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   2014| January-March  | Volume 10 | Issue 1  
    Online since January 6, 2014

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Laparoscopic versus open appendectomy in obese patients: A meta-analysis of prospective and retrospective studies
Andrea Ciarrocchi, Gianfranco Amicucci
January-March 2014, 10(1):4-9
DOI:10.4103/0972-9941.124451  PMID:24501501
Background: A meta-analysis of different kinds of studies was performed to assess outcomes of laparoscopic versus open appendectomy in obese patients. Materials and Methods: Retrospective and prospective studies enrolling patients with a body mass index greater than 30 kg/m 2 were included. Primary outcomes were days of hospital stay, surgical procedure duration, and overall post-operative complication rate. Secondary outcomes were wound infection and intra-abdominal abscesses formation rate, hospital charges. Results: Laparoscopic appendectomy showed to be significantly associated with lower wound infection (P < 0.001) and post-operative complication rate (P < 0.001). Surgical time was considered as a hallmark of technical challenge and resulted diminished in the laparoscopic group (P = 0.018). Although not clinically relevant per se, the statistically significant shorter hospital stay (P < 0.001) was probably the reason of decreased hospital charges (P < 0.001). Intra-abdominal abscesses formation rate was higher in the open appendectomy group (P = 0.058), although slightly above the statistical significance threshold. Conclusion: Laparoscopic approach seemed to show relevant advantages compared to open appendectomy, but a large prospective trial is necessary to collect high quality data and investigate long-term outcomes.
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Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery
José Gustavo Olijnyk, Guilherme Gonçalves Pretto, Omero Pereira da Costa Filho, Fernando Koboldt Machado, Sidney Raimundo Silva Chalub, Leandro Totti Cavazzola
January-March 2014, 10(1):23-26
DOI:10.4103/0972-9941.124460  PMID:24501505
Background: According to the precepts of reduced surgical trauma and better cosmesis, an intermediate laparoscopic appendectomy technique between the conventional three-trocar procedure and Laparoendoscopic Single Site Surgery (LESS) was performed, based on literature review and experience of the surgical team. Patients and Methods: Patients with early stage acute appendicitis and a favourable anatomical presentation were selected. The procedure was performed with two ports: A 10 mm trocar at the umbilicus site for laparoscope and a 5 mm one just above the pubic bone for grasper. The appendix was secured by external wire traction through a right iliac fossa puncture with 14-gauge intravenous catheter. Results: From August 2009 to December 2012, we performed 42 cases; two required conversion to a conventional laparoscopic technique. There were no complications in the remaining, no wound infections and a mean operation time of 64.5 minutes. Conclusion: The use of two-port laparoscopic appendectomy can act as a LESS intermediate step procedure, without loss of instrumental triangulation and maintenance of appropriate counter-traction. This technique can be used as an alternative to the three-port laparoscopic procedure in patients with initial presentation of appendicitis and a favourable anatomical position.
  3,527 195 -
Laparoscopic rectopexy for complete rectal prolapse: mesh, no mesh or a ventral mesh?
Deepraj S Bhandarkar
January-March 2014, 10(1):1-3
DOI:10.4103/0972-9941.124448  PMID:24501500
  3,234 280 -
Laparoscopic management of moderate: Severe endometriosis
Pranay R Shah, Anu Adlakha
January-March 2014, 10(1):27-33
DOI:10.4103/0972-9941.124463  PMID:24501506
Objectives: To assess the feasibility of laparoscopic surgery in cases of moderate-severe endometriosis. Materials and Methods: A prospective study was carried out in a tertiary centre over a period of 2 years. Moderate to severe endometriosis was defined by revised American fertility society (rAFS) classification (41 patients). Various procedures were done to provide symptomatic relief. Feasibility of laparoscopic surgery and various patient parameters were analysed. Results: Various procedures like adhesiolysis in POD, excision of endometriomas, resection of endometriotic nodules in the recto-vaginal septum, ureterolysis and total laparoscopic hysterectomy with/ without oophorectomy were done. Majority of patients underwent cystectomy for endometriomas (53.6%) or adhesiolysis with excision of endometriotic nodule (36.5%). Total laparoscopic hysterectomy with or without ooperectomy was done in 31.7% patients. Of the total 9 patients with primary infertility and moderate-severe endometriosis, 5 patients (55.5%) conceived after surgery. Conclusion: There is good evidence that in experienced hands laparoscopic surgery helps in long-term symptomatic relief, improves pregnancy rates and reduces recurrence of disease with largely avoiding complications.
  2,778 198 -
A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy
Manash Ranjan Sahoo, Anil Kumar Thimmegowda, Manoj S Gowda
January-March 2014, 10(1):18-22
DOI:10.4103/0972-9941.124456  PMID:24501504
Aim: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. Materials and Methods: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs) were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Results: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7) days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1%) patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3%) patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. Conclusion: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.
  2,648 213 2
Anaesthetic consideration during laparoscopic bilateral simultaneous nephrectomy
Manisha P Modi, Kalpana S Vora, Geeta P Parikh, Pranjal R Modi, Veena R Shah
January-March 2014, 10(1):10-13
DOI:10.4103/0972-9941.124453  PMID:24501502
Study Objective: To assess outcome from anaesthesia during laparoscopic bilateral simultaneous nephrectomy. Design: Retrospective study. Measurements: Preoperative Hb%, serum potassium, coagulation profile electrocardiography (ECG) changes, 2D Echography, x-ray chest, haemodynamic changes, end-tidal carbon dioxide (EtCO 2 ), fluid management and postoperative analgesia. Results: The mean age was 24.75 ± 14.35 years. The mean duration of surgery was 120 ± 80 minutes. The Hb%, serum creatinine and serum potassium were 9.4 ± 1.04%, 6.79 ± 4.91 meq/L and 3.61 ± 0.51 meq/L, respectively. Pulse rate mean blood pressure and EtCO 2 were recorded after creation of pneumoperitoneum and at 15, 30, 45 and after exsufflation of pneumoperitoneum. After pneumoperitoneum, there was increase in pulse rate, systolic blood pressure, diastolic blood pressure and EtCO 2 . After 30 minutes and throughout the surgery, these variables remained stable. Four patients required nitroglycerine infusion for intraoperative hypertention. Only one patient required packed cell volume (PCV) transfusion and total intravenous fluid was 1 ± 0.5 L. At the time of exsufflation, there was decrease in pulse rate, systolic and diastolic blood pressure and EtCO 2 . Conclusion: Because of advancement in anaesthetic agents and muscle relaxant, there is safe outcome from anaesthesia during laparoscopic bilateral simultaneous nephrectomy.
  2,473 187 -
Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery
Tayar Claude, Subar Daren, Salloum Chady, Malek Alexandre, Laurent Alexis, Azoulay Daniel
January-March 2014, 10(1):14-17
DOI:10.4103/0972-9941.124454  PMID:24501503
Background: Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH). Patients and Methods: From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure TM (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.). Results: Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins. Conclusion: SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.
  2,349 190 1
Mesh erosion after laparoscopic posterior rectopexy: A rare complication
Mittu J Mathew, Amit K Parmar, Prasanna K Reddy
January-March 2014, 10(1):40-41
DOI:10.4103/0972-9941.124473  PMID:24501509
Laparoscopic posterior mesh rectopexy (LPMR) is now an accepted surgical treatment for complete rectal prolapse. It is associated with complications such as partial mucosal prolapse, fecal impaction, constipation, and rarely recurrence. Erosion of the mesh into the rectum after LPMR is very rare. We report herein the case of 40-year-old man who presented with mesh erosion into the rectum and managed successfully by the laparoscopic excision of mesh. This is probably the first such case managed by the laparoscopic approach.
  2,263 120 3
Laparoscopic splenectomy for haemangioma of the spleen
Jaisingh Shinde, Subodh Pandit, Sanjay Kolte, Sudeekshna Pratap Singh
January-March 2014, 10(1):42-44
DOI:10.4103/0972-9941.124475  PMID:24501510
Splenic haemangioma is a rare disorder but remains the most common benign neoplasm of the spleen. It accounts for 0.1 to 14% of many large autopsy series. Most haemangiomas tend to be discovered in adults in the age group 30-50 years. In 80% of cases splenic haemangioma is usually found incidentally. Spontaneous rupture has been reported to occur in as many as 25% of these patients especially when the diameter of the tumour is more than 4 cm necessitating splenectomy as the only modality of treatment. We report a case of splenic haemangioma in a 23-year female. Laparoscopic splenectomy was undertaken and spleen removed through a small left inguinal hand port incision. Post-operative period was uneventful and histopathological examination report showed splenic haemangioma. She remains well three years post-operative.
  2,166 116 -
Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis
Gaurav V Kulkarni, Sharfi Sarker, Joshua M Eberhardt
January-March 2014, 10(1):48-50
DOI:10.4103/0972-9941.124482  PMID:24501512
Traditional management of gallstone pancreatitis (GP) has been to perform cholecystectomy during the same hospital admission after resolution. However, when GP develops in the immediate postoperative period from a major colorectal operation, cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs. Thus, delaying cholecystectomy until the inflammatory response subsides may be worthwhile, and it maximizes the chances of completing the cholecystectomy laparoscopically. We have described our management of 2 patients with GP occurring after colorectal operations, which required proximal diverting ileostomy. In both cases, we deferred management of GP with either endoscopic retrograde cholangiopancreatography (ERCP) or medical conservative measures during the acute attack and performed laparoscopic cholecystectomy during ostomy reversal surgery utilizing the existing ostomy takedown site for port placement. Both patients tolerated this management well.
  2,152 122 -
Minimal invasive endoscopic management of synchronous granular cell tumours in the colon and posterior mediastinum
Ali Kocatas, Ahmet Cem Dural, Nurten Sever, Burak Kankaya, Mahmut Dogan, Gulcin Yegen, Murat Gonenc, Bilge M Bilgic, Mehmet Ali Bedirhan, Halil Alis
January-March 2014, 10(1):34-36
DOI:10.4103/0972-9941.124469  PMID:24501507
Granular cell tumour (GCT), which is a rare benign soft tissue neoplasm, is mostly found in the skin and soft tissue but may develop anywhere in the body. There are less than 10 reported cases of mediastinal GCTs in the current literature. Furthermore, colonic GCTs have recently gained attention due to the increased public awareness on the importance of colonoscopy screening. We report a case of a 52-year-old woman diagnosed incidentally with synchronous GCTs of the mediastinum and the hepatic flexure on her routine screening for post-operative follow-up for status-post right modified radical mastectomy due to a T 2 N 1 M 0 , Stage 2B breast cancer.
  2,125 84 -
Laparoscopic management of post-cholecystectomy sectoral artery pseudoaneurysm
Nilanjan Panda, Mohan Narasimhan, Alwin Gunaraj, Ramesh Ardhanari
January-March 2014, 10(1):37-39
DOI:10.4103/0972-9941.124471  PMID:24501508
Vascular injuries during laparoscopic cholecystectomy can occur similar to biliary injuries and mostly represented by intraoperative bleeding. Hepatic artery system pseudoaneurysm are rare. It occurs in the early or late postoperative course. Patients present with pallor, signs of haemobillia and altered liver function. We report a case of right posterior sectoral artery pseudoaneurysm detected 2 weeks after laparoscopic cholecystectomy and successfully repaired laparoscopically. We also describe how laparoscopic pringle clamping saved the conversion. The actively bleeding right posterior sectoral artery pseudoaneurysm was diagnosed by CT angiogram. Embolisation, usually the treatment of choice, would have risked liver insufficiency as hepatic artery proper was at risk because the origin the bleeding artery was just after its bifurcation. Isolated right hepatic artery embolisation can also cause hepatic insufficiency. To our knowledge this is the first reported case of laparoscopic repair of post-laparoscopic cholecystectomy bleeding sectoral artery pseudoaneurysm.
  1,838 92 -
Laparoscopic extirpation of giant adrenal ganglioneuroma
George P Abraham, Avinash T Siddaiah, Krishanu Das, Ramaswami Krishnamohan, Datson P George, Jisha J Abraham, Sreerenjini K Chandramathy
January-March 2014, 10(1):45-47
DOI:10.4103/0972-9941.124479  PMID:24501511
Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT) scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland.
  1,831 93 -
Simultaneous submission, duplicate publication, self-plagiarism and the proper management
Viroj Wiwanitkit
January-March 2014, 10(1):51-51
DOI:10.4103/0972-9941.124487  PMID:24501513
  1,510 113 -
© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04