tertiary care referral centre. Patients or Participants We had 8059 patients enrolled in this study from Jan 2011 to March 2021. A full decade of developing and using this point. 2345 patients had one or multiple previous surgeries out of which 106 were having upper abdomen scars. Interventions Jain Point is located is 10-13 cm left and lateral to umbilicus. In all cases, first blind entry of veress needle and 5 mm trocar was made from this point, which continued as main working port throughout the surgery. Measurements and Main Results Special emphasis in this study was on entry in patients with upper quadrant surgical scars. We took note of major intra-operative or post-operative complication. Out of 8059, 2345 patients had previous surgeries, single or multiple. 1229 patients had open surgeries and 1116 had combination of laparoscopic and open procedures. 106 patients had upper abdominal scars or extension of long vertical scars. There was no bowel injury in upper abdominal scars, only one injury noted in a transverse scar at level of umbilicus for childhood Koch's. The incidence of bowel injury at Jain point was 0.04%, 1 in 2345 cases. There were no other major complications noted. Conclusion In previous upper abdominal scars, where entry is deemed more challenging by conventional non-umbilical, upper abdomen ports, namely Lee Haung and Palmer's, our study suggests Jain Point is a safe alternative being more lateral and lower at para-umbilical position. To study the safety of Jain Point, the left lateral port, in previous surgery cases especially upper abdomen scars. All laparoscopic entries made through the Jain Point, which has already been established to be free of adhesions and data analyzed retrospectively for previous surgery cases, especially scars in upper quadrant of abdomen. Tertiary care referral centre. We had 8059 patients enrolled in this study from Jan 2011 to March 2021. A full decade of developing and using this point. 2345 patients had one or multiple previous surgeries out of which 106 were having upper abdomen scars. Jain Point is located is 10-13 cm left and lateral to umbilicus. In all cases, first blind entry of veress needle and 5 mm trocar was made from this point, which continued as main working port throughout the surgery. Special emphasis in this study was on entry in patients with upper quadrant surgical scars. We took note of major intra-operative or post-operative complication. Out of 8059, 2345 patients had previous surgeries, single or multiple. 1229 patients had open surgeries and 1116 had combination of laparoscopic and open procedures. 106 patients had upper abdominal scars or extension of long vertical scars. There was no bowel injury in upper abdominal scars, only one injury noted in a transverse scar at level of umbilicus for childhood Koch's. The incidence of bowel injury at Jain point was 0.04%, 1 in 2345 cases. There were no other major complications noted. In previous upper abdominal scars, where entry is deemed more challenging by conventional non-umbilical, upper abdomen ports, namely Lee Haung and Palmer's, our study suggests Jain Point is a safe alternative being more lateral and lower at para-umbilical position.