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   2010| July-September  | Volume 6 | Issue 3  
    Online since August 20, 2010

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Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management
Robin Kaushik
July-September 2010, 6(3):59-65
DOI:10.4103/0972-9941.68579  PMID:20877476
Background: Laparoscopic cholecystectomy (LC) has established itself firmly as the 'gold standard' for the treatment of gallstone disease, but it can, at times, be associated with significant morbidity and mortality. Existing literature has focused almost exclusively on the biliary complications of this procedure, but other complications such as significant haemorrhage can also be encountered, with an immediate mortality if not recognized and treated in a timely manner. Materials and Methods: Publications in English language literature that have reported the complication of bleeding during or after the performance of LC were identified and accessed. The results thus obtained were tabulated and analyzed to get a true picture of this complication, its mechanism and preventive measures. Results: Bleeding has been reported to occur with an incidence of up to nearly 10% in various series, and can occur at any time during LC (during trocar insertion, dissection technique or slippage of clips/ ligatures) or in the postoperative period. It can range from minor haematomas to life-threatening injuries to major intra-abdominal vessels (such as aorta, vena cava and iliacs). Conclusion: Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.
  18 16,595 684
Laparoscopic splenectomy in patients of β thalassemia: Our experience
Nirmal M Patle, Om Tantia, Prakash Kumar Sasmal, Shashi Khanna, Bimalendu Sen
July-September 2010, 6(3):70-75
DOI:10.4103/0972-9941.68583  PMID:20877478
Background : Laparoscopic splenectomy has become a standard treatment of various haematological disorders, but its feasibility in the setting of β thalassemia has not been established. Materials and Methods: Fifty patients of β thalassemia underwent laparoscopic splenectomy between January 2006 and December 2008. "Anterior approach" method was practiced in all cases, with early ligation of splenic artery and delayed ligation of splenic vein. Specimen was extracted piecemeal via the umbilical port in initial 12 cases, while in 37 cases the specimen was extracted through a 7-8-cm pfannenstiel incision. Twelve patients of β thalassemia having grade IV splenomegaly with hepatomegaly were electively operated by conventional open method. Results: The procedure was completed in 49 patients. One (2%) patient required conversion to open surgery. Mean operating time in the first 12 cases was 151 minutes (110-210 minutes), while in 37 cases of splenectomy completed laparoscopically it was 124 minutes (80-190 minutes) [P < 0.05]. Mean intra-operative blood loss was 73.8 ml (30-520 ml). No major intra-operative complications occurred. No patient required per-operative blood transfusion. Mean postoperative hospital stay was 4.7 days (2-11 days). Mean preoperative blood transfusion requirement was 11.98 units per patient per year, while mean postoperative blood transfusion requirement was 4.04 units [P< 0.05]. Conclusion: Laparoscopic splenectomy is feasible and safe even in patients of β thalassemia with massive splenomegaly. Removal of specimen via a pfannenstiel incision significantly saves time, carries low morbidity and is a cosmetically acceptable alternative.
  8 6,267 232
Laparoscopic ureteric reimplantation of a single-system ectopic ureter in a girl: A rarity
Suresh Kumar, Malay Kumar Bera, Keya Pal Bera, Mukesh Kumar Vijay, Anup Kr Kundu
July-September 2010, 6(3):80-82
DOI:10.4103/0972-9941.68584  PMID:20877480
A 14-year-old girl presented with continuous dribbling of urine along with normal voiding pattern since childhood. Cystourethroscopy showed absence of right ureteric opening, and vaginoscopy showed right ureter opening into vaginal vault. Radiological images showed small right kidney with normal excretory function with single-system ectopic ureter. Patient underwent laparoscopic transperitoneal extravesical ureteric reimplantation. At 3 months' follow-up, intravenous urography (IVU) and micturating cystourethrogram (MCU) showed no obstruction and reflux.
  8 6,183 138
Boerhaave's syndrome: Thoracolaparoscopic approach
Shulmit Vaidya, Suraj Prabhudessai, Nitish Jhawar, Roy V Patankar
July-September 2010, 6(3):76-79
DOI:10.4103/0972-9941.68585  PMID:20877479
We present a case of Boerhaave's syndrome managed thoracolaparoscopically. A 45-year- old man presented with hydropneumothorax following severe retching. He was treated with Intercostal drainage insertion as the primary management and referred to a tertiary care centre. There endoscopic stapling was attempted, following which he developed a leak. He presented to us with severe sepsis and mediastinal collection on the ninth day following the perforation. We treated him with thoracoscopic mediastinal toilet, laparoscopic-assisted feeding jejunostomy and cervical oesophagostomy. The patient was managed conservatively. A computed tomography (CT) scan was repeated at intervals of 15 days. He was continued on full jejunostomy feeds. Regular assessment of the oesophagus injury was conducted via the CT scan. The patient had complete healing of the perforation at end of two months. His oesophagostomy was closed and he remained symptom-free at follow-up. We conclude that thoracoscopy has an important role to play in the management of patients with mediastinal sepsis and late presentation of Boerhaave's perforation.
  6 10,841 161
Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry
Anish P Nagpal, Harshad Soni, Sanjiv Haribhakti
July-September 2010, 6(3):66-69
DOI:10.4103/0972-9941.68581  PMID:20877477
Aims: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). Materials and Methods: Forty-six patients with typical symptoms of GERD, from March 2001 to November 2009, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by ourselves and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery. Results: Relief of the primary symptom responsible for surgery was achieved in 85% of patients at a mean follow-up of 28 months. Thirty-nine patients were asymptomatic, 2 had minor gastrointestinal symptoms not requiring medical therapy, 3 patients had gastrointestinal symptoms requiring medical therapy/ Proton Pump Inhibitors and in 2 patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in 6 patients. Median hospital stay was 3 days, decreasing from 6 in the first 10 patients to 3 in the last 10 patients. Conclusions: Preoperative oesophageal manometry is not mandatory for laparoscopic fundoplication done in selected patients with typical symptoms of GERD and upper GI endoscopy suggestive of large hiatus hernia.
  5 5,139 206
Laparoscopic right paraduodenal hernia repair
James G Bittner IV
July-September 2010, 6(3):89-89
DOI:10.4103/0972-9941.68578  PMID:20877483
  4 3,046 156
Novel technique for closure of defect in laparoscopic ventral hernia repair
Deborshi Sharma, Vikas Jindal, Om Prakash Pathania, Shaji Thomas
July-September 2010, 6(3):86-88
DOI:10.4103/0972-9941.68580  PMID:20877482
Laparoscopic repair of ventral hernia is the standard of care in today`s era. With increasing experience, different theories and techniques have been described by different authors to overcome the intraoperative and postoperative problems. We describe a novel technique for closure of defect in laparoscopic hernia repair which has the added advantage.
  3 5,379 308
Laparoscopic splenectomy for tuberculous abscess of the spleen
Deepraj Bhandarkar, Avinash Katara, Manu Shankar, Gaurav Mittal, Tehemton E Udwadia
July-September 2010, 6(3):83-85
DOI:10.4103/0972-9941.68582  PMID:20877481
Abscess of the spleen is an uncommon clinical entity and a tuberculous abscess is particularly rare. Although image-guided aspiration has been reported, splenectomy is the preferred modality of treatment. We report a 32-year-old female diagnosed to have a large, multilocular splenic abscess during investigation of a pyrexial illness. Her haemoglobin was 9.8 gm%, ESR 100 mm/1 st hour and she was HIV negative. She had been on anti-tubercular chemotherapy (started elsewhere) for 2 months but had shown poor response. A laparoscopic splenectomy undertaken using four-ports was challenging due to the presence of perisplenitis and adhesions in the splenic hilum. Also, fundus of stomach densely adherent to the upper pole of the spleen required stapled resection. Postoperatively, she developed a low-output pancreatic fistula that resolved with conservative treatment within a week. Histopathology of the spleen confirmed tuberculosis. She responded well to anti-tubercular chemotherapy and remains well 3 years later.
  1 4,634 168
Simultaneous laparoscopic nephrectomy in ADPKD
Ramen Kumar Baishya, Prabhat Ranjan, Ravindra B Sabnis, Mahesh R Desai
July-September 2010, 6(3):89-90
DOI:10.4103/0972-9941.68577  PMID:20877484
  - 2,919 121
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04