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   2007| July-September  | Volume 3 | Issue 3  
    Online since November 28, 2007

 
 
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ORIGINAL ARTICLES
Influence of obesity on the short-term outcome of laparoscopic colectomy for colorectal cancer
Kazuhiro Sakamoto, Shinichiro Niwa, Masanobu Tanaka, Michitoshi Goto, Hironobu Sengoku, Yuichi Tomiki
July-September 2007, 3(3):98-103
DOI:10.4103/0972-9941.37192  PMID:19789665
Purpose: Obesity has been generally associated with increased surgical risk. However, data on the outcome of laparoscopic colectomy in obese and non-obese patients are controversial. The aim of this study is to assess the short-term outcome of laparoscopic colectomy for colorectal cancer (CRC) in obese patients as compared with non-obese patients. Materials and Methods: Sixty-nine patients who underwent laparoscopic anterior resection for CRC during the past six years were retrospectively evaluated. The patients with CRC involving the sigmoid or rectosigmoid colon and subjected to intracorporeal anastomosis were included in this study. They were divided into three groups according to body mass index (BMI): obese (BMI ≥ 28.0 kg/m 2 ), pre-obese (BMI: 25.0-27.9 kg/m 2 ) and non-obese (BMI < 25.0 kg/m 2 ). Results: Nine patients (13.0 %) were obese, 11 patients (15.9%) were pre-obese and 49 patients (71.1%) were non-obese. Patient characteristics, such as age, gender, tumor location, previous laparotomy, were similar among the three groups. There were no significant differences in operative time, blood loss, intraoperative complications and conversion rates. Postoperative complications and duration of postoperative hospital stay were also similar among the three groups. However, two of the three patients in the pre-obese group had to be operated on again due to incarceration of the small bowel into a port site. Conclusions: Laparoscopic colectomy can be safely performed in obese patients with short-term results similar to those obtained in non-obese and pre-obese patients.
  12 4,506 264
REVIEW ARTICLE
Laparoscopic incisional and ventral hernia repair
Amrit Pal Singh Bedi, Tahir Bhatti, Alla Amin, Jamal Zuberi
July-September 2007, 3(3):83-90
DOI:10.4103/0972-9941.37190  PMID:19789663
Background : It has been more than a decade, since the introduction of laparoscopic management of ventral and incisional hernia. The purpose of this article was to systematically review the literature, analyze the results of Laparoscopic repair of ventral and incisional hernia and to ascertain its role. Materials and Methods: Pubmed was used for identifying the original articles. Both incisional and ventral hernia repair were included. Out of 145 articles extracted from Pubmed, 34 original studies were considered for review. More than three thousand patients were included in the review. Variables analyzed in the review were inpatient stay, defect size, mesh size, hematoma, seroma, wound infection, bowel perforation, obstruction, ileus, recurrence and pain. Qualitative analysis of the variables was carried out. Results: Seromas (5.45%) and post operative pain (2.75%) are the two common complications associated with this procedure. Recurrence rate was found to be 3.67%. Overall complication rate was 19.24%, with two deaths reported. Conclusion: The results suggest laparoscopic repair of ventral and incisional hernia as an effective procedure. Faster recovery and shorter in patient stay - makes it a feasible alternative to open repair.
  8 10,890 573
UNUSUAL CASES
Recurrent achalasia after Heller-Toupet procedure: Laparoscopic extended redo heller myotomy and floppy Dor
Vishwanath Golash
July-September 2007, 3(3):104-107
DOI:10.4103/0972-9941.37193  PMID:19789666
Recurrences of symptoms after the surgery for achalasia cardia are not uncommon. There are several causes of recurrences but the early recurrences are speculated to be secondary to incomplete myotomy and late recurrence due to fibrosis after the myotomy or megaesophagus. These recurrences can be managed by regular dilation failing which a redo surgery is indicated. Laparoscopic approach is now standard because of the obvious benefits for patients and surgeons. Extent of myotomy and addition of fundoplication are debatable issue in the management of achalasia cardia but evidence suggests that some kind of fundoplication would be necessary after the complete division of lower esophageal sphincter. We present our experience in a case of recurrent achalasia, secondary to incomplete myotomy managed laparoscopically by extended myotomy and a floppy anterior fundoplication. Patient is asymptomatic six months after the surgery and radiologically there is free passage of barium in the stomach.
  5 6,718 295
ORIGINAL ARTICLES
Endoscopic thyroidectomy: Our technique
Shailesh P Puntambekar, Reshma J Palep, Anjali M Patil, Neeraj V Rayate, Saurabh N Joshi, Geetanjali A Agarwal, Milind Joshi
July-September 2007, 3(3):91-97
DOI:10.4103/0972-9941.37191  PMID:19789664
Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure. Materials and Methods: From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided. Results : The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results. Conclusions : It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.
  3 14,248 544
UNUSUAL CASES
Laparoscopic redo fundoplication for intrathoracic migration of wrap
GS Maheshkumar, Kalpesh Jani, MV Madhankumar, C Palanivelu
July-September 2007, 3(3):111-113
DOI:10.4103/0972-9941.37195  PMID:19789668
Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.
  2 5,464 232
Left-sided gall bladder: Report of two cases
RK Chrungoo, SL Kachroo, Ashwani K Sharma, Arshad Bashir Khan, Aga Syed Nadim
July-September 2007, 3(3):108-110
DOI:10.4103/0972-9941.37194  PMID:19789667
Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD) and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.
  1 5,552 335
LETTERS TO EDITOR
Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration
Om Tantia
July-September 2007, 3(3):114-114
DOI:10.4103/0972-9941.37196  PMID:19789669
  - 2,940 206
Kurt Semm: A laparoscopic crusader
OP Sudrania
July-September 2007, 3(3):115-115
DOI:10.4103/0972-9941.37197  PMID:19789670
  - 2,935 184
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04