Repair of Laparoscopic Injury to Abdominal Wall Arteries Complicated by Cutaneous Necrosis

Operative laparoscopic techniques requiring placement of large-bore cannulas through the abdominal wall lateral to the midline result in increased numbers of injuries to abdominal wall vessels. Five cases of inferior epigastric artery hemorrhage were controlled by percutaneous transabdominal placement of polypropylene sutures, allowing the procedure to be completed with the cannula in place. In two patients the sutures were left in place for 72 to 96 hours, and cutaneous necrosis occurred requiring debridement and delayed primary closure. In the other three women, removal of the sutures less than 24 hours postoperatively resulted in satisfactory hemostasis and primary healing of the abdominal wound. Percutaneous placement of polypropylene sutures may provide effective hemostasis after inferior epigastric artery hemorrhage due to cannula injury. Early suture removal may avoid potential cutaneous necrosis.