The Comparative Study of Intra-peritoneal Access by Open Versus Closed Method to Create Pneumoperitoneum in Laparoscopic Surgery

Abstract

Background: Laparoscopic surgery has become an integral part of modern surgical practice and critical step is the safe establishment of pneumoperitoneum. The two commonly employed techniques for intraperitoneal access are the closed method using a Veress needle and the open (Hasson) method however there remains a lack of consensus regarding the safer and more efficient method for creating pneumoperitoneum

Aims: This study compare intraperitoneal access by closed versus open methods in laparoscopic abdominal surgeries with respect to efficacy, access time and access-related intraoperative and postoperative complications.

Methods and Material: Total of 74 patients undergoing elective laparoscopic abdominal surgeries  and divided into two groups based on the technique used for pneumoperitoneum creation. Parameters assessed included time required for access and creation  of pneumoperitoneum , number of attempts, intraoperative complications, postoperative pain using the Visual Analogue Scale (VAS) and postoperative access-related complications. Statistical analysis used:  All collected data were entered and analysed using Microsoft Excel. Categorical variables were presented as frequencies and percentages.

Results: The open method demonstrated a comparable efficacy to the closed method in establishing pneumoperitoneum. The time required for access and creation of pneumoperitoneum showed no clinically significant difference between the two groups. Access-related complications were fewer in the open method, while postoperative pain scores and minor complications were comparable between both techniques. No major vascular or visceral injuries were observed in either group.

Conclusions: Both open and closed methods are effective and safe for creating pneumoperitoneum. The open (Hasson) technique may offer a safety advantage, particularly in those with previous abdominal surgeries or altered anatomy. The choice of technique should be individualized based on patient factors and surgeon expertise.