Open versus close pneumoperitoneum: a pursuit for safer technique

Pneumoperitoneum is a prerequisite in all laparoscopic procedures. This is a very vital step and is still a matter of concern and a subject of further evaluation. Two basic methods commonly used with some modification are closed [veress needle] and open [Hasson] techniques and none of technique has proved to be better than other. We carried out this study to compare the two techniques in terms of access related complications and time consumed during creation of pneumoperitoneum and closure of port wounds. A comparative randomized prospective study was conducted in department of surgery. 475 patients were finally evaluated, 223 were randomized for open [Hasson] while 232 for closed [veress] technique. In open technique slight modification was used by making incision at junction of umbilical stalk and linea alba, while standard veress needle technique was used in closed group. Operative and post operative complications were recorded and analyzed. Mean time required to create pnemoperitoneum was significantly less with open group [6.61 +/- 3.89 minutes] compared to closed group [8.18 +/- 3.39 minutes]. Time required to close port wounds was also significantly less with open group as compared to closed group [7.41 +/- 1.87 versus 10 +/- 2.44 minutes]. No mortality and major complication regarding vascular and solid organ injury was recorded in both groups. Failure of procedure was observed in 4 cases [1.72%] in closed group and one case [0.44%] in open group. Bowel injury was recorded in two cases in closed group however it was not significant statistically. Other minor injuries were not significant on comparing both groups. Open technique is safe and quicker. We recommend this method in all cases of laparoscopy requiring access into abdominal cavity