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   2014| July-September  | Volume 10 | Issue 3  
    Online since June 20, 2014

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"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
Ricardo Zorron, Henrique N. Phillips, Greg Wynn, Manoel P. Galvao Neto, Djalma Coelho, Ricardo C. Vassallo
July-September 2014, 10(3):144-150
DOI:10.4103/0972-9941.134878  PMID:25013331
Background: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde ("Down-to-Up") total mesorectal excision for rectal cancer. Materials And Methods: Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis. Results: Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients. Conclusion: This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results.
  3,731 158 1
Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy
Manash Ranjan Sahoo, Manoj S Gowda, Anil T Kumar
July-September 2014, 10(3):132-138
DOI:10.4103/0972-9941.134876  PMID:25013329
Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS) in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22) patients received enhanced recovery programme (ERAS) management and rest twenty-five (n = 25) conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h) when compared to conventional group (140 ± 28 h). ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h). There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43) g/L vs. (73.07 ± 19.32) g/L, d3 (126.10 ± 18.62) g/L vs. (160.72 ± 26.18) g/L)]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.
  3,248 127 -
Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience
Mittu John Mathew, Amit Kumar Parmar, Diwakar Sahu, Prasanna Kumar Reddy
July-September 2014, 10(3):126-131
DOI:10.4103/0972-9941.134875  PMID:25013328
Context: Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management. Aims: Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date. Herein, we present our experience with laparoscopic management of pancreatic necrosis in 28 patients. Materials And Methods: A retrospective study of 28 cases [20 men, 8 women] was carried out in our institution. The medical record of these patients including history, clinical examination, investigations, and operative notes were reviewed. The mean age was 47.8 years [range, 23-70 years]. Twenty-one patients were managed by transgastrocolic, four patients by transgastric, two patients by intra-cavitary, and one patient by transmesocolic approach. Results: The mean operating time was 100.8 min [range, 60-120 min]. The duration of hospital stay after the procedure was 10-18 days. Two cases were converted to open (7.1%) because of extensive dense adhesions. Pancreatic fistula was the most common complication (n = 8; 28.6%) followed by recollection (n = 3; 10.7%) and wound infection (n = 3; 10.7%). One patient [3.6%] died in postoperative period. Conclusions: Laparoscopic pancreatic necrosectomy is a promising and safe approach with all the benefits of minimally invasive surgery and is found to have reduced incidence of major complications and mortality.
  3,124 193 -
Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis
Manash Ranjan Sahoo, Anil T Kumar, Aashish Patnaik
July-September 2014, 10(3):139-143
DOI:10.4103/0972-9941.134877  PMID:25013330
Introduction : The 'Rendezvous' technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. Materials And Methods: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In 'group-A',41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In 'group-B', 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. Results: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. Conclusion: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD.
  3,054 202 -
Spillage-free laparoscopic management of hepatic hydatid disease using the hydatid trocar canula
Kalpesh Jani
July-September 2014, 10(3):113-118
DOI:10.4103/0972-9941.134873  PMID:25013326
Introduction: This study was undertaken to demonstrate the efficacy of the Hydatid Trocar Canula system for safe and effective treatment of hepatic hydatid cysts. Materials And Methods: All cases presenting to our centre for treatment of hydatid cyst of the liver with certain exceptions were considered for laparoscopic management using the specifi cally designed Hydatid Trocar Canula system. The technique of surgery and the step wise sequence of deployment of the device are described. Results: Since January 2007, 16 patients compromising six males and 10 females underwent this procedure at our centre. The average age of the patients was 37.6 years and all of them had a single cyst. The average duration of surgery was 86 minutes. None of the cases suffered intraoperative mishap like spillage or anaphylaxis. Till date, follow-up has been maintained in 81.3% of the patients and no recurrence has been detected. Conclusion: The correct use of the Hydatid Trocar Canula system allows for spillage-free and complete evacuation of hepatic hydatid cysts.
  2,910 180 -
Single incision laparoscopic hepatectomy: A systematic review
Ioannis D. Gkegkes, Christos Iavazzo
July-September 2014, 10(3):107-112
DOI:10.4103/0972-9941.134872  PMID:25013325
Single incision laparoscopic surgery is a rather innovative surgical technique. A systematic literature review was performed with the intention to evaluate the till now clinical evidence regarding the application of single incision technique on liver resections as a method of management in hepatic lesions. Twelve relative studies were found in the field including 30 patients with a age range from 29 to 90 years and a body mass index from 20.1 to 36.5 kg/m 2 . Primary hepatic carcinoma (40%), metastatic nodules (26.7%), hepatic cysts (16.7%), hepatic haemangiomas (13.3%) and hepatic adenoma (3.3%) were the most common indications of the lesions resected. The types of hepatectomy performed included partial hepatectomy (43.3%), segmentectomy (30%) and lobectomy (26.7%). In the majority of the patients, left lateral segments (II-III-IV) (76.7%) were resected. The median operative time was 110 min (range: 55-235) while the median quantity of blood loss was 50 ml (range: 0-100). No conversion to open surgery and no transfusion were needed. The duration of hospital stay ranged between 2 and 11 days. No complications, no cases of disease recurrence or death of patients were reported. None of the studies included described data on the cosmesis of the application of single incision laparoscopic technique on hepatic resections. Moreover, the surgical technique, as well as the different type of ports used is also presented in this review. Single site port laparoscopic surgery is a promising minimally invasive procedure for liver resections.
  2,393 137 1
Meralgia paraesthetica: Laparoscopic surgery as a cause then and a cure now
Pradeep Jagdish Chopra, Raj Kumar Jananiculum Shankaran, Dilip Chander Murugeshan
July-September 2014, 10(3):159-160
DOI:10.4103/0972-9941.134883  PMID:25013335
Meralgia Paraesthetica (MP) is a rare condition, in which the patient experiences a burning sensation along the distribution of the lateral femoral cutaneous nerve of the thigh, due to entrapment neuropathy at the lateral end of the inguinal ligament as it exits the pelvis. There are several causes of this condition including laparoscopic inguinal hernioplasty. Diagnosed clinically, intervention is indicated for failed conservative measures. We herewith report a patient with MP and symptomatic cholelithiasis, treated for both laparoscopically. This is the third reported case in the literature that has been treated laparoscopically.
  2,348 91 -
Retention of an endoscopic capsule
Girish D Bakhshi, Mukund B Tayade, Kavita V Jadhav, Dayanand D Choure, Narsing L Mane, Sunil R Patil
July-September 2014, 10(3):163-165
DOI:10.4103/0972-9941.134886  PMID:25013337
Capsule endoscopy is a highly advanced, newer technology to look for small bowel diseases. But it has certain contraindications such as bowel narrowing, strictures that have to be ruled out on Barium studies or with computed tomography. We present a rare case of retention of endoscopic capsule even after ruling out stricture or bowel thickening on radiological imaging.
  1,955 81 -
The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy
Sofie AF Fransen, EPM Broeders, LPS Stassen, ND Bouvy
July-September 2014, 10(3):119-125
DOI:10.4103/0972-9941.134874  PMID:25013327
Introduction: Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. Materials And Methods: An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. Results: A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Conclusion: Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained before this procedure can be implemented into everyday practice.
  1,882 90 1
Primary laparoscopic cholecystectomy in patients with portal cavernoma and non-obstructive portal biliopathy: Two case reports
Parveen Bhatia, Suviraj John, Sudhir Kalhan, Mukund Khetan
July-September 2014, 10(3):161-162
DOI:10.4103/0972-9941.134885  PMID:25013336
A laparoscopic cholecystectomy can be technically challenging with co-existing portal hypertension, as commonly seen with cirrhosis of the liver. Extra hepatic portal vein obstruction (EHPVO) although less common, is a significant cause of portal hypertension in India. EHPVO has a unique clinical profile, which differentiates it from portal hypertension associated with cirrhosis of the liver. This impacts therapy in EHPVO algorithmically and operatively. We report two cases of symptomatic gall stones with portal cavernoma. Further evaluation revealed non-obstructive portal biliopathy. Both underwent a successful laparoscopic cholecystectomy. We highlight the importance of careful operative strategy, diligent haemostasis and the feasibility of performing a laparoscopic cholecystectomy in patients with symptomatic gall stones associated with a portal cavernoma.
  1,879 74 -
Asymptomatic intraperitoneal ascariasis: Importance of diagnostic laparoscopy
Santhosh Anand, Aditya P Sharma, Sandeep Aggarwal, Devajit Nath, Sandeep Mathur
July-September 2014, 10(3):157-158
DOI:10.4103/0972-9941.134881  PMID:25013334
Migration of Ascaris from intestine into peritoneal cavity is rare and usually presents as acute abdomen. We report a case of 41-year-old male who was admitted for laparoscopic mesh rectopexy for rectal prolapse. During the initial laparoscopy, purulent fluid was seen in pelvis. A complete diagnostic laparoscopy was done. An omental nodule was found, which was excised and extracted in a bag. On histopathology, the omental nodule revealed gravid Ascaris lumbricoides.
  1,852 90 -
Enhanced recovery after surgery in laparoscopic gastric cancer surgery: Many questions, few answers
Shailesh V. Shrikhande, Esha Pai
July-September 2014, 10(3):105-106
DOI:10.4103/0972-9941.134871  PMID:25013324
  1,802 131 -
Complete laparoscopic removal of a gastric trichobezoar
Deepti Vepakomma, Anand Alladi
July-September 2014, 10(3):154-156
DOI:10.4103/0972-9941.134880  PMID:25013333
Trichobezoars are seen usually in adolescent girls and laparotomy is required to remove them, though recently laparoscopic assisted and laparoscopic removal have been reported in adults and older children. We report this 4-year-old boy who underwent complete laparoscopic removal of a gastric trichobezoar, both for its rarity in such young boys and also because he is the youngest reported patient to undergo complete laparoscopic removal of a gastric trichobezoar.
  1,828 83 -
Laparoscopic excision of large ciliated hepatic foregut cyst
Janakiraman Saravanan, Govindhan Manoharan, Satheyanesan Jeswanth, Palaniyappan Ravichandran
July-September 2014, 10(3):151-153
DOI:10.4103/0972-9941.134879  PMID:25013332
Ciliated hepatic foregut cysts (CHFCs) are rare congenital cysts of the liver that originate from the embryologic foregut. Despite an increase in incidence, they remain rare and several key characteristics remain poorly understood, including the range of presentation and the risk of malignant conversion. Large, symptomatic cysts and small asymptomatic, atypical cysts should be resected. We present a patient who recently underwent laparoscopic excision of a CHFC, review the literature and propose the rationale for attempting removal of these cysts through a laparoscopic approach.
  1,808 80 -
Laparoscopic repair of a small bowel herniation through a broad ligament defect
Agustin Buero, Ezequiel A. Silberman, Pablo Medina, Matias E. Morra, Diego J. Bogetti, Eduardo A. Porto
July-September 2014, 10(3):166-167
DOI:10.4103/0972-9941.134887  PMID:25013338
A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful.
  1,524 76 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04