Aneurysm Needle as an Effective Tool in Laparoscopic Port Closure

Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia

Introduction

Port site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. Closure of a fascia defect at the port site is an important problem of laparoscopic surgery, especially in obese patients.

Aim

To evaluate needle grasper fascia closure.

Material and methods

We closed the port site fascia using a percutaneous organ-holding device (needle grasper) in laparoscopic cholecystectomy patients. This study included 334 patients who underwent laparoscopic cholecystectomy between January 2015 and January 2017 in our hospital. Patients were divided into 2 fascia closure groups: group 1 with a standard simple suturing technique and group 2 with a needle grasper to close the port site. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.

Results

There were 243 female and 91 male (total 334) patients with the mean age of 49.18 ±13.15 years. Only 1 patient in the BMI > 30 kg/m² group of patients had port site hernia development with the needle grasper technique at the end of the 8-month follow-up period. The port site hernia incidence was higher in group 1 than group 2 (p < 0.001), but there was no significant difference in terms of operation duration between the two groups (p < 0.001, p = 0.709, respectively). In patients with a BMI > 30 kg/m², both operation duration and port site hernia incidence were higher in simple suture closure than in the needle grasper technique (p < 0.001, p = 0.016, p = 0.005).

Conclusions

The needle grasper technique is easy, simple, safe, fast, and effective for fascia closure of port sites. This method can also be applied in obese patients easily, safely and in a short time.

Effective, simple, easy procedure for laparoscopic port closure in difficult cases

Background

Laparoscopic and rebotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial closure. Good fascial closure still represents problem, especially in difficult obese patients. This study reported simple technique is suitable in such cases.

Material and methods

We herein describe a simple technique for fascial closure after Laparoscopic surgery using percutaneous transabdominal approach by using two looped needles in 87 obese patients. This technique was done while the trocar sheath in its position.

Results

The procedure was used in 87 patients (69 females and 18 males) after laparoscopic cholecystectomy with mean body mass index 35.5 kg/m2 and mean age 47.1 years from May 2013 through June 2015. No intra-operative incidents and no port sites hernias were reported during a mean follow up of 18 months.

Conclusion

The procedure is easy to perform, safe, and effective for fascial port site closure in difficult obese (thick abdominal wall and oblique port wound) cases.

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The complete fascial closure of port site is essential for good outcome of laparoscopic surgery.

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Port site herniation is serious complication leading to loss all mini-invasive surgery advantages.

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Our technique is done under direct visualization and trocar sheath in its position.

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Our procedure is effective, easy to produce complete fascial closure at any port site type and in any case.