{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:32:46Z","timestamp":1792690366947,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Patients with prior abdominal surgeries are at higher risk of intra-peritoneal adhesions near the trocar entry site, increasing the likelihood of organ injury during laparoscopic cholecystectomy (LC). This study evaluates a novel technique where the epigastric trocar is inserted first, after creating pneumoperitoneum, to allow safe dissection of adhesions under direct vision before placing the umbilical trocar.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This prospective study included 244 patients with symptomatic uncomplicated gallstone disease and a history of previous abdominal surgeries extending to the umbilicus. Patients were randomly assigned to two groups: Group I (<jats:italic>n<\/jats:italic>\u2009=\u200998) underwent traditional umbilical trocar-first LC using the Hasson technique, while Group II (<jats:italic>n<\/jats:italic>\u2009=\u2009146) received LC using the epigastric trocar-first approach. Operative time, complications, and conversion rates were analyzed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>There was no significant difference in the demographics between both groups. The epigastric trocar-first approach significantly reduced total operative time (41.6\u2009\u00b1\u20097.7\u00a0min vs. 46.8\u2009\u00b1\u20098.8\u00a0min, <jats:italic>p<\/jats:italic>\u2009=\u20090.031) and small bowel injury rates (<jats:italic>p<\/jats:italic>\u2009=\u20090.006). Otherwise, intraoperative complications were comparable. Conversion to open surgery was lower in Group II (2.1% vs. 8.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.012). Postoperative pain at 6\u00a0h was significantly lower in Group II (<jats:italic>p<\/jats:italic>\u2009=\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The epigastric trocar-first approach, offers a safer alternative for patients with prior abdominal surgeries when undergoing LC. This approach is safe; minimizes bowel injury risk, reduces conversion rates, and enhances patient recovery. This approach may also be beneficial in other laparoscopic procedures requiring safe entry in patients with prior abdominal surgeries. Further studies are recommended to validate its broader clinical application.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00423-025-03624-9","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T10:51:29Z","timestamp":1738234289000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Safe access to laparoscopic cholecystectomy in patients with previous periumbilical incsions: new approach to avoid entry related bowel injury"],"prefix":"10.1007","volume":"410","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4951-016X","authenticated-orcid":false,"given":"Mostafa","family":"Seif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4714-7192","authenticated-orcid":false,"given":"Mohamed","family":"Mourad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0163-1707","authenticated-orcid":false,"given":"Mostafa Refaie","family":"Elkeleny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1920-6810","authenticated-orcid":false,"given":"Mohamed","family":"Wael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"3624_CR1","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1111\/j.1471-0528.1997.tb11539.x","volume":"104","author":"FW Jansen","year":"1997","unstructured":"Jansen FW, Kapiteyn K, Trimbos-Kemper T et al (1997) Complications of laparoscopy: a prospective multicentre observational study. 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Mohamed Wael, Mostafa Seif, Mohamed Mourad, and Mostafa Refaie Elkeleny wrote the manuscript\u2019s first draft. Mohamed Wael and Mostafa Seif made the necessary changes and corrections. The figures and editing were done by Mohamed Wael. The final manuscript was read and approved by all authors.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author contributions"}}],"article-number":"57"}}