Closing Laparoscopy Incisions

[JohnFerguson]

In what manner do ya'll close laparoscopy incisions? I typically close the longitudinal infraumbilical incision with 0 vicryl for fascia and 4-0 vicryl for skin with a subcuticular stitch. I have seen dehiscence issues with obese patients at the inferior aspect of the incision. What have you found works well?

[andersenpa]

That suture should be fine

You can reinforce transverse to the incision w/ steri strips or staples

[quarternote]

Dependng on the size of the trocar. I've used 1 or 2 deep interrupted with 4-0 or 5-0 PDS Or Vicryl. 0 Vicryl for fascia as above. Some larger trocars I've used a running subq. I did general & bariatrics, if the patient was very large I would throw a couple of deeper interrupted just for support against the

Pressure. Now in neuro we use Vicryl. 0 for fascia, then finish with 2-0. We do several layers of interrupted. We do a microscopic discectomy that has a 3 cm incision. Hope that helps.

 

 

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[JohnFerguson]

Thank you for the responses thus far. We tend to do laparoscopy on many obese patients and therefore have made a larger infraumbilical incision than we would for an average weight patient (sometimes up to 4cm). If closing with a running subcuticular stitch, what would you find would be the best way to secure the stitch at the end/inferior aspect as it will be under great tension?

[andersenpa]

-ensure good tissue aposition with the fascial /- deep dermal

-bury knot securely at the end of the SQ

-reinforce skin w/ dermabond or steris