Open versus closed laparoscopy entry--which are the evidences?

Abstract

Background/aims: Closed entry technique using the Veress needle is currently most commonly used and is reported to be associated with a high rate of complications. The open entry technique, requiring tissue preparation prior to insertion of the first trocar, is less popular despite being regarded as safer. The aim of the study was to objectively compare the two techniques with regard to the risk of complications when introducing the pneumoperitoneum. The evaluation was based on Evidence Based Medicine (EBM) criteria.

Methodology: Data were obtained from the Medline database, sources of Silesian University of Medicine and directly from the Google website at Internet.

Results: Thirty-one studies were accepted for inclusion. Open approach was found to be the safest in 17 studies (54.84%) and closed approach in 3 only (9.68%). It is noteworthy that none of the 20 studies showing a clearcut advantage of either of the two techniques was in the grade A recommendation category.

Conclusion: Our literature survey identified the open technique for laparoscopy entry associated with less surgical complications than the closed one. The finding was, however, supported mainly by studies not reaching EBM criteria with the highest level of scientific evidence. Therefore, further randomized studies of sufficient statistical power are needed.