Objective: The creation of the pneumoperitoneum is the
first surgical procedure in laparoscopic abdominal surgery. Morbid
obesity is a risk factor for iatrogenic injuries due to the considerable
thickness of the abdominal wall. The aim of this study was
to assess the feasibility and the incidence of complications of the
use of Veress needle (VN) in obese patients undergoing bariatric
surgery.
Methods: Between March 2004 and December 2010 a nonrandomized
retrospective study was performed on 139 obese
patients (mean BMI = 45,94 kg/m2). Blind VN insertion and insufflation
followed by optical trocar insertion was the most widely
used technique.
Results: Of 139 patients, VN was successful used in 138 cases
(99,28%), in one patient the procedure failed and an open laparoscopy
was performed (0.72%). During the study period, there
were 63 gastric bypass, 18 sleeve gastrectomy, 52 gastric banding
and 8 reoperations. The VN was inserted at left upper quadrant
in 46 cases and the midline above the umbilicus in 92 cases. A
colonic perforation after VN insertion at the left upper quadrant
occurred.
The overall rate of complications was 0,72% (1/138). There
were no access related complications when VN was inserted above
the umbilicus; complications rate was 2.17% (1/46) at upper left quadrant VN placement. No cases of subcutaneous emphysema or
extraperitoneal insufflation were observed.
Conclusions: In our experience, the success rate was 98.28%
and the overall rate of complications was 0.72%. The Veress needle
technique can be considered feasible and safe even when used in obese population