LAPAROSCOPIC INJURY OF ABDOMINAL-WALL BLOOD-VESSELS - A REPORT OF 3 CASES

Background: Operative laparoscopy is being used for an increasing numb er of applications. Many of these innovative techniques require the in sertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the an terior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques. Cases: Three cases are r eported in which abdominal wall blood vessels were injured during oper ative laparoscopy. Case 1 describes laceration of the inferior epigast ric artery above the pubic crest. Despite initial hemostasis with a tr ansabdominal suture ligation, postoperative blood loss necessitated tr ansfusion and reoperation to control bleeding. Case 2 describes hemato ma formation after unrecognized injury to one of the epigastric vessel s. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incis ion lateral to the umbilicus that progressed to an abscess and was tre ated with drainage, irrigation, and antibiotics.Conclusions: Choosing appropriate trocar types and insertion sites based on a thorough under standing of anterior abdominal wall anatomy may minimize the risk of v essel injury during operative laparoscopy. However, because of anatomi cal variation, strategies for managing vessel injuries and their seque lae are also necessary.