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   2005| January-March  | Volume 1 | Issue 1  
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Management of post cholecystectomy Mirizzi's syndrome
Simon Janes, L Berry, B Dijkstra
January-March 2005, 1(1):34-36
DOI:10.4103/0972-9941.15244  PMID:21234142
Various strategies have been proposed for the management of retained calculi within the biliary tree following cholecystectomy. We present a unique case of a cystic duct remnant calculus causing Mirizzi syndrome, only the fourth such case of its kind. An open procedure was planned, however the calculus was eventually extracted endoscopically. The pathophysiology and management of Mirizzi syndrome and retained calculi within the cystic duct remnant are discussed along with the merits of a minimally invasive approach.
  21,818 488 5
Laparoscopic versus open appendicectomy: An Indian perspective
Utpal De
January-March 2005, 1(1):15-20
DOI:10.4103/0972-9941.15241  PMID:21234139
BACKGROUND: Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is scant. This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis. MATERIALS AND METHODS: The study group consisted of two hundred and seventy nine patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendicectomy (LA) and one hundred seventy nine patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost in terms of their medians. The Mann-Whitney statistics (T) were calculated and because of large samples, the normal deviate test (Z) was used. RESULTS: Of the hundred patients, six patients (6%) had the procedure converted to open surgery. The rate of infections and overall complications (LA: 15%, OA: 31.8%, P < 0.001) were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA, 5 days after OA, P < 0.0001) than after OA. The operating time was shorter {OA: 25 min (median), LA: 28 min (median), 0.01< P < 0.05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. CONCLUSION: Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same. LA is also associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.
  18,761 523 7
Does laparoscopic Nissen fundoplication prevent the progression of Barrett's oesophagus? Is the length of Barrett's a factor?
Fahad Bamehriz, Sanjeev Dutta, Catherine Gill Pottruff, Christopher A Allen, Mehran Anvari
January-March 2005, 1(1):21-28
DOI:10.4103/0972-9941.15242  PMID:21234140
INTRODUCTION: Recent studies have suggested that both laparoscopic and open anti-reflux surgery may produce regression of Barrett's mucosa. MATERIAL AND METHODS; We reviewed 21 patients (13M: 8F, mean age 46.73.18 years) with documented Gastroesophageal Reflux Disease (GERD) and Non-dysplastic Barrett's esophagus (15 patients ?3 cm segment, 6 patients < 3 cm segment) on long term proton pump inhibitor therapy who underwent laparoscopic Nissen fundoplication (LNF) between 1993 and 2000. All patients had undergone pre and yearly postoperative upper GI endoscopy with 4 quadrant biopsies every 2 cm. All patients also underwent pre- and 6 months postoperative 24-hr pH study, esophageal manometry, SF36, and GERD symptom score. The mean duration of GERD symptoms was 8.41.54 years pre-operative. The mean follow-up after surgery was 396.32 months. RESULTS: Postoperatively, there was significant improvement in reflux symptom score (37.5 3.98 points versus 8.7 2.46 points, P = 0.0001), % acid reflux in 24 hr (26.5 3.91% versus 2.1 0.84%, P< 0.0001) and an increase in lower esophageal sphincter pressure (3.71 1.08 mmHg versus 12.29 1.34 mmHg, P = 0.0053). Complete or partial regression of Barrett's mucosa occurred in 9 patients. All patients with complete regression had <4 cm segment of Barrett's. Progression or cancer transformation was not observed in any of the patients. CONCLUSION: LNF in patients with Barrett's oesophagus results in significant control of GERD symptoms. LNF can prevent progression of Barrett's oesophagus and in patients with Barrett's <4 cm may lead to complete regression.
  16,818 393 1
Anaesthetic implications of paediatric thoracoscopy
Nandini Dave, Sarita Fernandes
January-March 2005, 1(1):8-14
DOI:10.4103/0972-9941.15240  PMID:21234138
Anaesthetic care during thoracic surgical procedures in children combines components of the knowledge bases of paediatric anaesthesia with those of thoracic anaesthesia. This article highlights the principles of anaesthesia during thoracoscopic surgery in children including preoperative evaluation, anaesthetic induction techniques, maintenance anaesthesia and options for postoperative analgesia. In addition, given the need to provide optimal surgical visualization during the procedure, one lung ventilation may be required. Techniques to provide one lung ventilation in the paediatric patient and the principles of anaesthesia care during one lung ventilation are discussed.
  11,227 440 6
Two-stage laparoscopic resection of colon cancer and metastatic liver tumour
Yukio Iwashita, Atsushi Sasaki, Toshifumi Matsumoto, Kohei Shibata, Masafumi Inomata, Masayuki Ohta, Seigo Kitano
January-March 2005, 1(1):37-38
DOI:10.4103/0972-9941.15245  PMID:21234143
We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both postoperative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.
  9,313 284 -
Barrett's oesophagus: Is there a need for laparoscopic anti-reflux surgery?
Abeezar I Sarela
January-March 2005, 1(1):5-7
DOI:10.4103/0972-9941.15239  PMID:21234137
  8,918 313 -
A study evaluating the safety of laparoscopic radical operation for colorectal cancer
Min-Hua Zheng, Ai-Guo Lu, Bo Feng, Yan-Yan Hu, Jian-Wen Li, Ming-Liang Wang, Feng Dong, Jing-Li Cai, Yu Jiang
January-March 2005, 1(1):29-33
DOI:10.4103/0972-9941.15243  PMID:21234141
AIM: This study aimed to assess the safety and feasibility of laparoscopic curative resection for colorectal cancer through the clinical practice and basic research. MATERIAL AND METHODS: From September 2001 to September 2002, 47 patients with colorectal cancer were treated using laparoscopic approach, compared with 113 patients underwent traditional operation. The length of intestinal segment excised, size of tumour, clearance of lymph nodes, local recurrence and distant metastasis rate during the period of follow-up in both groups were compared. The other part of the study involved the detection of exfoliated tumour cells in the peritoneal washing before and after surgery; flushing of the instruments was performed in both groups and the results compared. For the laparoscopic cases, the filtrated liquid of CO2 pneumoperitoneum was also checked for tumour cells. RESULTS: No significant differences existed in tumour size, operative site and manner between the two groups. The exfoliated tumour cell was not detected in the CO2 filtrated liquid. Between both groups there was no difference in the incidence of exfoliated tumour cells in peritoneal washing before and after surgery as well as in the fluid used for flushing the instruments. The total number of lymph nodes harvested was 13.719.57 for the laparoscopic group and 12.109.74 for the traditional procedure. Similar length of colon was excised in both groups; this was (19.387.47) cm in the laparoscopic and (18.608.40) cm in the traditional groups. The distal margins of resection for rectal cancer were (4.192.52) cm and (4.162.00) cm respectively. The local recurrence rate was 2.13% (1/47) and 1.77% (2/113) with the distant metastasis rate 6.38% (3/47) and 6.19% (7/113) respectively. Both the statistics were comparable between the laparoscopic and traditional surgery for the colorectal cancer. CONCLUSIONS: Laparoscopic curative resection for colorectal cancer can be performed safely and effectively. In the treatment of colorectal malignancy, laparoscopic resection can achieve similar radicalilty as compared to the traditional laparotomy.
  8,535 283 2
Gastric diverticulum - 'Double pylorus appearance'
Kaushik Bhattacharya
January-March 2005, 1(1):39-39
DOI:10.4103/0972-9941.15246  PMID:21234144
  7,972 221 1
Yet another journal
Tehemton E Udwadia
January-March 2005, 1(1):3-4
DOI:10.4103/0972-9941.15238  PMID:21234136
  6,439 212 1
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04