Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion

Objective: To determine the frequency of peritoneal and visceral adhesions to the umbilical region according to past surgical history and to estimate the risk of bowel injury with blind insertion of the principal trocar-cannu la. Design: Prospective, unicentric study by a single operator. Setting: Clinique Saint-Sernin and Polyclinique de Bordeaux, Bordeaux, Fran ce. Patient(s): Eight hundred fourteen patients undergoing diagnostic or operat ive laparoscopy were classified into four groups based on their history of abdominal surgery: group I (n = 469), no previous abdominal surgery; group II (n = 125), prior laparoscopic surgery; group III (n = 131), previous lap arotomy with a horizontal supra-pubic incision; group IV (n = 89), previous laparotomy with a midline incision. Intervention(s): Initial microlaparoscopy performed through the left upper quadrant of the abdomen, inspection of the anterior abdominal wall and part icularly the umbilical area for the presence of adhesions. Patients who had adhesions were assessed as to whether or not they were at significant risk of injury from blind insertion of the principal trocar. Main Outcome Measure(s): Incidence of umbilical adhesions and the potential risk of bowel injury with blind insertion of the umbilical (principal) tro car. Result(s): Umbilical adhesions were found in 9.82% of the 814 cases. The ra tes of umbilical adhesions were as follows: group I, 0.68%; group II, 1.6%; group III, 19.8%; and group IV, 51.7%. Severe adhesions with potential ris k of bowel injury with blind insertion of the umbilical trocar in the four groups were 0.42%, 0.80%, 6.87%, and 31.46%, respectively. Conclusion(s): Women with previous laparotomy have a higher incidence of um bilical adhesions, especially in case of midline incision. Preliminary insp ection of the umbilical area with a microlaparoscope and insertion of the u mbilical trocar under direct vision are recommended for patients at risk fo r adhesions to reduce complications associated with insertion of the princi pal (umbilical) trocar. (C) 2000 by American Society for Reproductive Medic ine.