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2008| July-September | Volume 4 | Issue 3
September 26, 2008
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Post cholecystectomy syndrome: Role of cystic duct stump and re-intervention by laparoscopic surgery
Om Tantia, Mayank Jain, Shashi Khanna, Bimalendu Sen
July-September 2008, 4(3):71-75
Laparoscopic cholecystectomy is the most common surgery performed for symptomatic gallstones. However even after surgery, symptoms may persist in some patients. Various causes for such post-cholecystectomy syndrome have been noted. We report our experience of seven such patients with post-cholecystectomy syndrome where on investigations, presence of stone in the biliary tree could be confirmed along with remnant gall-bladder. All these patients underwent completion cholecystectomy with removal of the stones by laparoscopic surgery and had good post-operative result. The patients were followed-up from three months to one year and all were asymptomatic till their last follow-up.
Laparoscopic versus open pyeloplasty: Comparison of two surgical approaches- a single centre experience of three years
Punit Bansal, Aman Gupta, Ritesh Mongha, Srinivas Narayan, AK Kundu, SC Chakraborty, RK Das, MK Bera
July-September 2008, 4(3):76-79
Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We compared laparoscopic (LP) and open pyeloplasty (OP) in a randomized prospective trial.
Materials and Methods:
A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at three months and IVP at six months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared.
Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in OP group. Compared to OP group, the post operative diclofenac requirement was significantly less in LP group (mean 107.14 mg) and OP group required mean of (682.35 mg). The duration of analgesic requirement was also significantly less in LP group. The postoperative hospital stay in LP was mean 3.14 Days (2-7 days) significantly less than the open group mean of 8.29 days (7-11 days).
LP has a minimal level of morbidity and short hospital stay compared to open approach. Although, laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
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Laparoscopic management of superior mesentric artery syndrome: A case report and review of literature
Ramesh Makam, Tulip Chamany, Vamsi Krishna Potluri, Prashanth J Varadaraju, Rajesh Murthy
July-September 2008, 4(3):80-82
Superior mesentric artery syndrome is a rare cause of high small bowel obstruction, caused by compression of the transverse part of the duodenum in between the superior mesentric artery and aorta. Patients present with chronic abdominal pain, vomiting and weight loss. We report a case of superior mesenteric artery syndrome, managed laparoscopically with laparoscopic duodenojejunostomy.
Changing role of laparoscopy in the management of patients with cirrhosis
AO Adisa, RK Mishra
July-September 2008, 4(3):63-70
Cirrhosis was previously a contraindication to laparoscopic surgery. The associated coagulation defects, portal hypertension and nutritional disorders were seen as risk factors for high morbidity and mortality. Open surgery in cirrhotic patients over the years have witnessed poor outcome. However, as experience with laparoscopic surgery continues to grow, several studies have described the use of laparoscopy for the diagnosis of cirrhosis as well as the treatment of various surgical conditions among cirrhotic patients. This article reviews the effect of laparoscopy on the cirrhotic patient and describes the increasing role of laparoscopy in management of cirrhosis as well as its proven benefits.
Laparoscopic Ladd procedure in infants: Report of three cases from a developing country
Mohammed A Youssef
July-September 2008, 4(3):83-84
Infants with intestinal malrotation present with bilious emesis and the diagnosis is generally obtained by an upper gastrointestinal barium study. Malrotation is suspected if the ligament of Treitz is not positioned to the left of the vertebral body. Three patients were admitted to our department from March 2006 to May 2007, aged three weeks,one month and eight months, weighing 3,3.200 and 8 kg respectively to whom laparoscopic Ladd's procedure was done successfully.
Irreducible inguinal hernia with appendices epiploicae in the sac
Mayank Jain, Shashi Khanna, Bimalendu Sen, Om Tantia
July-September 2008, 4(3):85-87
Inguinal hernia has a nature to surprise surgeons with its unexpected contents. Appendix epiploicae alone in the hernial sac is a rare entity and that too if hypertrophied and presenting as irreducible hernia is still more uncommon. We report a 52-year-old male with complains of irreducible inguinal mass with little pain on Left side for seven days. A diagnosis of irreducible inguinal hernia was made and the patient was treated laparoscopically by Trans-Abdominal Pre-Peritoneal Mesh Hernioplasty (TAPP). As a surprise, content of the hernial sac was enlarged / hypertrophied appendix epiploicae of sigmoid colon with appendigitis. Patient also had and incidental hernia on the other side, which was repaired in the same sitting. Postoperative recovery of the patient was excellent.
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