Body piercings remain a popular form of art and may pose risks during laparoscopic surgery, including electrical burns and local or systemic infections. Generally, all navel piercings are performed with the patient in the supine position, due to aesthetic rather than safety concerns. Body piercers in the US are not able to use anesthetic injections due to government regulations that limit their use to licensed health professionals. They also typically avoid using topical anesthetics due to safety concerns, e.g., allergic reactions, and the like. Nevertheless, other countries, such as the United Kingdom, allow body piercers to apply topical anesthetics, such as Xylocaine spray and other creams prescribed by a physician. Certain regulations still apply though. Topical anesthetics are generally discouraged for tongue piercings, and if applied, information on potential risks must be provided to the patient prior to the piercing.8
The presence of intestinal adhesions due to previously removed umbilical piercings has been reported in the past.7
However, the actual incidence of this complication or the presence of any associated symptoms remains unknown. This is of particular importance, because the umbilicus remains a favorite site for both body piercings and laparoscopic point of entry. Previous studies indicate that laparoscopic bowel injury would most likely occur during the access phase, typically in patients who have had a history of adhesions or previous laparotomies, and carries a significant morbidity rate.9,10
There are several methods to gain access to the peritoneal cavity, each offering distinct advantages and drawbacks in terms of ease of entry or safety.11,12,13,14
A thorough discussion of this topic, however, is beyond the scope of our case report. The optimal entry technique also remains unclear. In this particular patient, our decision to utilize the small-sized open technique though her previous scar was directed by the patient's wishes and her favorable abdominal wall anatomy. At the time, our team was unaware of the potential for an intestinal adhesion following the removal of body jewelry. In retrospect, choosing a separate entry site in one of the upper quadrants, utilizing our customary optical trocar entry technique, and downplaying the patient's cosmetic concerns would have been more prudent and may have avoided this complication.
Surgeons performing laparoscopy should be cognizant of complications associated with navel piercings even long after their removal. The umbilicus and the scar left from jewelry remain attractive sites for the initial entry; nevertheless, careful consideration should be given to the potential presence of lingering intestinal adhesions that, in turn, may lead to major injury and additional morbidity. Therefore, we do not recommend utilizing past surgical or body-art scars as the initial port of entry into the abdominal cavity.