Transabdominal Sutures Research Articles

Laparoscopic percutaneous jejunostomy for long term enteral access.

Patients suffering from upper gastrointestinal pathology may require jejunal feeding for adequate nutrition. A laparoscopically guided percutaneous jejunostomy offers a minimally invasive means of obtaining such feeding access. Laparoscopic jejunostomy was performed in 32 patients. The most common indications were gastroparesis (n = 16), neurological deficits (n = 7), and proximal obstruction (n = 5). The proximal jejunum was affixed to the abdominal wall using intracorporeal and extracorporeal transabdominal sutures, allowing safe insertion of an 18-Fr Silastic dual-lumen tube. Laparoscopic jejunostomy was successfully completed for 28 patients; the procedure was converted to an open operation in four cases. Three of these four were among 14 patients undergoing the procedure who had a history of previous abdominal surgery. Major complications were observed in seven patients, including one reoperation and one death from aspiration pneumonia. Tube feeding was accomplished in all patients; progression to full enteral feeding proceeded without interruption in 20 patients. Laparoscopic jejunostomy can be performed with relative safety. Morbidity, though high, is usually related to preexisting disease. Previous abdominal surgery is not necessarily a contraindication to laparoscopic jejunostomy.

Laparoscopic injury of abdominal wall blood vessels: A report of three cases

Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques.Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics.Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.

Laparoscopic procedures for small bowel disease

Small bowel procedures such as placement of feeding jejunostomy, diagnosis of small bowel ischaemia and obstruction, bowel resection and lysis of adhesions can all be performed laparoscopically. Diagnostic laparoscopy can be performed with low complication rates, and can help avoid unnecessary laparotomy. The open method of trocar placement is preferred in patients with adhesions or distended bowel due to obstruction or ileus. Feeding jejunostomy can be placed by laparoscopically assisted methods, pulling the jejunum out or completely laparoscopically. The latter requires fixation of the jejunum to the abdominal wall by transabdominal sutures or T-fasteners. The T-fastener technique for feeding jejunostomy is simple to perform, safe and effective. Small bowel ischaemia can be difficult to diagnose laparoscopically. Fluorescein and ultrasound Doppler examination of the small bowel may be as useful as in laparotomy, but there is little clinical experience with these techniques. Laparoscopically assisted small bowel resection involves intraperitoneal division of the mesenteric vessels and exteriorization of the small bowel through a small abdominal incision, followed by resection and anastomosis. The causes of small bowel obstruction can be diagnosed laparoscopically, and adhesions can be lysed under laparoscopic guidance. The laparoscopic approach is replacing laparotomy for many small bowel procedures. Improvements in instruments and experience in laparoscopic procedures will continue to make these procedures easier and safer to perform.

Laparoscopic injury of abdominal wall blood vessels: A report of three cases

Background: Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques. Cases: Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics. Conclusions: Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.(Obstet Gynecol 1993;82:673-6)

Laparoscopic injury of abdominal wall blood vessels: A report of three cases

Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques. Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics. Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.

Trans-Abdominal Suture of the Left Ureter upon a Ureteral Sound; Healing by First Intention

Trans-Abdominal Suture of the Left Ureter upon a Ureteral Sound; Healing by First Intention