| Discussion in 'All Categories' started by mohammad atieh - Mar 13th, 2016 7:22 pm. | |
mohammad atieh
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Dear sir , I did a laparoscopic ovarian cystectomy . After 1 week patient still complains of bleeding from site of trocar entry at umbilicus. I treat her with antibiotics but without improvement . Thanks |
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re: complication at trocer site entry
by Dr. Nidhi -
Apr 3rd, 2016
4:43 pm
#1
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Dr. Nidhi
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Laparoscopic techniques have revolutionized the field of surgery. Benefits include decreased postoperative pain, quicker return to normal activity, and less postoperative complications. However, unique complications are associated with gaining access to the abdomen for laparoscopic surgery. Inadvertent bowel injury or major vascular injury are uncommon but potentially life-threatening complications, usually occurring during initial access. Incidence of port site bleeding was found to be 0.7%. Most of them are associated with the placement of secondary trocars. There was no associated bleeding with port site dilatation for specimen removal. Injury to epigastric vessels can be related to carelessness during the operative procedure usually during the placement of secondary trocars which should be placed under direct vision and with prior illumination of the abdominal wall. Bleeding from the abdominal wall may not become apparent until after the port is removed because the port may tamponade muscular or subcutaneous bleeding. In addition to visually inspecting the access site upon its creation, the site should also be inspected during and following removal of the port. Bleeding points can usually be identified and managed with electrocautery. On occasion, the skin incision may need to be enlarged to control the bleeding. If persistent bleeding continues, a Foley catheter can also be inserted, inflated, and gentle traction applied to tamponade the site. Also, U-stitches can be placed into the abdominal wall under direct laparoscopic visualization using a suture passer with absorbable braided sutures. A number of specialized instruments have been devised for fascial closure at the port site and these may also be useful for managing abdominal wall bleeding. In your case it is difficult to predict which vessel was injured but the delayed bleeding may be due to internal hematoma. With regard Dr. Nidhi |
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