|Discussion in 'All Categories' started by mary flynn - Jan 17th, 2012 8:10 pm.|
|I had a hysterctomy 5 years ago. They did not take my cervix. My cervix is fine but i am very uncomfortable. I am having a Laparascopic adhesiolysis. They cannot go through my naval as my scar was from there to the bottom of my stomach. They will go through under my rib cage have been advised it could rupture my bowel. I am worried about this but i just want the discomfort to end.|
re: internal pain in the abdomen by Dr M.K. Gupta - Jan 22nd, 2012 3:25 am
Dr M.K. Gupta
Your surgeon decided to enter with telescope inside your abdome through palmer's point and this is very good. Alternate entry sites are thought when umbilical placement of a Veress or Primary trocar is deemed risky, for example in patients recognized to have umbilical adhesions. Palmer's point, located 3cm underneath the left costal margin at mid clavicular line is a popular safe alternative. A stomach tube is first inserted to prevent inadvertent gastric injury. Surgeons should be particularly careful in patients with portal hypertension, gastric/pancreatic masses, splenomegaly or previous left upper abdominal surgery. In high-risk patients, an initial parietal umbilical inspection is possible with the EndoTIP visual cannula, Optical Veress micro-laparoscope, or any other optically guided trocars.
Peritoneal adhesions are mapped and extra ports inserted accordingly. Successful peritoneal entry on first Veress passage through conventional sites does not exclude chance of umbilical adhesions or subsequent bowel injury upon insertion of a conventional trocars. Incidence of umbilical adhesion is under 0.03 %, however, it may be up to 68% in patients with previous laparotomy, especially in those in which a midline surgical scars extends to the umbilical region.
Patients with known peritoneal adhesions, individuals with a history of more that certain previous laparoscopy, the morbidly obese, individuals with history of previous failed laparoscopy or insufflation and others with special circumstances may be candidates for alternate entry techniques, with specialized laparoscopic visual entry instruments.
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