The role of microlaparoscopy for safer wall entry: incidence of umbilical adhesions according to past surgical history

Objective To determine the incidence of umbilical adhesions related to prev ious surgical history. Design A prospective single-centre study with a single operator. Setting Clinique Saint-Sernin and Polyclinique de Bordeaux, Bordeaux, Franc e. Subjects 900 patients undergoing diagnostic or operative laparoscopy, class ified into four groups: group I, 419 patients with no previous surgical sur gery (control group); group II, 140 patients with previous major operative laparoscopy; group III 145 patients with previous laparotomy with a horizon tal suprapubic incision; group IV, 96 patients with a previous laparotomy w ith a midline incision. Intervention Inspection of the umbilical area for the presence of adhesions , with a microlaparoscope passed through a Veress needle at Palmer's point. Main outcome measures Incidence and severity of umbilical adhesions and the ir potential risk in case of blind insertion of the umbilical trocar. Results Umbilical adhesions were noticed in 9.77% of the 900 patients. The incidence was different in the four groups: group I, 0.77%; group II, 1.42% ; group III, 21.37%; group IV, 53.12%. Severe adhesions, with a potential r isk in case of blind insertion of the umbilical trocar, were encountered in 0.38%, 0.71%, 6.89% and 31.25%, respectively, in the patients in the four groups. Conclusions Women with previous laparotomy have a higher incidence of umbil ical adhesions, especially in the case of midline incisions. Preliminary in spection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended in these high risk pa tients, in order to reduce complications of trocar insertion.