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   2008| October-December  | Volume 4 | Issue 4  
    Online since January 20, 2009

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Diagnosis and management of Spigelian hernia: A review of literature and our experience
T Mittal, V Kumar, R Khullar, A Sharma, V Soni, M Baijal, PK Chowbey
October-December 2008, 4(4):95-98
DOI:10.4103/0972-9941.45204  PMID:19547696
Spigelian hernia occurs through slit like defect in the anterior abdominal wall adjacent to the semilunar line. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. The hernia ring is a well-defined defect in the transverses aponeurosis. The hernial sac, surrounded by extraperitoneal fatty tissue, is often interparietal passing through the transversus and the internal oblique aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique. Spigelian hernia is in itself very rare and more over it is difficult to diagnose clinically. It has been estimated that it constitutes 0.12% of abdominal wall hernias. The spigelian hernia has been repaired by both conventional and laparoscopic approach. Laparoscopic management of spigelian hernia is well established. Most of the authors have managed it by transperitoneal approach either by placing the mesh in intraperitoneal position or by raising the peritoneal flap and placing the mesh in extraperitoneal space. There have also been case reports of management of spigelian hernia by total extraperitoneal approach. We retrospectively reviewed our experience of ten patients between 1997 and 2007. Eight patients (8/10) presented with abdominal pain and two patients (2/10) were asymptomatic. In six patients (6/10) we performed an intraperitoneal onlay IPOM repair, in two patients (2/10) transabdominal preperitoneal repair (TAPP), and in two (2/10) total extraperitoneal repair (TEP). There were no recurrences, or other morbidity at mean follow up period of 3.2 years (range 6 months to 10 years).
  36,312 608 28
Laparoscopic fundoplication for gastro-esophageal reflux disease: An 8 year experience
KP Balsara, CR Shah, M Hussain
October-December 2008, 4(4):99-103
DOI:10.4103/0972-9941.45205  PMID:19547698
Background :Laparoscopic fundoplication (LF) has become the operation of choice for patients who need surgery for gastro esophageal reflux disease (GERD). Several studies have shown that the long-term results with surgery for GERD are better than medical therapy. In this retrospective study, we outline our experience with LF over an 8 year period. We analyzed factors that would affect the results of surgery and help in a better selection of patients for the operation. Materials and Methods :From 1999 to 2007, 107 patients underwent a LF. Eighty five patients had surgery for GERD and form the basis of this article. The other 22 patients had paraesophageal hernias and were excluded from the study. Pre-operative evaluation consisted of endoscopy, a barium study, esophageal manometry and 24h pH monitoring. Patients were followed up every 3rd month for the 1st year, twice in the 2nd year and then annually. Follow up was by personal interview or telephonic conversation. At the last follow up the results of surgery were graded as good or poor as per a scoring system. Those with a poor result were evaluated and re-operation advised when an anatomical problem caused the poor result. Subjective, objective and technical variables were analyzed which could affect the outcome of surgery. Results :In 84 patients, the operation was completed by laparoscopic access. One patient with bleeding was converted to open surgery. There were 5 intra-operative complications; 3 pnemothoracis, 1 esophageal perforation and 1 gastric fundus perforation. There was no mortality. Two patients underwent re-operation, 1 for delayed gastric emptying and 1 for dysphagia. Seventy four patients have been followed up from 7 months to 8 years. Eleven have been lost to follow up. Fifty seven patients (77%) have had a good result from surgery. Seventeen (23%) had a poor result; of these there were 4 wrap failures, 1 delayed gastric emptying and 1 excessive gas bloat as the cause. In 11 patients, there was no apparent cause of a poor result. Individual variables which predicted a good response to surgery ( P <0.5); were a good response to proton pump inhibitors (PPis), volume reflux and a pH score of more than 14. Conclusion :LF gives good long-term relief of symptoms in patients with GERD. Strict selection criteria are necessary to optimize the results of surgery. Poor selection will result in a patient who is no better, or often worse than before surgery.
  6,087 344 4
Ascariasis cholecystitis: An unusual cause
Balakrishna Shetty, Prashanth Kumar Shetty, Pritam Sharma
October-December 2008, 4(4):108-110
DOI:10.4103/0972-9941.45207  PMID:19547655
Ascariasis is the most common helminthic infection to infest man. Usually the adult worm lives in the small intestine. Rarely it migrates through the ampulla of vater and enters the common bile duct. We are reporting a case of gall bladder ascariasis causing acute cholecystitis treated by laparoscopic cholecystectomy. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to the narrow and tortuous cystic duct.
  4,643 237 2
Cerebral oxygenation monitoring using near infrared spectroscopy during one-lung ventilation in adults
Joseph D Tobias, Garry A Johnson, Saif Rehman, Robert Fisher, Norman Caron
October-December 2008, 4(4):104-107
DOI:10.4103/0972-9941.45206  PMID:19547695
Background :Changes in oxygenation occur during one-lung ventilation (OLV) due to intrapulmonary shunt. Although arterial oxygenation is generally adequate, there are no studies evaluating the effect of these changes on cerebral oxygenation. Materials and Methods :Cerebral oxygenation (rSO 2 ), heart rate (HR), blood pressure (BP), oxygen saturation (SaO 2 ), and end-tidal carbon dioxide (ETCO 2 ) were prospectively monitored during OLV in adults. Cerebral oxygenation was monitored using near infrared spectroscopy. No clinical decisions were made based on the rSO2 value. BP and HR were the inspired oxygen concentration was adjusted as needed to maintain the SaO 2 ≥ 95%. Results :The study cohort included 40 adult patients. 18,562 rSO 2 values were collected during OLV. The rSO 2 was ≥ baseline at 3,593 of the 18,562 data points (19%). The rSO2 was 0-9 ≤ baseline in 7,053 (38%) of the readings, 10-19 ≤ baseline in 4,084 (22%) of the readings, and 20-29 ≤ baseline in 3,898 (21%) of the readings. 2,599 (14%) of the rSO 2 values were less than 75% of the baseline value. Thirteen patients (32.5%) had at least one rSO2 value that was less than 75% of the baseline. Eight patients (20%) had rSO 2 values less than 75% of baseline for ≥ 25% of the duration of OLV. These patients were older (63.7 10.2 vs 54.6 9.8 years, P <0.025), weighed more (95.8 17.4 vs 82.6 14.6 kgs, P =0.038), and were more likely to be ASA III vs II (7 of 8 versus 25 of 32, relative risk 1.75) than the remainder of the cohort. Conclusions :Significant changes in rSO2 occur during OLV for thoracic surgical procedures. Future studies are needed to determine the impact of such changes on the postoperative course of these patients.
  4,185 226 6
Bronchobiliary fistula
Ajay Mandal, Sanjay Sen, Sarfaraz Jalil Baig
October-December 2008, 4(4):111-113
DOI:10.4103/0972-9941.45208  PMID:19547697
Bronchobiliary fistula is a very rare complication of liver abscess. It presents with biliptysis (bile in cough), and chronic cough. Here we present a case of intractable biliptysis from a bronchobiliary fistula secondary to a liver abscess with biliary obstruction.
  3,207 189 2
Pregnancy and laparoscopic cholecystectomy
Anjum Malik, Iqbal Saleem Mir
October-December 2008, 4(4):117-117
DOI:10.4103/0972-9941.45210  PMID:19547656
  2,735 176 -
Knotting of the guide wires: A rare complication during minimally invasive procedure on kidney-Lessons learnt
Pankaj M Joshi, Subodh R Shivde, Tushar A Dighe
October-December 2008, 4(4):114-116
DOI:10.4103/0972-9941.45209  PMID:19547654
Guide wires are frequently used in various endourologic procedures to access the upper as well as lower urinary tract. Flexible guide wires have lesser complication rate of tissue injury as compared to stiff guide wires. Flexible guide wires are however more prone to bending and kinking due to their mechanical properties. We report an unusual complication of knotting of flexible guide wires during endourologic procedure and the trick to remedy this problem. We have also discussed the structural design and mechanical properties of commonly used guide wires.
  2,611 165 1
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04