General Risks from the creation of pneumoperitoneum and possibly adhesiolysis: Injuries to vessels and hollow organs during blind insertion with the Veress needle but also with the visual trocar are possible. However, in previously operated patients, preference should be given to the visual trocar.
During adhesiolysis, thermal damage to the intestinal wall must be considered and safely excluded.
If laparoscopic visualization is not possible, immediate open surgery.
Place additional working trocars under direct vision to avoid intra-abdominal injuries.
Bleeding:
- Epigastric vessels should be noted, bleeding from the trocar insertion sites is preferably managed with U-sutures using suture aids for fascia closure.
- Bleeding from the staple line -> oversewing or clipping
- Bleeding from retroperitoneal vessels (V. cava or aorta)
- Bleeding from the omentum
- -> If laparoscopic visualization is not possible, immediate open surgery. The risk of injury to retroperitoneal vessels is increased by adhesions.
Injury to Adjacent Organs:
- Spleen: Compression, hemostatics, thermal methods, as a last resort -> splenectomy
- Liver parenchymal tears by the retractor -> Hemostasis with monopolar current, compression, hemostatics (see Medical Equipment tab)
- Injury to the pancreas -> oversewing, target drainage
- Injury to the esophagus by the large-caliber gastric tube: Endoscopic approach with endo-clips in combination with epinephrine injection.
Too Short Alimentary Limb:
Not expected due to the primarily sleeve-like pouch form, possibly retrocolic elevation.
Loop Rotation:
To avoid loop rotation (“blue loop syndrome”), the loop is brought under direct vision (mesentery facing left). If rotation occurs, it is corrected.