A virgin belly is the best starting place for surgery. After a belly has been opened adhesions (scar like tissue) can develop and cause varying degrees of complications/difficulty during any additional surgery. The time and skill required to take these adhesions down before you can start taking care of the objective at hand can be quite extensive. This is a recognized cause for undesirable morbidity. Another thing to consider is that unlike the consumers on this site, it is amazing what patients don’t know about the extent of past surgeries. A patient may say that they had a bump taken out of the belly and when you open you find that the patient had an extensive colon resection. Admittedly most of the time with the quality of imaging we have available this is discovered and planned for prior to surgery, however occasionally you can open an abdomen and the anatomy is unexpectedly rearranged. Also as noted in above post various implants can be problematic depending upon the type of surgery and planned operative approach. Prior to surgery all of these things and other considerations should be discussed and documented as part of the informed consent process. There is absolutely nothing inappropriate with a surgeon aborting a planned laparoscopic procedure and converting to an open procedure. It should not be very common but I expect that most high volume surgeons taking care of a general population of patients should have this happen from time to time.
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