Most Downloaded Articles

Sanjay Patolia, Ibrahim Hazza

Laparoscopic Management of Stomach Sleeve Obstruction after Sleeve Gastrectomy

[Year:2017] [Month:January-April] [Volumn:10 ] [Number:1] [Pages:43] [Pages No:40-43][No of Hits : 1548]


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

Mohammed Hamdy Abdelhady, Asaad F Salama

Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultrasonically Activated (Harmonic) Scalpel

[Year:2017] [Month:January-April] [Volumn:10 ] [Number:1] [Pages:43] [Pages No:17-21][No of Hits : 715]


Introduction: Laparoscopic cholecystectomy (LC) is the “gold standard” in the treatment of symptomatic gallbladder lithiasis. Monopolar hook, i.e., used currently is associated with some complications, such as the risk of thermal injuries and biliary complications. The ultrasonically activated (harmonic) scalpel has been increasingly used for dissection of the gallbladder and for division of vessels and the cystic duct, because it reduces the risk of thermal injuries with encouraging results.

Materials and methods: In this prospective study, 60 patients with gallbladder stones were planned to do LC. Patients were randomly assigned to either group I, including 30 patients who were subjected to traditional LC using cautery and clip applier, or to group II, including 30 planned for clipless cholecystectomy using harmonic (Ethicon Endosurgery Ultracision Harmonic Scalpel, Generator 300).

Results: Neither minor nor major bile leaks were encountered in either groups. Similarly, no bile-duct injuries were encountered in the present study. The incidence of gallbladder perforation was less in group II. Operative time was significantly shorter in group II (p = 0.032). Mean hospital stay was significantly less in group II (p = 0.046). No statistically significant difference was found in the incidence of postoperative complications between both groups.

Conclusion: The harmonic shears are as safe and effective as the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the LC. Further, it provides a superior alternative to the currently used highfrequency monopolar technology in terms of shorter operative time and lower incidence of gallbladder perforation.

Keywords: Clipless, Harmonic scalpel, Laparoscopic cholecystectomy.

How to cite this article: Abdelhady MH, Salama AF. Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultrasonically Activated (Harmonic) Scalpel. World J Lap Surg 2017;10(1):17-21.

Source of support: Nil

Conflict of interest: None

Riki Singal, Pradeep Goyal, Muzzafar Zaman, RK Mishra

Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery

[Year:2017] [Month:January-April] [Volumn:10 ] [Number:1] [Pages:43] [Pages No:12-16][No of Hits : 711]