European Journal of Biomedical and Pharmaceutical Sciences

BEST APPROACH IN CREATING PNEUMOPERITONIUM FOR BARIATRIC SURGERY. CLOSED VERSUS OPEN WHICH IS SUPERIOR?

Mohammad Atrooz MD*, Ashraf Al-tamimi MD, Alaa Albadaina MD, Husam Frihat MD, Zaid Al-Rawabdeh MD, Mohammad Ahuniti MD, Ramadan Hassanat MD and Yousef Alsardia MD

ABSTRACT

Introduction: Establishing pneumoperitoneum is a critical step in laparoscopic bariatric surgery and is achieved through either the open (Hasson) or closed Veress needle techniques. Despite their widespread use, comparative data on their safety profiles in bariatric surgery remain limited. Methods: A retrospective comparative study was conducted at King Hussein Medical Hospital, involving 280 patients who underwent laparoscopic bariatric surgery between June 2022 and May 2024. Patients were divided into Group A (open technique, n=120) and Group B (closed Veress needle technique, n=160). Data on demographics, surgical methods, and complications were collected and analyzed using appropriate statistical tests. Then we observe the complications during surgery and shortly after surgery. The comparison between two groups focused on complications like bleeding, viscous injury and postop port site hernia, by transferring patients to radiological department to rollout port site hernia and to CT scan abdomen to rollout bowel injury in case of closed method. Open technique underwent by open skin and abdominal layer by layer after that insertion of trocher 10mm to insufflate the abdominal cavity, while closed technique performed through 2mm small incision in the left upper quadrant and verres needle inserted carefully till penetrating peritoneum after that the abdomen insufflated by low flow CO2 gas. Results: The overall complication rate was low (1.9%). Group A had no intraoperative complications, while Group B reported 1.9% intraoperative complications, including bleeding (0.6%) and viscus injury (1.3%). Postoperative trocar site hernia occurred in one patient (0.8%) in Group A, with no postoperative complications in Group B. No significant differences were observed in demographic or clinical characteristics between groups. Conclusion: Both techniques demonstrated excellent safety profiles with low complication rates. The open technique was free from intraoperative complications, while minor complications in the closed Veress needle group were effectively managed.

Keywords: Pneumoperitoneum, Bariatric Surgery, Open Technique (Hasson), Closed Technique (Veress needle), Complications.