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   2013| January-March  | Volume 9 | Issue 1  
    Online since February 14, 2013

 
 
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ORIGINAL ARTICLES
Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre
Ameet Kumar, TS Ramakrishnan
January-March 2013, 9(1):7-12
DOI:10.4103/0972-9941.107126  PMID:23626413
Background: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive - from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. Materials and Methods: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. Results: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8-25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. Conclusion: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre.
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HOW I DO IT DIFFERENTLY
A modified minimally invasive technique for the surgical management of large trichobezoars
Amit Javed, Anil K Agarwal
January-March 2013, 9(1):42-44
DOI:10.4103/0972-9941.107142  PMID:23626422
Background: Trichobezoar which were traditionally managed by open surgical retrieval are now often managed by minimally invasive surgical approach. Removal of a large trichobezoar by laparoscopy, however, needs an incision (usually 4-5 cm in size) for specimen removal and has the risk of intra-peritoneal spillage of hair and inspissated secretions. Materials and Methods : The present paper describes a modified laparoscopy-assisted technique with temporary gastrocutaneopexy for the effective removal of a large trichobezoar using a camera port and a 4-5 cm incision (which is similar to that needed for specimen removal during laparoscopy). Results: Three patients with large trichobezoar were managed with the described technique. The average duration of surgery was 45 (30-60) min and the intraoperative blood loss was minimal. There was no peritoneal spillage and the trichobezoar could be retrieved through a 4-5 cm incision in all patients. All had an uneventful recovery and at a median followup of 6 months had excellent cosmetic and functional results. Conclusion: The described technique is a minimally invasive alternative for trichobezoar removal. There is no risk of peritoneal contamination and the technical ease and short operative time in addition to an incision limited to size required for the specimen removal, makes it an attractive option.
  1 2,477 139
ORIGINAL ARTICLES
Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon's initial experience
Sanoop K Zachariah
January-March 2013, 9(1):13-18
DOI:10.4103/0972-9941.107128  PMID:23626414
Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA) was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52) years, mean BMI was 22.7 (range 17-28) kg/m 2 and the mean operative time was 85.5 (range 45-150) min. The mean postoperative stay was 3.6 (range 1-7) days. The commonest position of the appendix was retro-caecal (50%) followed by pelvic (30%). In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.
  1 3,496 194
Minimal access surgery in newborns and small infants; five years experience
Sandesh V Parelkar, Sanjay N Oak, Mitesh K Bachani, Beejal V Sanghvi, Rahul Gupta, Advait Prakash, Rajashekhar Patil, Subrat Sahoo
January-March 2013, 9(1):19-24
DOI:10.4103/0972-9941.107129  PMID:23626415
Aims and Objectives: The aim of this study was to assess and present the outcome (initial experience and lessons learnt) of minimally invasive surgery for various indications in neonates and small infants (< 5 kg) at a single medical centre. Materials and Methods: A retrospective analysis was performed on 65 patients (age day 2 to 10 months) managed with minimal access surgery (MAS) for various indications, between 2005 and 2010. We analyzed demographic information, procedures, complications, outcomes, and follow-up and overall feasibility of the procedure. Results: No serious complications except one death in congenital diaphragmatic hernia (CDH) (due to other comorbidities) occurred. Intra operative hypercarbia and hypoxia were observed more frequently in thoracoscopic procedures. Intra operative hypothermia was not common and was well tolerated. Conversion to open procedure (n = 5), post operative ileus (n = 3), port site infection (n = 5) were other complications. Conclusion: MAS in neonates and small infants is a technically demanding but a feasible choice available. Some prior experience in older children is required for safe and effective outcome. Good quality optics, video equipments and instruments are required for safe and effective procedure. Intra operative measurement of oxygen saturation and temperature, and diligent post operative ICU care are mandatory for safe and successful outcome.
  1 3,653 173
UNUSUAL CASES
Retained surgical sponge mimicking GIST: Laparoscopic diagnosis and removal 34 years after original surgery
Jonatan W R Justo, Paulo Sandler, Leandro T Cavazzola
January-March 2013, 9(1):29-30
DOI:10.4103/0972-9941.107133  PMID:23626417
The term gossypiboma denotes a cotton foreign body retained inside the patient during surgery, a rare surgical complication. The symptoms following this entity are non-specific, such as pain, palpable mass and fever, which make clinical diagnosis difficult. The computerized tomography (CT) scan is the most useful method for diagnosis; however, sometimes the preoperative diagnosis remains uncertain even after the imaging exam. In that case, laparoscopy arises as a valuable diagnostic tool, as well as a prompt treatment option. However, when diagnosis is made years after the original surgery, the laparoscopic approach becomes harder. Our patient presented without clear symptoms, remaining asymptomatic for 34 years. The CT scan presumptive diagnosis was a gastrointestinal stromal tumour, and laparoscopy was performed providing an accurate diagnosis and treatment in the same surgical time.
  1 2,534 142
EDITORIAL
Journal of Minimal Access Surgery: Looking back and looking ahead
Deepraj Bhandarkar
January-March 2013, 9(1):1-2
DOI:10.4103/0972-9941.107106  PMID:23626411
  - 2,044 171
LETTERS TO THE EDITOR
The "BASE FIRST" technique in laparoscopic appendectomy
Ketan Vagholkar
January-March 2013, 9(1):45-45
DOI:10.4103/0972-9941.107143  PMID:23626423
  - 1,514 126
Authors' reply
Giuseppe Piccinni, Andrea Sciusco, Angela Gurrado, Germana Lissidini, Mario Testini
January-March 2013, 9(1):46-47
  - 1,294 79
ORIGINAL ARTICLES
Bronchogenic cyst: Clinical course from antenatal diagnosis to postnatal thoracoscopic resection
Sophie Maurin, Géraldine Hery, Brigitte Bourliere, Alain Potier, Jean-Michel Guys, Pascal De Lagausie
January-March 2013, 9(1):25-28
DOI:10.4103/0972-9941.107132  PMID:23626416
Purpose: The purpose of this study was to describe an approach to surgical management of bronchogenic cysts based on the natural course observed from the time of antenatal screening to surgical resection in patients treated at our institution and reported in the literature. Materials and Methods: We retrospectively reviewed the clinical features of all children presenting bronchogenic cyst diagnosed antenatally from 2007 to 2010. A total of six children were included. Results: Antenatal diagnosis was accurate in 62.5% of cases. In the first year of life, the size of the cyst remained stable in four patients, doubled in one, and increased 30% within six months in one. The indication for surgery was emphysema of the left bronchus in two patients and rapid growth in two patients. One patient is still awaiting surgery. Conclusion: Bronchogenic cysts grow slowly in the first months of life, but growth is exponential even in the absence of complications. We recommend complete resection before the age of two years to prevent infectious complications and facilitate surgery.
  - 1,991 133
Long-term experience on laparoscopic incontinent urinary diversion unrelated to cystectomy in radiated or recurrent pelvic malignancies
Marcos Tobias-Machado, Leonardo S Lopes, Felipe Brandao Correa de Araujo, Eduardo S Starling, Antonio Carlos Lima Pompeo
January-March 2013, 9(1):3-6
DOI:10.4103/0972-9941.107121  PMID:23626412
Background: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. Materials and Methods: We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years. Results: All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.
  - 2,541 169
UNUSUAL CASES
Lower gastrointestinal bleeding due to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy
Ajay D Mate, Kailas R Surnare, Samir S Deolekar, Anil K Gvalani
January-March 2013, 9(1):31-33
DOI:10.4103/0972-9941.107135  PMID:23626418
Pseudoaneurysm of hepatic artery is a rare but known complication of laparoscopic cholecystectomy (LC). Such pseudoaneurysms may bleed in biliary tree, upper gastrointestinal (GI) tract or peritoneal cavity leading to life-threatening internal haemorrhage. It is very rare for them to present as lower GI bleeding. We report an unusual case of Right hepatic artery pseudoaneurysm developed following LC, which ruptured into hepatic flexure of colon resulting in catastrophic lower GI bleeding. This was associated with partial celiac artery occlusion due to thrombosis. Due to failure of therapeutic embolisation, the patient was subjected to exploratory laparotomy to control haemorrhage. Postoperatively, patient recovered well and was discharged on postoperative day 10. A strong index of suspicion is necessary for early diagnosis of such condition and to limit resultant morbidity. Angioembolisation is the first-line treatment and surgery is indicated in selected cases.
  - 2,339 109
Laparoscopic excision of intra-abdominal oesophageal duplication cyst in a child
Vijay C Pujar, Santosh Kurbet, Deepak K Kaltari
January-March 2013, 9(1):34-36
DOI:10.4103/0972-9941.107137  PMID:23626419
Duplication cysts are congenital cystic malformation of the alimentary tract consisting of a duplication of the segment to which it is adjacent. It can occur anywhere from mouth to anus.Oesophageal duplication cysts comprise 4% of the same. Of these, total intra-abdominal oesophageal duplication cysts are extremely rare. On review of literature, only 3 case reports of total intra-abdominal oesophageal duplication managed laparoscopically are found. All these cases were adults. We report the first paediatric case of intra-abdominal oesophageal duplication cyst excised laparoscopically.
  - 2,296 113
Laparoscopic excision of mesenteric cyst of sigmoid mesocolon
Ajay H Bhandarwar, Mukund B Tayade, Ashok D Borisa, Gaurav V Kasat
January-March 2013, 9(1):37-39
DOI:10.4103/0972-9941.107138  PMID:23626420
Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision.
  - 2,648 132
Polypropelene mesh eroding transverse colon following laparoscopic ventral hernia repair
Manash Ranjan Sahoo, Suryakanta Bisoi, Santosh Mathapati
January-March 2013, 9(1):40-41
DOI:10.4103/0972-9941.107139  PMID:23626421
Polypropylene mesh when used in laparoscopic ventral hernia repair can produce the worst complication such as enterocutaneous fistula. We report an interesting case of incisional hernia operated with laparoscopic polypropylene mesh hernioplasty who subsequently developed an enterocutaneous fistula 1 month after surgery. A fistulogram showed dye entering into the transverse colon. On exploration, the culprit polypropylene mesh was found to have eroded into the mid-transverse colon causing the fistula. Resection and end-to-end anastomosis of the colon were done with the removal of the mesh. On literature review, polypropylene mesh erosion in to transverse colon is rare.
  - 2,570 125
© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04