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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  CASE REPORT
Laparoscopic Management of Stomach Sleeve Obstruction after Sleeve Gastrectomy
Sanjay Patolia, Ibrahim Hazza
[Year:2017] [Month:January-April] [Volume:10 ] [Number:1] [Pages:43] [Pages No:40-43] [No of Hits : 1150]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1300 | FREE

ABSTRACT

Introduction: Stomach sleeve obstruction can occur after sleeve gastrectomy (SG). It results in absolute intolerance to liquid and food intake. The obstruction of sleeve may be because of stomach torsion, twisting, kinking, folding, adhesions, and stenosis/narrowing.
We present a case report of two patients with absolute intolerance to liquid intake because of sleeve obstruction. The reason for obstruction was folding, twisting, and partial torsion of the stomach sleeve after SG.

Case/technique description: Two patients with absolute intolerance to liquid intake were received on day 5 and on day 12 after undergoing primary laparoscopic SG.
The endoscopy findings were similar in both the cases. It was not possible to reach pylorus without great difficulty and high level of maneuverability.
The laparoscopic findings were twisting and partial torsion due to laxity of the sleeve. Gastropexy was done in both the cases. The recovery in terms of excellent tolerance for liquid intake was immediate and that too without recurrence.

Discussion: The distal passage for food and liquid in the lumen of the sleeve should remain very smooth. The lumen can accept arrival of the Ryle’s tube or gastric calibration tube up to antrum without any great assistance. This will not be possible in case of improper architecture of the crafted sleeve. The design of the sleeve may be improper from the beginning or it may mutate because of abnormal adhesion at any time during postoperative course. Symptoms and endoscopic findings are diagnostic of the problem. Laparoscopic correction of the architecture of the sleeve by doing adhesiolysis and gastropexy is successful.

Keywords: Gastric sleeve kinking, Gastric sleeve obstruction, Gastric sleeve twisting, Gastric torsion, Gastric volvulus, Gastropexy, Sleeve gastrectomy.

How to cite this article: Patolia S, Hazza I. Laparoscopic Management of Stomach Sleeve Obstruction after Sleeve Gastrectomy. World J Lap Surg 2017;10(1):40-43.

Source of support: Nil

Conflict of interest: None

 
2.  Research Article
Laparoscopic-assisted Vaginal Hysterectomy vs Handassisted Laparoscopic Hysterectomy
Sheriff Z Kotb, Mohamed El-Metwally, Nazem Shams, Ashraf Khater
[Year:2016] [Month:May-August] [Volume:9 ] [Number:2] [Pages:56] [Pages No:63-70] [No of Hits : 703]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1274 | FREE

ABSTRACT

Objectives and background: The use of laparoscopic techniques now permits combination of benefits of both abdominal and vaginal hysterectomy. But, laparoscopic hysterectomy has been associated with a higher risk of urinary tract injury compared with abdominal and vaginal procedures, and the risks of these minimally invasive approaches must be balanced with the benefits. Hand-assisted laparoscopic surgery was first described in the early 1990s as a surgical method designed to facilitate the performance of challenging laparoscopic procedures while maintaining the advantages of a minimally invasive approach.
Our present study aims to compare between laparoscopicassisted vaginal hysterectomy (LAVH) and hand-assisted laparoscopic hysterectomy (HALH).

Materials and methods: This study was conducted at the Oncology Center of Mansoura University (OCMU). A total of 41 sequential patients scheduled for hysterectomy were divided randomly (patient by patient) into two groups: group 1 included 21 patients who underwent LAVH and group 2 included 20 patients who underwent HALH from August 2010 to March 2013.

Patients were excluded from this study if they had contraindications to either vaginal hysterectomy, such as several prior abdominal surgeries, vaginal stenosis, or severe endometriosis, or to laparoscopy, including underlying medical conditions that could be worsened by pneumoperitoneum or the Trendelenburg position. Body mass index was not a limiting factor for patient inclusion in the study.

Results: The clinical characteristics of the 41 patients were similar as regards age, parity, and uterine size. The indications for hysterectomy among the study groups were nearly similar. No statistically significant difference was found between the two groups in operative time. Operative blood loss was higher in the LAVH group. Two cases in the LAVH group were converted to laparotomy to control bleeding and to repair a urinary bladder tear.

Conclusion: The HALH group had less analgesic consumption, earlier ambulation, shorter hospital stay, and earlier regain of daily and coital activities. On the contrary, the HALH group had much more direct costs, which requires much effort to be directed toward this fruitful technique and more training programs to surgeons to increase their experience in enriching hand skills in this emerging technique.

Keywords: Hand-assisted laparoscopy surgery (HALS), Hysterectomy, Laparoscopic-assisted vaginal hysterectomy.

How to cite this article: Kotb SZ, El-Metwally M, Shams N, Khater A. Laparoscopic-assisted Vaginal Hysterectomy vs Hand-assisted Laparoscopic Hysterectomy. World J Lap Surg 2016;9(2):63-70.

Source of support: Nil

Conflict of interest: None

 
3.  REVIEW ARTICLE
Should Laparoscopy be the Gold Standard for Isthmocele?
Roshan Zeirideen Zaid
[Year:2016] [Month:September-December] [Volume:9 ] [Number:3] [Pages:35] [Pages No:118-121] [No of Hits : 537]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1287 | FREE

ABSTRACT

Isthmocele is born due to the overwhelmingly increasing cesarean section (CS) rates all over the world. It was an unknown entity in the last century. Cesarean sections are and can be responsible for short- and long-term maternal and fetal morbidity, mortality, and financial issues, directly and indirectly associated to the former. Out of the many problems that are caused by CS, isthmocele is a growing surgical concern that needs attention in identifying, diagnosing, managing, and treating this problem. Currently, treatments include medical and surgical approaches. Hysteroscopy as well as laparoscopy are used in the treatment. This review was carried out to show that laparoscopy is superior in treating an isthmocele than all other treatment modalities.

Materials and methods: An electronic search was done and various articles and studies were reviewed to support the hypothesis.

Keywords: Cesarean section, Hysteroscopy, Isthmocele, Niche, Postmenstrual bleeding, Scar defect.

How to cite this article: Zaid RZ. Should Laparoscopy be the Gold Standard for Isthmocele? World J Lap Surg 2016; 9(3):118-121.

Source of support: Nil

Conflict of interest: None

 
4.  Case Report
Novel Technique in Laparoscopic Staple-line Reinforcement
Hanan M Alghamdi
[Year:2016] [Month:May-August] [Volume:9 ] [Number:2] [Pages:56] [Pages No:104-106] [No of Hits : 518]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1284 | FREE

ABSTRACT

Bleeding prevention and control can be very challenging in laparoscopic surgery. The author describes a new and less expensive technique to lower the incidence of staple-line bleeding in laparoscopic surgery.

Keywords: Laparoscopic, Laparoscopic hemostasis, Laparoscopic staple line, Laparoscopic staple-line reinforcement.

How to cite this article: Alghamdi HM. Novel Technique in Laparoscopic Staple-line Reinforcement. World J Lap Surg 2016;9(2):104-106.

Source of support: Nil

Conflict of interest: None

 
5.  LITERATURE REVIEW
Comparison between Robotic Radical Hysterectomy with Laparoscopic and Open Abdominal Radical Hysterectomy in the Treatment of Early Stage Cervical Cancer
Boy Busmar
[Year:2015] [Month:January-April] [Volume:8 ] [Number:1] [Pages:34] [Pages No:26-31] [No of Hits : 2262]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1241 | FREE

ABSTRACT

Robot-assisted procedures are being increasingly incorporated in gynecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over laparoscopic and open abdominal radical hysterectomy approaches with regard to operative time, blood loss and hospital stay.
Also, initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be compensated by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches.

Keywords: abdominal radical hysterectomy, blood loss, conversion rate, early cervical cancer, hospital stay, laparoscopic radical hysterectomy, number of lymph node, operative time, postoperative infection, recurrence, Robot-assisted radical hysterectomy, urinary tract complication.

How to cite this article: Busmar B. Comparison between Robotic Radical Hysterectomy with Laparoscopic and Open Abdominal Radical Hysterectomy in the Treatment of Early Stage Cervical Cancer. World J Lap Surg 2015;8(1):26-31.

Source of support: Nil

Conflict of interest: None

 
6.  ORIGINAL ARTICLE
Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain
A Rubbia, GA Faryal, I Javeria, M Roohul
[Year:2015] [Month:January-April] [Volume:8 ] [Number:1] [Pages:34] [Pages No:7-12] [No of Hits : 924]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1237 | FREE

ABSTRACT

Aim: The aim of our study was to evaluate and establish the role of diagnostic laparoscopy (DL) in unexplained/nonspecific abdominal pain (NSAP) in this era of therapeutic laparoscopy, and thus to analyze and support the theory of minimal access surgery in diagnosing and treating abdominal conditions.

Materials and methods: In this prospective study included patients with abdominal pain of (i) more than 6 hours and less than 6 days duration (acute) and (ii) more than or equal to 6 months duration (chronic) were included whether presenting as a surgical emergency or coming to surgical outpatient department (OPD) in whom a DL was performed after failure to achieve a diagnosis with conventional methods. The study included a total of 168 consecutive patients who fulfilled our inclusion criteria and underwent DL for NSAP. Their demographic and clinical data, admission dates and dates of surgery were noted. Outcome of surgery was recorded and the data were analyzed to ascertain the role and diagnostic yield of laparoscopy in our department, both in acute and chronic abdominal pain of nonspecific nature. Patients were followed postoperative for 3 months for any recurrence of symptoms.

Results: Laparoscopy yielded diagnoses in 161 of these patients giving a diagnostic yield of 95.8%. Appendicitis (39.2%), gynecological pathology (16%) and abdominal tuberculosis (8.9%) were the major findings. Therapeutic procedures were performed in 112 cases (66.6%) where peroperative pathology was identified. In 38 cases (22.6%) where there was strong clinical suspicion of appendicitis and no pathology could be identified peroperative, an appendectomy was performed. Twenty-eight (73.6%) of these appendix specimens were found inflamed on subsequent histologic examination. There were no complications in this series.

Conclusion: This study establishes the role of early DL as a safe procedure with high efficacy. Hence, it is an effective investigative tool in undiagnosed abdominal pain of both acute and chronic nature.

Keywords: acute appendicitis, Diagnostic laparoscopy, gynecological pathology.

How to cite this article: Rubbia A, Faryal GA, Javeria I, Roohul M. Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain. World J Lap Surg 2015;8(1):7-12.

Source of support: Nil

Conflict of interest: None

 
7.  RANDOMIZED CONTROL TRIAL
Effect of Warm-up Exercises on Laparoscopic Trainer: Improvement of Operator Smoothness
Nava Navaneethan, Peter Hewett
[Year:2015] [Month:January-April] [Volume:8 ] [Number:1] [Pages:34] [Pages No:21-25] [No of Hits : 774]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1240 | FREE

ABSTRACT

Background: Several recent studies have produced conflicting results of warming up prior to laparoscopic surgery and surgical performance. The purpose of this study was to investigate whether warming up prior to a laparoscopic task improves a subsequent task performed on a laparoscopic trainer.

Materials and methods: A prospective randomized controlled trial was conducted to compare warm-up modalities to no warm-up. The study was conducted at a single site, with 44 participants, including surgeons, medical students and surgical trainees. Randomization done within each group.
Control group was asked to do a designated task without a warm-up. Warm-up groups were asked to perform a warmup exercise prior to the designated task. Performances were recorded and analyzed with a computerized software different performance parameters were compared.

Results: Warm-up was a significant predictor of smoothness of the operator’s hand movement at the 5% significance level (p = 0.0358).
While there were some improvement of performances between control groups was demonstrated, they were not clinically significant.

Conclusion: This study shows that warming up prior to a task has a positive influence in the subsequent performance in smoothness of instrument movement in surgeons group. The major limitation of the study was the number of participants.

Keywords: Exercises, Laparoscopy, Simulation, Training, Warm-up.

How to cite this article: Navaneethan N, Hewett P. Effect of Warm-up Exercises on Laparoscopic Trainer: Improvement of Operator Smoothness. World J Lap Surg 2015;8(1):21-25.

Source of support: Nil

Conflict of interest: None

 
8.  ORIGINAL ARTICLE
Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study
Muzzafar Zaman, Kunal Chowdhary, Pradeep Goyal
[Year:2015] [Month:January-April] [Volume:8 ] [Number:1] [Pages:34] [Pages No:13-15] [No of Hits : 671]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1238 | FREE

ABSTRACT

Background: Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient. Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum. We designed a study to compare the postoperative pain after laparoscopic cholecystectomy at low pressure (7-8 mm Hg) and standard pressure technique (12-14 mm Hg).

Aim: To compare the effect of low pressure and standard pressure pneumoperitoneum in post-laparoscopic cholecystectomy pain. Further to study, the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy.

Settings and design: A prospective randomized double blind study.

Materials and methods: A prospective randomized double blind study was done in 50 ASA grade I and II patients. They were divided into two groups-25 each. Group A, patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum (7-8 mm Hg) while group B, underwent laparoscopic cholecystectomy with standard pressure pneumoperitoneum (12-14 mm Hg). Both the groups were compared for pain intensity, analgesic requirement and complications. Shoulder tip pain was recorded on a visual analog pain scale 1, 6, 12, 24 and 48 hours after operation.

Statistical analysis: Demographic data and intraoperative complications were analyzed using Chi-square test. Frequency of pain, intensity of pain, analgesics consumption and other pneumoperitoneum related complications were compared by applying ANOVA test.

Results: Postoperative pain score was significantly less in low pressure group as compared to standard pressure group. Number of patients requiring rescue analgesic doses was more in standard pressure group. This was statistically significant. Also total analgesic consumption was more in standard pressure group. There was no difference in intraoperative complications.

Conclusion: This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of postoperative pain, and hence early recovery and better outcome. This study also shows that low pressure technique is safe with comparable rate of intraoperative complications.

Keywords: laparoscopic cholecystectomy, Low pressure pneumoperitoneum, shoulder tip pain.

How to cite this article: Zaman M, Chowdhary K, Goyal P. Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study. World J Lap Surg 2015;8(1):13-15.

Source of support: Nil

Conflict of interest: None

 
9.  Review Article
Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention
Abdullah Badawi
[Year:2015] [Month:May-August] [Volume:8 ] [Number:2] [Pages:32] [Pages No:43-47] [No of Hits : 664]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1245 | FREE

ABSTRACT

Background: Anastomotic leakage (AL) is a common complication and still is a significant problem following laparoscopic colorectal surgery. Risk factors and prevention for AL are not well-defined.

Methods: A systematic search of electronic databases. Cohort, case-control studies and randomized controlled trials that examined clinical risk factors and prevention for AL were included.

Conclusions: In conclusion, tumor location ≤ 6 cm from the anal verge, tumor size > 5 cm, preservation of the left colic artery, male gender, severe malnutrition, body mass index (BMI) ≥ 25, preoperative Neoadjuvant therapy and steroid therapy, American Society of Anesthesiologists (ASAs) score ≥ 3, tobacco abuse, operating time ≥ 180 minutes, precompression before stapler firing and multiple firing of the stapler are associated with increase the risk of developing AL. On the other hand, Improve nutritional status, control comorbidities, stop smoking at least 2 weeks before surgery and preoperative use of mechanical bowel preparation, assessment and subsequent adaptation of operative technique without multiple firings of stapler or precompression before stapler firings and the use of transanal tube postoperatively, showed decrease in the al rate following laparoscopic colorectal procedures.

Keywords: Anastomotic leak, Colon cancer, Colorectal cancer, Laparoscopic colorectal surgery, Laparoscopy, Prevention of anastomotic leakage, Risk factor of anastomotic leakage.

How to cite this article: Badawi A. Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention. World J Lap Surg 2015;8(2):43-47.

Source of support: Nil

Conflict of interest: None

 
10.  Research Article
Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entry-related Complicatons and Failure of Technique
Muzzafar Zaman, Samita Singal, Rikki Singal, Aliya Shah, Karamjot Singh Sandhu, Bir Singh, Aadhar Khera, Sagar Bassi
[Year:2015] [Month:September-December] [Volume:8 ] [Number:3] [Pages:40] [Pages No:69-71] [No of Hits : 513]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1250 | FREE

ABSTRACT

The modern art of examining the abdominal cavity by laparoscopy and its contents which requires insertion of a cannula through abdominal wall, creation of pneumoperitoneum and visualization of abdominal cavity to perform any surgical procedure has become a routine in many institutions. The first step in any laparoscopic procedure is creation of pneumoperitoneum for which mostly carbon dioxide is the recommended gas used. Two commonly used methods to create pneumoperitoneum are closed (veress needle) and open technique (Hasson technique). Both have their own advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety of the procedure, time for induction of pneumoperitoneum, air leakage, and time required to complete the procedure.

Aim: To compare the open and closed methods of creating pneumoperitoneum for doing various laparoscopic procedures in terms of their safety, operating time and other parameters.

Settings and design: A prospective randomized double blind study.

Materials and methods: This was a randomized controlled prospective study conducted at Department of General and minimal access surgery, MMIMSR Medical College, Ambala Haryana from August 2013 to December 2015. Pneumoperitoneum was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitoneum was calculated in each group. Failure to induce pneumoperitoneum was determined for each technique. Time required to induce pneumoperitoneum, total operating time, air leakage and injuries sustained during induction of pneumoperitoneum were compared in both techniques.

Result: Out of the total 200 patients included in study, 100 were in group A and 100 in group B. Mean time required for successful pneumoperitoneum was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in groups A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. Air leakage was seen in five patients in group B and none in group B. In two cases in group A minor complications during creation of pneumoperitoneum were observed while in group B no complication occurred. Port site infection and port site hernia was seen in group B and none in group A. No patient died in the study. Two patients were having preperitoneal insufflation which was presented as injury due to induction of pneumoperitoneum.

Conclusion: We concluded from this study that open technique of pneumoperitoneum was, less time consuming and safer than the closed technique.

Keywords: Hasson’s technique, Laparoscopic cholecystectomy, Pneumoperitoniem, Veress needle.

How to cite this article: Zaman M, Singal S, Singal R, Shah A, Sandhu KS, Singh B, Khera A, Bassi S. Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entryrelated Complications and Failure of Technique. World J Lap Surg 2015;8(3):69-71.

Source of support: Nil

Conflict of interest: None

 
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