Emin DALDAL, Hasan DAĞMURA, Ahmet AKBAŞ, Fatih DAŞIRAN, Ertan BÜLBÜLOĞLU

Feasible first trocar insertion technique in bariatric surgery: A novel technique

Although tremendous advancements in bariatric surgery have been made, there is still no universal approach to initial abdominal access. Herein, we describe a novel technique for first trocar entry that is feasible, safe and fast to perform in morbidly obese patients undergoing laparoscopic bariatric surgery. Our aim is to describe a trocar insertion technique in bariatric surgery used as a routine in our obesity clinics and to present its results.The registries from the Tokat Gaziosmanpasa University Hospital recorded between January 2017 and January 2019 were reviewed to retrieve data on morbidly obese patients operated on by a single surgical team using the novel trocar insertion technique.A total of 244 consecutive morbidly obese patients who underwent sleeve gastrectomy and gastric bypass performed by the same surgical team with the same technique were included in this study. Among 244 patients, 224 (91.8%) underwent sleeve gastrectomy, and 20 (8.2%) underwent gastric bypass. The mean body mass index was 46.23 kg/m2 (range 31 – 80 kg/m2 ). All interventions were performed laparoscopically with no cases of conversion to open surgery. During this study, eight cases of omental (3.27%) and three cases of small bowel mesentery (1.22%) injuries were encountered in 11 different patients (4.5%) and were self-limited; no major bleeding, bowel injuries, gas emboli or deaths occurred. As a conclusion this technique for direct trocar entry in morbidly obese patients is considered to be safe since no major complications occurred, fast because no dissection or time-consuming steps were required and finally, feasible because the trocar insertion procedure is straightforward.

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