Mapping of the Deep Epigastric Vessels Stratified by Body Mass Index (BMI).

Abstract

Objective: To investigate the positioning of deep epigastric vessels in obese patients to determine the need to redefine laparoscopic port placement 'safe zones' based on body habitus.

Design: Retrospective case series.

Setting: University-affiliated 500-bed hospital.

Participants: One hundred ninety-four male and female subjects who underwent abdominal and pelvic computed tomography (CT) scans with contrast, stratified by body mass index (BMI) per World Health Organization (WHO) criteria. Patients < 18 years of age and those with conditions potentially altering epigastric vessel locations were excluded.

Interventions: N/A RESULTS: The location of the right and left deep epigastric vessels from the midline at the umbilicus were mapped at 5 levels using CT images with contrast: the xiphoid, midway (M1) between the xiphoid and anterior superior iliac spine (ASIS), the ASIS, midway (M2) between the ASIS and pubic symphysis (PS), and at the PS. Key demographics showed a mean age of 50.2 ± 18.8 with a mean BMI of 30.4 ± 8.6. The mean distance of the deep epigastric vessels from the midline increased significantly at every level when categorized by BMI group. Distances exceeded 8cm at the M1 and ASIS levels for BMI>35 and >40 categories, with values up to 11.3cm in the BMI>40 category. Regression analyses showed a significant positive correlation between BMI and the distance to the midline at all levels except the PS.

Conclusion: The mean distance from the midline to the deep epigastric vessels increases with increasing BMI, indicating lateral displacement of the vessels in obese patients. Our findings suggest positioning ports more than 10cm from the midline in patients with BMI>35 to minimize injury risks. Previously established safe zone mappings of deep epigastric vessels are more applicable to patients with a BMI<35 and can increase the risk of vessel injury in patients with a BMI>35.