Risk of pneumoperitoneum in obese: Old myths and new realities

Abstract

Objective: To provide an overview of difficulties encountered during laparoscopic entries in obese patients and the contemporary methods used to establish the safest possible laparoscopic entry in obese. Methods: Twenty-six articles related to laparoscopy procedures, in general, and associated difficulties in obese patient, in particular, were examined. Results: Obesity imposes a challenge for the minimal access surgery procedures; particularly those related to the primary access of peritoneal cavity. However, closed and open peritoneal entry using blunt or optical instruments, through different sites, have been used to prevent entry failures or possible complications if difficulties are encountered whenever the surgeon cannot safely use his/her preferred entry procedure. Conclusion: Induction of pneumoperitoneum can be a difficult, time-consuming and occasionally hazardous task in a morbidly obese patient. Different alternatives are possible according to differences in the method of entry, the site or the instruments used. The riskbenefit and the alternative options must be examined individually by the healthcare provider. © Jaypee Brothers Medical Publishers (P) Ltd.