OPEN VERSUS CLOSED METHOD OF ESTABLISHING PNEUMOPERITONEUM FOR LAPAROSCOPIC SURGERY- A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure and associated with many complications including life threading vascular and visceral injuries. Objectives:To compare the efcacy and safety of the open (direct trocar insertion/ DTI) and closed method (veress needle) to gain access in the abdominal cavity for laparoscopic surgery. Methods: This is Prospective Observational study conducted in the department of General surgery, from April 2020 to March 2022 comprising of 100 cases, 50 cases from each methods. The patients admitted in our department for Laparoscopic surgery was taken up for the study. 100 patients of either sex were selected who undergone operative procedure for laparoscopy surgery and written informed consent, appropriate workup is done. Purposive sampling technique was used. SPSS (Version 22.0) was used for analysis. Results: Duration for pneumoperitoneum creation in open method group is shorter as compared to closed method group for pneumoperitoneum creation in laparoscopic surgery and it was statistically signicant (p<0.05). Also difculties like multiple attempts, gas leak at port site and port site bleeding are more in open method than in closed method, which is attributed to larger size of incision in open method, Furthermore, a signicant higher incidence of such minor complications is found in case of BMI >25 (p<0.05). Wound infection (clear discharge) occurred in ve cases, one in open method and four in closed method group which was statistically signicant and were treated successfully by antibiotics and dressing. Port site hernia is reported in none 3 cases on the follow up period till date but longer period of follow up is needed. Previous surgery especially laparoscopic surgery and surgery around umbilicus and their scar may cause adhesions between viscera and scar and may increases likelihood of injury during pneumoperitoneum which was more in closed method and was signicant. Conclusions: Open technique is as good as closed technique, and is good alternative to closed technique.