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   2012| April-June  | Volume 8 | Issue 2  
    Online since May 2, 2012

 
 
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REVIEW ARTICLE
The role of laparoscopic surgery in gastric cancer
Theodoros E Pavlidis, Efstathios T Pavlidis, Athanasios K Sakantamis
April-June 2012, 8(2):35-38
DOI:10.4103/0972-9941.95524  
The laparoscopic surgery in gastric cancer is applied with increasing frequency nowadays; noticeable reports come mainly from Korea and Japan with satisfactory results. This review presents briefly the issue by evaluating its role. A PubMed search of relevant articles published up to 2010 was performed to identify current information. Most data come from Far East, where gastric cancer occurs more often, and the proportion of early gastric cancer is high. Laparoscopic approach includes both the diagnostic laparoscopy and laparoscopic resection. Laparoscopic gastrectomy has currently limited application for gastric cancer in the West; it is not widely accepted and raises important considerations necessitating the planning of multicentre randomised control trials based mainly on the long-term results.
  7 3,259 225
HOW I DO IT DIFFERENTLY
Endoscopic single-port "components separation technique" for postoperative abdominal reconstruction
Francesco Rulli, Massimo Villa, Gianfranco Tucci
April-June 2012, 8(2):62-64
DOI:10.4103/0972-9941.95541  
Background: In 1990, Ramirez introduced a new procedure to close abdominal wall hernia (AWH), called "components separation technique (CST)". Thanks to endoscopy, surgical repair possibilities have risen, reducing the operative trauma and preserving vascular and neuronal anatomical structures. This report aims to describe a single port endoscopic approach for CST to repair the abdominal wall of a patient undergoing surgery for abdominal aneurysm and already subject to placement of a mesh for AWH. Methods: We performed endoscopic-assisted CST, using a single-port access with a gasless technique. Conclusion: CST is a useful procedure to close large abdominal wall incisional hernia avoiding the use of mesh, notably under contamination, when prosthetic material use is contraindicated. The endoscopic-assisted CST produces same results than the conventional open separation technique and also minimised tissue trauma that ensures blood supply and prevents postoperative wounds complications. The described single port method was found to be safe and effective to close large midline abdominal hernias when a primary open or laparoscopic closure is not feasible or when patients have been previously treated with abdominal meshes.
  1 2,707 148
LETTERS TO THE EDITOR
Laparoscopic perforostomy for treating a delayed colonoscopic perforation: Novel approach
Ketan Vagholkar
April-June 2012, 8(2):65-66
DOI:10.4103/0972-9941.95543  
  1 1,865 109
ORIGINAL ARTICLES
A prospective nonrandomized comparison of laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication in Indian population using detailed objective and subjective criteria
Pawanindra Lal, Nitin Leekha, Jagdish Chander, Richa Dewan, Vinod K Ramteke
April-June 2012, 8(2):39-44
DOI:10.4103/0972-9941.95529  
Background: Laparoscopic Nissen fundoplication (LNF) is a commonly performed procedure for the treatment of gastro esophageal reflux disease (GERD) worldwide. However, unfavourable postoperative sequel, including gas bloat and dysphagia, has encouraged surgeons to perform alternative procedures such as laparoscopic Toupet fundoplication (LTF). This prospective nonrandomized study was designed to compare LNF with LTF in patients with GERD. Materials and Methods: Hundred and ten patients symptomatic for GERD were included in the study after having received intensive acid suppression therapy for a minimum of 8 weeks. A 24-hour pH metry was done on all patients. Fifty patients having reflux on 24-hour pH metry were taken up for the surgery. Patients were further divided into group-A (LNF) and group-B (LTF). Results: The median percentage time with esophageal pH < 4 decreased from 10.18% and 12.31% preoperatively to 0.85% and 1.94% postoperatively in LNF and LTF-groups, respectively. There was a significant and comparable increase in length of lower esophageal sphincter (LES), length of intraabdominal part of LES and LES pressure at respiratory inversion point in both the groups. In LNF-group, five patients had early dysphagia that improved afterwards. There were no significant postoperative complications. Conclusion: LNF and LTF are highly effective in the management of GERD with significant improvement in symptoms and objective parameters. LNF may be associated with significantly higher incidence of short onset transient dysphagia that improves with time. Patients in both the groups showed excellent symptom and objective control on 24-hour pH metry on short term follow-up.
  1 3,160 155
UNUSUAL CASES
Laparoscopic management of massive spontaneous external haemorrhage from the umbilical varix due to recanalisation of the paraumbilical vein in a patient with 'Child's Class A' liver cirrhosis
Sanoop K Zachariah, Sreejith L Krishnankutty, Nirmalan Raja
April-June 2012, 8(2):54-56
DOI:10.4103/0972-9941.95536  
Spontaneous external haemorrhage from the umbilical varix is an extremely rare complication of portal hypertension. Bleeding is usually into the peritoneal cavity and the treatment involves urgent laparotomy and ligation of the bleeding varices. We describe a cirrhotic 38-year-old man who presented with spontaneous external haemorrhage from the umbilical varix which was successfully managed laparoscopically by in-situ distal clipping and proximal transcutaneous ligation of the recanalised paraumbilical veins. We therefore feel that laparoscopy can be safely and effectively employed to control external haemorrhage from the umbilical varix associated with liver cirrhosis. This novel technique can help avoid a laparotomy and also help preserve the umbilicus.
  1 2,775 133
Laparoscopic resection of giant liver hemangioma using laparoscopic Habib probe for parenchymal transection
Srikanth Gadiyaram, Neel Shetty
April-June 2012, 8(2):59-61
DOI:10.4103/0972-9941.95540  
Experience with laparoscopic liver resections is limited. Laparoscopic resection of a variety of liver lesions has been reported and is considered appropriate for lesions in the left lateral segment and inferior segments of the right lobe. Herein, we report a 52-year-old male patient who underwent a laparoscopic resection of giant liver hemangioma with the use of a laparoscopic 4× Habib probe.
  1 4,713 110
LETTERS TO THE EDITOR
Laparoscopic cholecystectomy and appendicectomy in situ inversus totalis
Ketan Vagholkar
April-June 2012, 8(2):65-65
DOI:10.4103/0972-9941.95542  
  - 1,627 83
ORIGINAL ARTICLES
Role of diagnostic laparoscopy in assessing operability in borderline resectable gastrointestinal cancers
Chandramohan K Nair, Kiran C Kothari
April-June 2012, 8(2):45-49
DOI:10.4103/0972-9941.95533  
Background: Diagnostic laparoscopy helps in diagnosing and staging Gastrointestinal (GI) cancers. Routine laparoscopy before laparotomy, especially in cancers that have equivocal operability, helps to avoid unnecessary laparotomies. Present study evaluates utility of laparoscopy in diagnosing and staging GI cancers. Materials and Methods: Diagnostic laparoscopy was done in 41 patients with gastrointestinal (GI) cancers who were thought to have equivocal operability. Patients with suspected or known non-metastatic GI cancers, in whom resectability was found doubtful by clinical assessment and pre-operative imaging, were included. Patients with non-GI cancers (lymphoma, gynaecologic cancers, genitourinary cancers, retroperitoneal sarcoma, sarcoma and abdominal metastasis of non-GI cancers) and metastatic cancers which were beyond the scope of curative surgery were excluded from the study. Results: After diagnostic laparoscopy (DL) five patients had benign diagnosis. Out of 36 patients with malignant diagnosis, after DL, 22 patients (61.1%) were inoperable, 11 patients (30.6%) were operable, and three (8.3%) patients were of equivocal operability. Sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopy in detecting operability were 100%, 91.7%, 81.8%, and 100%, respectively. Conclusions: Laparoscopy helped in a significant number of patients with advanced GI cancers to avoid laparotomy. The morbidity of DL was acceptable.
  - 2,822 164
UNUSUAL CASES
Type-I complex regional pain syndrome of umbilical port site: An unforeseen complication of laparoscopic surgery
Ragavan Munisamy, Haripriya Uppalu, Raja Raghavendra, Naveen Prasad Siddam Venkata, Skandha Harshita, Sarva Vinothini Janarthanam
April-June 2012, 8(2):50-53
DOI:10.4103/0972-9941.95535  
Many complications have been observed after laparoscopic surgery. Persisting pain in the umbilical port site is due to infection, hernia, endometriosis, metastasis, etc. There is no case report due to neuralgic complex regional pain syndrome, and we have dealt a case which is described with relevant literature review and etiopathogenesis.
  - 5,183 140
Laparoscopic excision of a giant mesothelial omental cyst
Aparna A Deshpande, Abhay N Dalvi
April-June 2012, 8(2):57-58
DOI:10.4103/0972-9941.95538  
A 42-year-old patient presented with right-sided abdominal discomfort. Investigations revealed a 19 × 21 centimetres large cystic lesion occupying nearly the entire right side of the abdomen. It was situated between ascending colon and right kidney and extended from the liver to the pelvic inlet supero-inferiorly. Laparoscopic excision was planned. The cyst was aspirated completely and dissected from the surrounding structures. It was eventually found to be arising from the right free edge of the greater omentum. Due to its size and weight it was lodged behind the ascending colon. Post-operative course was uneventful. Histology revealed a mesothelial omental cyst. Omental cysts are rare abdominal tumours. Complete excision is the treatment advised to prevent recurrence. Laparoscopic excision can be safely performed taking care to ascertain diagnosis and not to damage any structures intra-operatively.
  - 2,238 101
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04