The method to ensure the safety of the approach of laparoscopic surgery for the patients with previous abdominal operation
[Abstract]Object: To introduce a safety method of establishing pneumoperitoneum for laparoscopic surgery in the patients with previous abdominal operation by pneumoperitoneum helico-CT imaging(PHCT). Method: There were 205 patients that with previous abdominal operation for laparoscopic surgery again in our hospital from 2007 to 2011.Before laparoscopic surgery ,all the patients had established pneumoperitoneum by puncturing the abdominal wall to inject gas in the local anesthesia state. To determined whether the existence abdominal wall adhesion and the adhesion of parts、the scope and structure by the 64 row helical CT scanning for choosing the safety site of the closed-application of the laparoscopic surgery provided the technical support. Results: By PHCT before the laparoscopic surgery, 21 patients had no abdominal wall adhesion; 142 patients had the local abdominal wall adhesion of the no umbilical parts; 42 patients had the local abdominal wall adhesion around the umbilical hole. There were 131 patients which the observation port (the first port) was made at umbilicus, and 74 patients were observed the first port on the other parts of the abdominal wall. In laparoscopic surgery, the closed-application were performed confidently and all ports were placed successfully, no related complication happened. Conclusion: Adequate information about the abdominal adhesion obtained by fine needle PHCT before laparoscopic surgery for patient with previous abdominal operation is useful for success diagnosis and treatment step by step. The neumoperitoneal approach can safely achieved by conventional blind puncture with veress needle or trocar directly.