Ilayaraja, S (2019) Comparative study of Peritoneal Access by Open Vs Closed Technique for creating Pneumoperitoneum in Laparoscopic Surgeries. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Access into the peritoneal cavity is the most important step in laparoscopic surgery. Usually there will be less complications in laparoscopic surgery but may happens during primary trocar insertion. The prime complications are intestinal or visceral injury or injury to main arteries or veins. There are two methods in access technique. 1) Closed access technique, 2) Open access technique. Closed Access technique: This is the oldest technique with Verres needle. The complications associated with this technique are injury to major blood vessels, bowel injury and preperitoneal insufflations. Open access technique: 1) Hasson technique, 2) Fielding technique, 3) Scandinavian technique. AIM OF THE STUDY: The aim of the study is to compare peritoneal access with open vs closed technique in laparoscopic surgeries in terms of outcomes and complications. OBJECTIVES: To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumo peritoneum in different surgical procedures. METHODOLOGY: This is a prospective study involving patients presenting with acute or chronic abdominal conditions like calculus cholecystitis, cholelithiasis, acute or subacute or chronic appendicitis, carcinoma rectum etc at Govt Rajaji Hospital, Madurai. In this study 50 patients underwent laparoscopic surgeries for the above said condition with open access technique and 50 cases underwent closed techniques This study is done between September 2017– August 2018. MODE OF SELECTION: 100 cases with acute or chronic abdominal conditions like cholecystitis, cholelithiasis, appendicitis, ca rectum etc without co morbidities were selected and studied in detail. A structured proforma was used to collect relevant information for each individual patient selected. Data was entered in the master chart for the analysis. Data is analysed by using unpaired ‘t’ test and ‘chi square test’. Cases were selected with the following inclusion and exclusion criteria. INCLUSION CRITERIA: Age more than 18 years in both sexes presenting with acute or chronic abdominal surgical conditions. Without co-morbidity, Consented for inclusion. EXCLUSION CRITERIA: Patients less than 18 years of age, With co-morbidity contraindicated for laparoscopy, Patient not consented. SUMMARY: Totally 100 patients were studied. All 50 patients underwent laparoscopic surgery with open access technique. Out of them, females are 72% and males 28%. In 50 patients underwent laparoscopic surgery with closed technique. Out of these, female 10 and male 40, age between 20 to 60 years. In 50 patients underwent laparoscopic surgery with open technique. Out of these, female 9 and male 41 age between 22 to 60 years. Among them, maximum 30% of patients were underwent surgery for sub acute appendicitis, calculus cholecystectomy is 15%, cholelithiasis is 11%, Acute appendicitis 9%, TB abdomen 10%, acute on chronic appendicitis is 9%, patients with previous abdominal surgery 3% and varicose is 5%. Maximum time taken for the primary trocar was only 8 minutes and minimum time was 3 minutes. Maximum time taken for entire procedure was 160 minutes and minimum time taken was 30 minutes. Out of 50 patients, none of them had intraoperative complications like Bowel injury, vascular injury, preperitoneal insufflation or gas embolism. Only one patient had minor wound infection. According to this study, open access technique is the safest technique for all patients particularly for thin individuals, suspected TB and patients with previous abdominal surgery than closed technique.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Peritoneal Access, Open Vs Closed Technique, Pneumoperitoneum, Laparoscopic Surgeries. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 03 Sep 2019 23:52 |
| Last Modified: | 06 Sep 2019 09:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11442 |
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