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   2015| April-June  | Volume 11 | Issue 2  
    Online since March 24, 2015

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Techniques of laparoscopic cholecystectomy: Nomenclature and selection
Sanjiv P Haribhakti, Jitendra H Mistry
April-June 2015, 11(2):113-118
DOI:10.4103/0972-9941.140220  PMID:25883450
There are more than 50 different techniques of laparoscopic cholecystectomy (LC) available in literature mainly due to modifications by surgeons in aim to improve postoperative outcome and cosmesis. These modifications include reduction in port size and/or number than what is used in standard LC. There is no uniform nomenclature to describe these different techniques so that it is not possible to compare the outcomes of different techniques. We brief the advantages and disadvantages of each of these techniques and suggest the situation where particular technique would be useful. We also propose a nomenclature which is easy to remember and apply, so that any future comparison will be possible between the techniques.
  6,769 371 -
Postlaparoscopic cholecystectomy biloma in the lesser sac: A rare clinical presentation
Sudesh Sharda, Anil Sharma, Rajesh Khullar, Vandana Soni, Manish Baijal, Pradeep Chowbey
April-June 2015, 11(2):154-156
DOI:10.4103/0972-9941.140215  PMID:25883459
Bilomas resulting as a complication of cholecystectomy are often due to a leak from an inadequately secured cystic duct stump, an accessory bile duct or a duct of Luschka in the gallbladder fossa of the liver. Occasionally, bilomas may have an unusual presentation. We describe here a rare case of biloma in the lesser sac after an uneventful laparoscopic cholecystectomy.
  4,994 103 -
Congenital pulmonary airway malformation and sequestration: Two standpoints for a single condition
Lucile Fievet, Claudia Natale, Xavier-Benoit D'Journo, Stéphanie Coze, Jean-Christophe Dubus, Jean-Michel Guys, Pascal Thomas, Pascal De Lagausie
April-June 2015, 11(2):129-133
DOI:10.4103/0972-9941.137759  PMID:25883453
In adults, congenital pulmonary malformations are candidates for surgery due to symptoms. A pre-natal diagnosis is simple and effective, and allows an early thoracoscopic surgical treatment. A retrospective study was performed to assess management in two different populations of adults and children to define the best strategy. Subjects and Methods: Pulmonary malformations followed at the University Hospital from 2000 to 2012 were reviewed. Clinical history, malformation site, duration of hospitalisation, complications and pathology examinations were collected. Results: A total of 52 cases (33 children, 19 adults) were identified. In children, 28 asymptomatic cases were diagnosed pre-natally and 5 during the neonatal period due to infections. Surgery was performed on the children between the ages of 2 and 6 months. Nineteen adults underwent surgery, 16 because of symptoms and 3 adults for anomalies mimicking tumours. The mean age within the adult group was 42.5 years. In children, there was one thoracotomy and 32 thoracoscopies, with 7 conversions for difficult exposure, dissection of vascular pedicles, bleeding or bronchial injury. In the adults, there were 15 thoracotomies and 4 thoracoscopies, with one conversion. Post-operative complications in the adults were twice as frequent than in children. The mean time of the children's hospitalisation was 7.75 days versus 7.16 days for the adults. Pathological examinations showed in the children: 7 sequestrations, 18 congenital cystic pulmonary malformations (CPAM), 8 CPAM associated sequestrations; in adults: 16 sequestrations, 3 intra-pulmonary cysts. Conclusion: Early thoracoscopic surgery allows pulmonary parenchyma conservation with pulmonary development, reduces respiratory and infectious complications, eliminates a false positive cancer diagnosis later in life and decreases risks of thoracic parietal deformation.
  4,435 121 -
Laparoscopy-assisted cutaneous ureterostomy at suprapubic creaseline facilitates subsequent reimplantation
Md. Jafrul Hannan
April-June 2015, 11(2):139-142
DOI:10.4103/0972-9941.137758  PMID:25883455
Background: Cutaneous ureterostomy is still practiced despite a trend towards primary surgical correction for obstructive or refluxive uropathy. For future open reimplantation, ureterostomy can be created by minimal invasive technique at the end(s) of the suprapubic creaseline. Materials and Methods: From 1 January 2009 to 31 July 2012, seven children were treated with laparoscopy-assisted cutaneous ureterostomy followed by ureteric reimplantation. Indications were primary obstructive megaureter 3, hugely dilated ureters with reflux 3 and posterior urethral valve with poor general health 1. The distal manoeuverable part of tortuous ureter was pulled to the surface at either end of suprapubic creaseline to create the stoma. During reimplantation, this stoma was dismembered and brought inside urinary bladder obviating the need for stoma-site repair. Results: Mean age was 4.6 ± 2.8 years with six males. There were three bilateral cases with total 10 lesions. Mean operating time was 39.8 ± 12.5 minutes. Mean follow-up was 1.7 ± 0.8 years and except for peri-stomal excoriations no major complication occurred. All these were reimplanted 6-12 months after ureterostomy and faring well except in one case. Conclusions: Laparoscopy-assisted cutaneous ureterostomy can be fashioned at suprapubic creaseline to facilitate future reimplantation without much jeopardy and extra scar.
  4,360 119 -
Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study
Rajeev Sinha, Vivek Malhotra, Prashant Sikarwar
April-June 2015, 11(2):134-138
DOI:10.4103/0972-9941.142401  PMID:25883454
Background: Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure. Patients and Methods: All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded. Results: All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period. Conclusions: SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly.
  4,152 130 -
Minimally invasive management of anastomotic leak after bariatric Roux-en-Y gastric bypass
Ilhan Ece, Huseyin Yilmaz, Husnu Alptekin, Fahrettin Acar, Serdar Yormaz, Mustafa Sahin
April-June 2015, 11(2):160-162
DOI:10.4103/0972-9941.144094  PMID:25883461
The aim of this retrospective study was to examine the anastomotic erosion due to drain and success of fibrin sealant in its management. Between 2013 and 2014, 102 patients underwent LRYGB and gastrojejunal anastomotic leak occurred due to drain erosion in 2 of them. The diagnosis was established with saliva drainage and was confirmed by upper gastrointestinal series. The absence of hemodynamic instability was directed us to conservative treatment. During the endoscopy, dehiscence was assessed and fibrin sealant was applied. The leaks healed progressively in a few days, and the drains removed within 6 days. Seven and 9 days later, the patients were discharged without any problem. Anastomotic leaks after bariatric surgery can cause severe morbidity, cost, and effects quality of life. Hemodynamically stable and drained patients are candidates for conservative methods. Endoscopic injection of fibrin sealant has been successful in closing gastric leaks.
  3,973 107 -
Amyand's hernia: Our experience in the laparoscopic era
Diwakar Sahu, Sudeepta Swain, Majid Wani, Prasanna Kumar Reddy
April-June 2015, 11(2):151-153
DOI:10.4103/0972-9941.147368  PMID:25883458
Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment.
  3,820 124 -
Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial
Aly Saber, Emad N Hokkam, Goda M Ellabban
April-June 2015, 11(2):123-128
DOI:10.4103/0972-9941.153809  PMID:25883452
Introduction: The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence. Materials and Methods: A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections. Results: The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B. Conclusion: In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence. Trial Registration ACTRN12613001050741
  3,687 199 -
Transfascial suture in laparoscopic ventral hernia repair; friend or foe?
Diwakar Sahu, Somak Das, Majid Rasool Wani, Prasanna Kumar Reddy
April-June 2015, 11(2):157-159
DOI:10.4103/0972-9941.147367  PMID:25883460
'Suture hernia' is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus.
  3,748 97 -
Comparison of two minimal invasive techniques of splenectomy: Standard laparoscopy versus transumbilical multiport single-site laparoscopy with conventional instruments
Baris Bayraktar, Onur Bayraktar, Ibrahim Ali Ozemir, Ebru Kizilkilic, Erman Ozturk, Rafet Yigitbasi
April-June 2015, 11(2):143-148
DOI:10.4103/0972-9941.137756  PMID:25883456
Background: Laparoendoscopic single-site (LESS) splenectomy which is performed on small number of patients, has been introduced with better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy. Materials and Methods : Thirty six patients were included in the study comparing standard laparoscopic splenectomy (LS, 17 patients) transumbilical multiport splenectomy performed with conventional laparoscopic instruments (TUMP-LS, 19 patients). Two groups of patients were compared retrospectively by means of operation time, intra- and postoperative blood loss, perioperative complications, packed red cell and platelet requirements, lenght of hospitalization, pain scores and patient satisfaction. Results: There was no mortality in any of the groups, and no significant differences determined in operative time (P = 0,069), intraoperative blood loss (P = 0,641), patient satisfaction (P = 0,506), pain scores (P = 0,173) and the average length of hospital stay (P = 0,257). Umbilical incisions healed uneventfully and no hernia formation or wound infection was observed during follow-up period (2-34 months). There were no conversions to open surgery. Conclusions: Transumbilical multiport splenectomy performed with the conventional laparoscopic instruments is feasible and could be a logical alternative to classical laparoscopic splenectomy by combining the advantages of single access techniques and standard laparoscopy.
  3,563 140 -
Minimally invasive video-assisted thyroidectomy: Ascending the learning curve
Michela Giulii Capponi, Carlo Bellotti, Marco Lotti, Luca Ansaloni
April-June 2015, 11(2):119-122
DOI:10.4103/0972-9941.153808  PMID:25883451
Background: Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. The aim of this report is to point out some aspects of the learning curve of the video-assisted thyroid surgery, through the analysis of our preliminary series of procedures. Patients and Methods: Over a period of 8 months, we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm and total thyroid volume <20 ml; presence of biochemical and ultrasound signs of thyroiditis and pre-operative diagnosis of cancer were exclusion criteria. We analysed surgical results, conversion rate, operating time, post-operative complications, hospital stay and cosmetic outcomes of the series. Results: We performed 36 total thyroidectomy and in one case we performed a consensual parathyroidectomy. The procedure was successfully carried out in 33 out of 36 cases (conversion rate 8.3%). The mean operating time was 109 min (range: 80-241 min) and reached a plateau after 29 MIVAT. Post-operative complications included three transient recurrent nerve palsies and two transient hypocalcemias; no definitive hypoparathyroidism was registered. The cosmetic result was considered excellent by most patients. Conclusions: Advances in skills and technology allow surgeons to easily reproduce the standard open total thyroidectomy with video-assistance. Although the learning curve represents a time-consuming step, training remains a crucial point in gaining a reasonable confidence with video-assisted surgical technique.
  3,337 151 -
Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy
Chih-Yang Hsiao, Ting-Chun Kuo, Hong-Shiee Lai, Ching-Yao Yang, Yu-Wen Tien
April-June 2015, 11(2):163-164
DOI:10.4103/0972-9941.144097  PMID:25883462
A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice.
  3,168 75 -
Combination injuries of diaphragm and urinary bladder resulting urinothorax
R King Gandhi, B Sai Dhandapani, R Chithra Barvadheesh
April-June 2015, 11(2):149-150
DOI:10.4103/0972-9941.144099  PMID:25883457
Isolated diaphragmatic or urinary bladder injuries are uncommon, but rare are combination of these injuries. We report a rare case of urinothorax occurred as a result of combination injury of diaphragm and urinary bladder and our successful laparoscopic only management. A 26-year-old male presented with a history of trauma and features suggestive of bilateral pleural effusion. Radiological investigations revealed diaphragmatic and urinary bladder rupture. Laparoscopic examination of the abdomen confirmed the presence of ruptures and successful repair of both defects were done laparoscopically. High index of suspicion and early diagnosis are crucial for a better outcome in the management of diaphragmatic rupture. Laparoscopic management is a feasible and successful method in trained hands.
  2,932 76 -
ERAS in laparoscopic-assisted total gastrectomy
Aditya J Nanavati
April-June 2015, 11(2):165-165
DOI:10.4103/0972-9941.142402  PMID:25883463
  2,821 75 -
2004 Journal of Minimal Access Surgery
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