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   2009| April-June  | Volume 5 | Issue 2  
    Online since August 20, 2009

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Novel cost-effective method of laparoscopic feeding-jejunostomy
Rajesh C Mistry, Sanket S Mehta, George Karimundackal, CS Pramesh
April-June 2009, 5(2):43-46
DOI:10.4103/0972-9941.55108  PMID:19727379
A feeding jejunostomy tube placement is required for entral feeding in a variety of clinical scenarios. It offers an advantage over gastrostomies by eliminating the risk of aspiration. Standard described laparoscopic methods require special instrumentation and expensive custom-made tubes. We describe a simple cost-effective method of feeding jejunostomy using regular laparoscopic instruments and an inexpensive readily available tube. The average operating time was 35 min. We had no intra-operative complications and only one post-operative complication in the form of extra-peritoneal leakage of feeds due to a damaged tube. No complications were encountered while pulling out the tubes after an average period of 5-6 weeks.
  8 3,989 318
The laparoscopic transperitoneal approach for irreducible inguinal hernias: Perioperative outcome in four patients
Rajan B Jagad, Jignesh Shah, Gulabbhai R Patel
April-June 2009, 5(2):31-34
DOI:10.4103/0972-9941.55104  PMID:19727375
Background : Incarceration and strangulation are the most feared complications of inguinal hernia. Till date, incarcerated hernias have traditionally been treated by conventional open repair. Reports are now available for the feasibility of laparoscopic repair of incarcerated inguinal hernia. Here, we described our experience with the transperitoneal approach for incarcerated hernias. Materials and Methods : Between January 2008 and May 2008, four patients were presented with a history of irreducible hernia, abdominal distention and vomiting. All the patients had right-sided inguinal hernia. Reductions of the hernia contents were not possible in any patient. The patients were treated on emergency basis with laparoscopic transabdominal preperitoneal hernia repair. Retrospective analyses of all the patients were done. Results: Reduction of the bowel was achieved in all but one patient, who required the division of the internal ring on lateral side. Transperitoneal mesh repair was performed. No major complications were encountered. One patient developed seroma formation that was treated conservatively. Conclusion: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time. The division of the internal ring can be done under direct vision. Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time.
  7 3,759 487
Venous gas embolism: An unusual complication of laparoscopic cholecystectomy
Tim N Wenham, Donald Graham
April-June 2009, 5(2):35-36
DOI:10.4103/0972-9941.55105  PMID:19727376
Venous gas embolism (VGE) is a rare but potentially lethal complication of many forms of surgery, especially posterior fossa neurosurgery where the incidence is reported to be up to 80% - it can also occur in laparoscopic surgery. It usually occurs early in the procedure during insufflation of the abdomen. Rapid entry or large volumes of gas entering the venous circulation initiate a predictable chain of pathophysiological events which may continue to cardiovascular collapse. Arterial hypoxaemia, hypercapnia, decreased end-tidal CO 2 , arrhythmias, myocardial ischaemia and elevated central venous and pulmonary arterial pressures can occur. The management of VGE relies on a high index of suspicion and close liaison between anaesthetist, surgeon and theatre staff. The authors present a case of venous gas embolism (VGE) during laparoscopic cholecystectomy (LC) which presented without many of the usual clinical features and was diagnosed by auscultation of a millwheel murmur.
  3 4,786 404
Thoracoscopic splanchnicectomy as a palliative procedure for pain relief in carcinoma pancreas
Arun Prasad, Piush Choudhry, Sunil Kaul, Gaurav Srivastava, Mudasir Ali
April-June 2009, 5(2):37-39
DOI:10.4103/0972-9941.55106  PMID:19727377
Thoracoscopic splanchnicectomy has been used for the management of upper abdominal pain syndromes as an alternative to celiac plexus block for conditions such as chronic pancreatitis or supramesocolic malignant neoplasms, including unresectable pancreatic cancer. This procedure is similar to the percutaneous block with a higher degree of precision and avoids the side effects associated with the local diffusion of neurolytic solutions. Thoracoscopic splanchnicectomy appears to be a better treatment in such cases as the procedure is done under direct vision and less dependent on anatomical variations.
  3 5,018 348
Laparoscopic closure of small bowel perforation: Technique of small bowel anchoring to the abdominal wall
Rajan B Jagad
April-June 2009, 5(2):47-48
DOI:10.4103/0972-9941.55109  PMID:19727380
Introduction: More and more complicated laparoscopic abdominal surgeries are now being performed across the world. Laparoscopic suturing of the bowel perforations is being performed by experienced surgeons. We have developed our own technique of small bowel anchoring to the abdominal wall before suturing the perforation. Our Modification: A single stitch is taken at the corner of the perforation. The long end of the suture is retrieved by a suture retrieval needle and the small bowel is anchored to the abdominal wall. Rest of the bowel perforation is suture by the intracorporeal knot-tying technique. Advantages: Anchoring the bowel to the abdominal wall helps in fixation of the bowel to be sutured. This helps specifically for large perforation. Suturing and knot tying is relatively easy by this technique.
  1 3,053 298
Video-assisted thoracic surgery for superior posterior mediastinal neurogenic tumour in the supine position
Laleng M Darlong
April-June 2009, 5(2):49-51
DOI:10.4103/0972-9941.55110  PMID:19727381
Video-assisted thoracic surgery (VATS) for a superior posterior mediastinal lesion is routinely done in the lateral decubitus position similar to a standard thoracotomy using a double-lumen endotracheal tube for one-lung ventilation. This is an area above the level of the pericardium, with the superior thoracic opening as its superior limit and its inferior limit at the plane from the sternal angle to the level of intervertebral disc of thoracic 4 to 5 vertebra lying behind the great vessels. The lateral decubitus position has disadvantages of the double-lumen endotracheal tube getting malpositioned during repositioning from supine position to the lateral decubitus position, shoulder injuries due to the prolonged abnormal fixed posture and rarer injuries of the lower limb. There is no literature related to VATS in the supine position for treating lesions in the posterior mediastinum because the lung tissue falls in the dependent posterior mediastinum and obscures the field of surgery; however, VATS in the supine position is routinely done for lesions in the anterior mediastinum and single-stage bilateral spontaneous pneumothorax. Thus, in the selected cases, 'VATS in supine position' allows an invasive procedure to be completed in the most stable anatomical posture.
  1 3,325 217
Colonoscopic retrieval of migrated copper-T
Laleng M Darlong, Subrat Panda, Noor Topno, Ranendra Hajong
April-June 2009, 5(2):40-42
DOI:10.4103/0972-9941.55107  PMID:19727378
Intrauterine contraceptive devices have been in use for a long time as family planning measures, one of its complications of perforating the uterus and migrating into the peritoneal cavity is also well known. Retrieval in such cases depends on the location of the migrated intrauterine devices and involves laparotomy or laparoscopy. We present here such a case that migrated partially into the lumen of the rectosigmoid and was successfully removed using a colonoscope.
  1 2,896 212
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04