Current Issue Volume 11, Number 1 , January-April 2018

EDITORIAL
RK Mishra

Editorial

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:v]



Robot-assisted procedures have now become more popular in a few kinds of surgeries. In 2017, there were about 4,500 of them scattered around the world’s hospitals, and they took part in 850,000 operations. Most of those procedures were urological and gynecological. But robots also helped surgeons operate on colons, hearts and other organs. The operations that are performed laparoscopically can be made through the robot, with more accuracy and safety. The use of robot surgery favors a less invasive operation, with a much better view of the organs being operated, with great approximation of the structures, with the surgeon’s vision in three dimensions, procedure even less invasive, and with less tissue trauma.


ORIGINAL RESEARCH
Hesham Kasem, Wael Alshahat

Laparoscopic Appendectomy for Perforated Appendicitis in Children

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:1-4]



Aim: To evaluate the outcome of laparoscopic (LA) vs open appendectomy (OA) in children with perforated appendicitis.

Materials and methods: Retrospective review was conducted from January 2013 to October 2016 evaluating 81 patients with perforated appendicitis based on surgical approach. We compared demographics, mean operative time, length of stay, infectious complications, and follow-up in patients with OA (n = 37) and LA (n = 44).

Results: Compared with OA, LA resulted in a lower rate of wound infection (4.5 vs 8.1.5%; p < 0.05). The occurrence of the intraabdominal abscess was significantly lower in the LA group (0 vs 5.4%; p < 0.05). There was a significant difference in the duration of operation between the two groups; it was 61.6 ± 20.3 minutes in OA, compared with the LA group (51.6 ± 28.6 minutes) (p < 0.05).

Conclusion: We conclude that LA provides better postoperative course, less postoperative pain, and less postoperative complications.

Keywords: Children, Complicated appendicitis, Complications, Laparoscopic appendectomy, Open appendectomy.

How to cite this article: Kasem H, Alshahat W. Laparoscopic Appendectomy for Perforated Appendicitis in Children. World J Lap Surg 2018;11(1):1-4.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Kunal Chowdhary, Muzzafar Zaman, Rahul Yadav, Ashish K Choudhary, Preeti Grewal, Ashutosh Bawa, Aliya Shah

Injectable Tramadol vs Diclofenac for Postoperative Pain Management in Laparoscopic Cholecystectomy Surgery: A Comparative Prospective Study

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:5-7]



Introduction: Laparoscopic management of gallstones is considered as the gold standard treatment nowadays and is the most common surgery done in the present scenario. Postoperative pain remains one of the most common complaints after laparoscopic cholecystectomy and should be managed with proper analgesia with minimal side effects.

Aim: To compare the efficacy of injectable tramadol and diclofenac in the pain management after laparoscopic cholecystectomy surgery.

Materials and methods: A randomized prospective study was done at Maharishi Markandeshwar College of Medical Science & Research in the Department of General Surgery on 50 patients undergoing laparoscopic surgery between December 2016 and December 2017. Postoperative analgesic is decided randomly with the help of dice. Pain is measured on visual analog scale (VAS) on 6, 12, 18, and 24 hours.

Results: A total of 50 patients, divided in two groups I and II, were taken in this study from December 2016 to December 2017 who underwent laparoscopic cholecystectomy. Group I was given injection diclofenac and group II was given injection tramadol postoperatively for pain management 8 hourly. Both I and II groups were matched in all respect with age, weight, and operative time. Pain relief after diclofenac first dose postoperatively in 8 hours was seen in 7 patients, in 9 to 16 hours in 12 patients, and 17 to 24 hours in 18 patients. Pain relief after tramadol first dose postoperatively in 8 hours was seen in 16 patients, in 9 to 16 hours in 21 patients, and 17 to 24 hours in 25 patients. Postoperatively, patients complained of nausea and vomiting. Group II having tramadol infusion complained of higher incidence of nausea and vomiting as compared with group I having diclofenac for pain management.

Conclusion: Pain after laparoscopic cholecystectomy is a common complaint encountered. Good analgesia should be given to patients but should have minimal side effects. It was concluded from our study that tramadol in injectable form is a better option than diclofenac for pain relief and comfortable postoperative period.

Keywords: Diclofenac, Laparoscopic cholecystectomy, Pain, Tramadol.

How to cite this article: Chowdhary K, Zaman M, Yadav R, Choudhary AK, Grewal P, Bawa A, Shah A. Injectable Tramadol vs Diclofenac for Postoperative Pain Management in Laparoscopic Cholecystectomy Surgery: A Comparative Prospective Study. World J Lap Surg 2018;11(1):5-7.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Utpal De, Pronoy Kabiraj

Preoperative Infraumbilical Anthropometry: A Selective Guide to Endoscopic Hernia Repair—A Pilot Study

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:8-11]



Introduction: Specific preoperative indications for endoscopic hernia repair are nonexistent. The study was aimed to examine the feasibility of preoperative infraumbilical anthropometry (PIA) as a guide to define endoscopic repair.

Materials and methods: Forty-five patients were recruited for the study based on predefined inclusion and exclusion criteria. Preoperative anthropometric measurements (fixed bony points of pelvis and umbilicus) were done. All patients were subjected to total extraperitoneal repair (TEP). Failure of TEP was converted to transabdominal preperitoneal repair (TAPP) and reasons for conversion were noted and statistically analyzed.

Results: A total of 33 patients underwent TEP (73.3%) and 12 (26.7%) patients had to be converted to TAPP. Raised body mass index (BMI) [mean 22.53, standard deviation (SD) 0.35, p < 0.001], increased infraumbilical fat pad thickness (mean 2.77 cm, SD 0.27, p < 0.00), and pelvic anthropometric parameters were found to be significant (p < 0.001).

Conclusion: Preoperative pelvic anthropometry could be a selective guide to endoscopic hernia repair.

Keywords: Anthropometry, Endoscopy, Hernia, Treatment.

How to cite this article: De U, Kabiraj P. Preoperative Infraumbilical Anthropometry: A Selective Guide to Endoscopic Hernia Repair’A Pilot Study. World J Lap Surg 2018;11(1):8-11.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Maulana M Ansari

Posterior Rectus Sheath: A Prospective Study of Laparoscopic Live Surgical Anatomy during Total Extraperitoneal Preperitoneal Hernioplasty

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:12-24]



Aim: Posterior rectus sheath (PRS) recently assumed great importance during laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty. However, literature is scanty and cadaveric. Novel observations on live PRS anatomy are reported here.

Materials and methods: Totally, 60 male patients with primary inguinal hernia underwent 68 TEPP hernioplasties. Standard 3-midline-port technique was used with telescopic dissection. Data were analyzed as mean ± standard deviation (SD).

Results: All patients were male with mean age and body mass index of 50.1 ± 17.2 years (18-80) and 22.6 ± 2.0 kg/m2 (19.5-31.2) respectively. The classically described PRS (normal-length whole tendinous) was found in only 46% of the cases, while in the remaining 54%, the PRS was found as variant types, which included short whole-tendinous (4.4%), long whole tendinous (LWT) (4.4%), complete-length whole tendinous (8.8%), normal-length partly tendinous (NPT) (11.8%), long partly tendinous (LPT) (10.3%), normal-length thinned-out (NTO) (1.5%), complete-length thinned-out (4.4%), normal-length grossly attenuated (1.5%), complete-length grossly attenuated (4.4%), complete-length partly tendinous (CPT) (1.5%), and complete-length musculo-tendinous (CMT) (1.5%). Additionally, anatomy of the PRS was not a mirror image on the two sides of the body in 75% of patients with bilateral hernias. No hernia recurrence occurred in mean follow-up of 33 months.

Conclusion: Posterior rectus sheath varied markedly in its extent and morphology, resulting in its categorization of 12 types. Truly new visions of the structures known for centuries are realized under excellent perspective and magnification of laparoscopy, and, therefore, continued anatomic research is strongly recommended.

Clinical significance: Crisp, precise knowledge of preperitoneal anatomy is of paramount importance for timely identification of its variations in order to perform a seamless laparoscopic hernia repair with better outcome.

Keywords: Clinical research, Laparoscopic live surgical anatomy, Posterior rectus canal, Posterior rectus sheath, Preperitoneal anatomy, Total extraperitoneal preperitoneal access anatomy, Total extraperitoneal preperitoneal anatomy.

How to cite this article: Ansari MM. Posterior Rectus Sheath: A Prospective Study of Laparoscopic Live Surgical Anatomy during Total Extraperitoneal Preperitoneal Hernioplasty. World J Lap Surg 2018;11(1):12-24.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Malwinder Singh, Atul Jain, Subhajeet Dey, Tanweer Karim, Nabal Mishra, Mansoor Bandey

Rouviere's Sulcus and Critical View of Safety: A Guide to prevent Bile Duct Injury during Laparoscopic Cholecystectomy

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:25-28]



Context: Laparoscopic cholecystectomy is a commonly performed minimal invasive surgery. However, its advantages are somewhat tempered due to risk of injury to bile duct.

Aims: The objective of the study is to identify Rouviere’s sulcus (RS) and critical view of safety (CVS) before commencement of dissection of Calot’s triangle to prevent injury to bile duct.

Materials and methods: A series of consecutive 100 patients admitted in the Department of Surgery in our hospital with uncomplicated symptomatic cholelithiasis underwent laparoscopic cholecystectomy identifying RS and CVS and complications (if any) emphasizing bile duct injury.

Results: The average duration of surgery after identifying RS and achievement of CVS was 65.30 minutes. There was no incidence of bile duct injury after identification of RS and achievement of CVS.

Conclusion: Rouviere’s sulcus is an important anatomical landmark for the safe laparoscopic cholecystectomy. Achievement of CVS should be tried in all laparoscopic cholecystectomy.

Keywords: Bile duct injury, Critical view of safety, Laparoscopic cholecystectomy, Rouviere’s sulcus.

How to cite this article: Singh M, Jain A, Dey S, Karim T, Mishra N, Bandey M. Rouviere’s Sulcus and Critical View of Safety: A Guide to prevent Bile Duct Injury during Laparoscopic Cholecystectomy. World J Lap Surg 2018;11(1):25-28.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Abhipsa Mishra, Sujit Behera

Pouch of Douglas: A Noble Route for Surgical Specimen Retrieval in Laparoscopic Pelvic Mass Surgery

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:29-32]



Aim: To evaluate the feasibility and surgical outcome of surgical specimen retrieval through the pouch of Douglas by an innovative way of puncturing the same with a 10 mm trocar and cannula in 100 consecutive women undergoing laparoscopic gynecological procedures for a pelvic mass.

Materials and methods: A prospective study over a period of 2 years from June 2012 to June 2014; 100 cases of pelvic mass (small-to-large) surgeries were done laparoscopically and specimens removed through pouch of Douglas by our own new method of puncturing the same with 10 mm trocar and cannula and putting the mass in endobag and removing with a grasper. Parameters studied were indications, operative time, blood loss, spillage, postoperative pain, long-term complications.

Results: In 96% of cases, surgical specimens were retrieved successfully, with minimal spillage without any intraoperative or postoperative complication. Though the rest 4% were retrieved successfully, 2% had laceration but they were managed intraoperatively, 2% had postoperative abscess formation managed conservatively. Only 5% had pain in vagina at 24 hours on 10 cm visual analog scale (VAS); 95% cases had no complaint of dyspareunia on 3rd month follow-up and 5% were lost to follow-up.

Conclusion: A pouch of Douglas approach for specimen removal by our new method after laparoscopic resection of pelvic masses offers the advantage of less postoperative pain, with minimal spillage, good cosmetic result, and patient satisfaction without prolonging the operative time.

Clinical significance: Tissue retrieved through pouch of Douglas after puncturing with 10 mm trocar with cannula under vision is a safe, feasible, less time-consuming method in laparoscopic pelvic mass surgery. It avoids the enlargement of operative port site.

Keywords: Incisional hernia, Laparoscopic, NOTES, Port closure.

How to cite this article: Mishra A, Behera S. Pouch of Douglas: A Noble Route for Surgical Specimen Retrieval in Laparoscopic Pelvic Mass Surgery. World J Lap Surg 2018;11(1):29-32.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Sugandha Agarwal

Robot-assisted Laparoendoscopic Single-site Myomectomy: Current Status

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:33-37]



Introduction: The commercial availability of robotic da Vinci surgical system (Intuitive Surgical inc., Sunnyvale, California, USA) has attracted the gynecologic surgeon’s interest due to proposed favorable surgical ergonomics, greater precision in dissection, and easier suturing as well as knot tying. Robot-assisted laparoendoscopic single-site surgery appears to be encouraging for more suture-intensive surgeries like myomectomy as it offers potential in resolving the ergonomic challenges imposed by the restrictive range of motion and vision of conventional LESS.

Aim: The aim of this review is to appraise the available literature on robot-assisted laparoendoscopic single-site (RA-LESS) myomectomy and comment on the feasibility, reproducibility, learning curve as well as financial implications of this technique.

Results: The studied outcome measures of mean operative time, estimated blood loss, and number and type of myomas removed suggest that this is a feasible technique. It was found to be a safe procedure with no reported intraoperative complications or conversions and negligible postoperative complications. The data on financial implication are, however, limited.

Conclusion: Current initial data indicate that RA-LESS is a promising technique. It is a safe and reproducible procedure for performing myomectomy. However, more studies with larger cohorts and long-term follow-ups are needed to conclusively recommend this technique for a wider application.

Clinical significance: With increasing experience in minimal invasive techniques and availability of single-port da Vinci surgical system, more challenging surgeries like myomectomy can be safely performed to optimize clinical benefits to the patients.

Keywords: Myomectomy, Robotic, Single site.

How to cite this article: Agarwal S. Robot-assisted Laparoendoscopic Single-site Myomectomy: Current Status. World J Lap Surg 2018;11(1):33-37.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Md Sumon Rahman

Efficiency of Laparoscopic Appendicectomy in Perforated Appendicitis

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:38-42]



Minimal access surgery is nowadays widely practiced in both diagnosis and management of various infective conditions of abdomen. Laparoscopic appendicectomy (LA) is a procedure of choice in acute or chronic appendicitis in any age group. Laparoscopy is also recommended in appendicolithiasis, perforated appendicitis, and appendicular abscess with evidence of less morbidity and hospital stay in comparison to open approach.
Some studies reported formation of postoperative intraabdominal abscess (IAA) and challenged the laparoscopic management in perforated appendicitis. We searched through internet for relevant articles with the keywords like LA in acute appendicitis, burst appendix, appendicular abscess, intraabdominal abscess, perforated appendicitis, etc. Individual case report or case series lack in control group for comparison were excluded from our review.
This study reviewed the efficacy of LA in perforated appendicitis. Parameters we concentrated were on operation techniques related to operation time, conversion rate, surgical site infection, IAA formation, hospital stay, use of analgesics, and the cost.

Keywords: Burst appendix, Complicated appendicitis, Intraabdominal abscess, Laparoscopic appendicectomy, Perforated appendicitis.

How to cite this article: Rahman MS. Efficiency of Laparoscopic Appendicectomy in Perforated Appendicitis. World J Lap Surg 2018;11(1):38-42.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Shalmali Alva

Laparoscopic vs Robotic Surgery in Colorectal Cases

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:43-47]



Minimally invasive techniques have become the new norm in the arena of colorectal cases with surgeons preferring laparoscopic commonly and robotics occasionally and sometimes hand-assisted laparoscopic surgery to deal with a variety of conditions in the colorectal region. Minimally invasive techniques have resulted in better and smaller postoperative scars, lesser postoperative pain, reduced hospital stay, and resultant faster return to daily activities and work. The aim of this review article is to compare the short-term outcomes of laparoscopic colorectal surgery and robotic colorectal surgery as also the cost vs overall benefit of both techniques. The studies have been taken from reputed institutes (both teaching and nonteaching) from across the world and have been sourced from Medline, Cochrane Central, and PubMed which have compared laparoscopic vs robotic techniques in colorectal cases on various parameters.
The two methods have shown fairly comparable duration of hospital stay and postoperative recovery and places performing higher load of robotics are having cost benefit over open surgeries in colorectal cases owing to faster discharge from hospital comparable to laparoscopic approach. This promising factor will probably enable further widespread use of robotics in colorectal cases.

Keywords: Colorectal surgery, Cost vs benefit, Laparoscopic surgery, Learning curve, Robotic surgery.

How to cite this article: Alva S. Laparoscopic vs Robotic Surgery in Colorectal Cases. World J Lap Surg 2018;11(1):43-47.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Shyam Sundar, Balaji Purushotham, Rajkumar Rathinasamy, Prabu Kathiresan

Meandering Pancreatic Duct as a Cause of Idiopathic Recurrent Pancreatitis

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:48-50]



Idiopathic pancreatitis contribute to about 20% of acute and recurrent pancreatitis. Here we present a case of loop-type variant of meandering pancreatitis. A patient with a very rare anomaly of the main pancreatic duct presented with recurrent episodes of pancreatitis.

Keywords: Anomalous pancreatic biliary junction, Idiopathic pancreatitis, Loop type, Meandering pancreatic duct.

How to cite this article: Sundar S, Purushotham B, Rathinasamy R, Kathiresan P. Meandering Pancreatic Duct as a Cause of Idiopathic Recurrent Pancreatitis. World J Lap Surg 2018;11(1):48-50.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Ankit Shukla, Varun Verma, Bhanu Gupta, Rajesh Chaudhary, Nishant Nayar

Percutaneous Closure of Internal Ring: A Leap Ahead

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:51-53]



Surgery for inguinal hernia is commonly performed in children. Traditional approach is open herniotomy. However, numerous minimal invasive methods are evolving with the same or low complication and recurrence rates. Percutaneous internal ring suturing (PIRS) under vision is a minimal invasive technique which is simple, effective, remarkably cosmetic, economical, easy to learn and reproduce with short operative time, and helpful in identifying occult contralateral hernia. This procedure was performed first time in our secondary care set-up with gratifying results for the patient, parents, and the operating team.

Keywords: Inguinal hernia, Laparoscopic, Laparoscopically assisted simple suture obliteration, Percutaneous internal ring suturing.

How to cite this article: Shukla A, Verma V, Gupta B, Chaudhary R, Nayar N. Percutaneous Closure of Internal Ring: A Leap Ahead. World J Lap Surg 2018;11(1):51-53.

Source of support: Nil

Conflict of interest: None


INNOVATION RESEARCH
Patrick O Igwe

Laparoscopy in Developing Countries: A Resident-friendly Endo-Lap New Training Device\

[Year:2018] [Month:January-April] [Volumn:11 ] [Number:1] [Pages:57] [Pages No:54-57]



Introduction: Surgery via minimal access is the beauty of a surgical procedure. With minimal access, besides less pain and early return to activity for the patient, the surgeon also feels fulfilled. Minimal access surgery is currently gaining ground in developing countries. Training devices to achieve this especially for residents are not only scarce but expensive also in developing economies.

Aim: The aim of this study is to present a new resident-friendly training device for laparoscopy with the hope of improving residents’ training in developing countries.

Materials and methods: A normal television monitor, camera, and bucket with cover is used to design an Endo-Lap trainer. Sigmoidoscopy and colonoscopy conduits are also incorporated in this device.

Conclusion: Surgery using minimal access technique can be aided with a training device made locally to achieve costeffective and wider training benefits.

Keywords: Developing country, Endoscopy, Laparoscopy, Training device.

How to cite this article: Igwe PO. Laparoscopy in Developing Countries: A Resident-friendly Endo-Lap New Training Device. World J Lap Surg 2018;11(1):54-57.

Source of support: Nil

Conflict of interest: None


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