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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 : 1422]
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.  ORIGINAL ARTICLE
Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery
Riki Singal, Pradeep Goyal, Muzzafar Zaman, RK Mishra
[Year:2017] [Month:January-April] [Volume:10 ] [Number:1] [Pages:43] [Pages No:12-16] [No of Hits : 624]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1294 | FREE

ABSTRACT

Aims and objectives: To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, postoperative pain, incidence of complications, and cosmetic results.

Materials and methods: The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Totally, 200 adult patients of cholelithiasis with chronic cholecystitis were included in the study. These cases were randomly divided into two groups (I and II) consisting of 100 cases in each group.
The study was conducted for a period of 1 year from April 2014 to March 2015. Three-port LC was performed in group I patients and four-port LC was performed in group II. The cosmetic results, incidence of postoperative complications, and operative time were noted in both the groups. The present study is being undertaken to compare the various merits and demerits of three-port LC vs four-port LC performed by the same surgical team in the same scenario, in terms of parameters mentioned subsequently and assess the feasibility of both the procedures in our setup in a medical college.

Results: Gallstone disease is found to be more common in the 4th and 5th decades. Mean age of presentation was 41 years. Three-port LC is difficult in cases of dense adhesions. There were significant differences in operative time (93.16 minutes for three-port LC and 50.66 minutes for four-port LC). There was no significant difference due to type of operation. Cosmetic appearances for both the procedures were comparable.

Conclusion: We concluded that both three-port and four-port cholecystectomies are equally good procedures in the hands of experienced laparoscopic surgeons. The complications, operative time, hospital stay, cosmesis, and disability days were comparable in both groups. The four-port technique should be accepted and adopted only by beginners in minimal access surgery. The operator who performs three-port LC should be prepared for placement of an additional port or conversion to open laparotomy whenever complication arises.

Keywords: Cholecystectomy, Complications, Incision, Laparoscopy, Ports.

How to cite this article: Singal R, Goyal P, Zaman M, Mishra RK. Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery. World J Lap Surg 2017;10(1):12-16.

Source of support: Nil

Conflict of interest: None1

 
3.  ORIGINAL ARTICLE
Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultrasonically Activated (Harmonic) Scalpel
Mohammed Hamdy Abdelhady, Asaad F Salama
[Year:2017] [Month:January-April] [Volume:10 ] [Number:1] [Pages:43] [Pages No:17-21] [No of Hits : 587]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1295 | FREE

ABSTRACT

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

 
4.  ORIGINAL ARTICLE
Laparoscopic Appendectomy as a Standard of Care for Both Complicated and Uncomplicated Appendicitis in South Africa, Is It Safe? Single Center Experience
Fusi Mosai, Zach M Koto
[Year:2017] [Month:January-April] [Volume:10 ] [Number:1] [Pages:43] [Pages No:22-25] [No of Hits : 513]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1296 | FREE

ABSTRACT

Aim: The aim of this descriptive analytical study was to describe the outcomes of using laparoscopic appendectomy (LA) as the standard of care for both complicated and uncomplicated cases of acute appendicitis in South Africa.

Background: Laparoscopic appendectomy has been widely accepted as safe when performed in uncomplicated cases of acute appendicitis. However, acceptance of this procedure as the standard of care has been surrounded by controversies, with the main concern been around the safety of this procedure in complicated cases of appendicitis. Currently, there is no consensus in published literature regarding the use of LA as the standard of care in both complicated and uncomplicated appendicitis.

Materials and methods: A retrospective analysis of all patients who were diagnosed with acute appendicitis at Dr George Mukhari Academic Hospital over a 3-year period was reviewed. Data were retrieved from our departmental database and analyzed using descriptive statistics.

Results: A total of 746 patients were reviewed and 576 were included in the study. All these patients were offered LA. The mean age was 26.37, with 66% of our patients been males. Complicated cases formed 38% of our total study population. Laparoscopic appendectomy was performed in both complicated and uncomplicated cases of appendicitis with a success rate of 96%. Intraoperative complication rate and the relook rate was 0.5 and 7% respectively, with an overall mortality of 1.7%.

Conclusion: The positive outcome found in this study when LA was used in both complicated and uncomplicated cases of acute appendicitis suggests that this approach is possible in carefully selected patients and with appropriate basic laparoscopic skills.

Clinical significance: Complicated appendicitis is not a contraindication to laparoscopy.

Keywords: Appendicitis, Complicated appendicitis, Laparoscopic appendectomy, Uncomplicated appendicitis.

How to cite this article: Mosai F, Koto ZM. Laparoscopic Appendectomy as a Standard of Care for Both Complicated and Uncomplicated Appendicitis in South Africa, Is It Safe? Single Center Experience. World J Lap Surg 2017;10(1):22-25.

Source of support: Nil

Conflict of interest: None

 
5.  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 : 994]
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

 
6.  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 : 837]
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

 
7.  REVIEW ARTICLE
Various Port-site Closure Techniques in Laparoscopic Surgeries
MK Medha
[Year:2016] [Month:September-December] [Volume:9 ] [Number:3] [Pages:35] [Pages No:138-141] [No of Hits : 660]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1291 | FREE

ABSTRACT

Introduction: Minimally invasive surgeries are the advantageous and cosmetically better surgical procedures nowadays. But laparoscopic trocars do create wounds. It is necessary to close these wounds with a good technique in order to decrease the complications related to port-site complications, especially hernia.

Aim: This study is to review and list different techniques used for closure of port-site wounds.

Materials and methods: A literature search was performed for the articles related with techniques of closure of trocar sites. For this purpose, the search engines used were Google, HighWire Press, and SpringerLink. Only those techniques that include the usage of suture materials, suture carriers, and various needles were reviewed in this study. Special devices made for port-closure are not reviewed here.

Results: The study describes many techniques, including classical closure using curved needles, such as the Grice needle, Maciol needles, spinal needles, dual hemostat, suture carrier, modified Veress needle with a slit made in retractable brunt tip, dental awl with an eye, prolene 2/0 on straight needle aided by Veress needle, straight needle armed with suture, modified Veress needle bearing a crochet hook at tip; Foley catheter threaded through port-hole for elevation of fascial edge upon traction; fish-hook needle improvised out of a hypodermic needle by bending it to 180°; U-shaped purse-string suture placed in the fascia around port-hole.

Conclusion: There are plenty of techniques for closure of trocar-site wounds, all of them are effective in closing the fascial defect of abdominal wall.

Keywords: Laparoscopic surgeries, Port-site closure techniques, Trocar-site hernia.

How to cite this article: Medha MK. Various Port-site Closure Techniques in Laparoscopic Surgeries. World J Lap Surg 2016;9(3):138-141.

Source of support: Nil

Conflict of interest: None

 
8.  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 : 641]
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

 
9.  Original Article
Smartphone/Tablet-based Laparoscopy Simulation System: A Low-cost Training Module for Beginners in Minimally Invasive Surgery
Ashish Saxena
[Year:2016] [Month:January-April] [Volume:9 ] [Number:1] [Pages:49] [Pages No:26-29] [No of Hits : 606]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1265 | FREE

ABSTRACT

Laparoscopic surgery is a well-established domain of surgery and it has become essential for surgical practitioners to be well versed in the technique. It has a steep learning curve which exists because of a number of additional skills required for a successful transition from open surgery to minimally invasive procedures. Hence, it is desirable that a trainee should practice laparoscopy upon simulation devices before attempting an actual procedure on a patient. Two types of simulators are currently available in the market: box type and virtual reality type. The major limitation in their use is the cost factor involved. These simulators are relatively expensive, which the trainees in developing countries can ill afford. My efforts were directed at developing a low-cost simulator that is easy to assemble, requires minimal investment, and helps in improving depth perception and ambidexterity at the same time. I devised a simulation system based on smartphone/tablet. These gadgets (smartphone/tablet) are easily available everywhere at a reasonable cost. In the apparatus devised by me, the rear camera of a smartphone works as a laparoscopic camera and its screen works as the monitor. Light-emitting diode flash of the device functions as the light source. The smartphone has to be attached to a specially designed box fitted with accessories to perform various tasks. The practice sessions can be recorded and used for monitoring and evaluation by experts. A satisfactory level of elementary laparoscopy training can be imparted at a lower cost using smartphone-based simulation system.

Keywords: Box-type trainer, Depth perception, Laparoscopy training, Simulation system, Smartphone, Virtual reality trainer.

How to cite this article: Saxena A. Smartphone/Tablet-based Laparoscopy Simulation System: A Low-cost Training Module for Beginners in Minimally Invasive Surgery. World J Lap Surg 2016;9(1):26-29.

Source of support: Nil

Conflict of interest: None

 
10.  Review Article
Stump Cholecystitis
Abhilash Jayachandran
[Year:2016] [Month:January-April] [Volume:9 ] [Number:1] [Pages:49] [Pages No:34-37] [No of Hits : 579]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1267 | FREE

ABSTRACT

Laparoscopic cholecystectomy is most commonly performed minimal access surgery by general surgeons. But still, some postoperative patients are not getting relieved from their symptoms. Most retrospective studies show that presence of stone is mostly in the cystic duct or in the common bile duct and some also show the presence of cystic stump (1-1.5 cm). Most of the patients with complaints were thoroughly evaluated and subjected to completion cholecystectomy. These patients were followed-up from 6 months to 1 year and all patients were asymptomatic.

Keywords: Common bile duct stone, Gallbladder stone disease, Laparoscopic cholecystectomy, Remnant gallbladder, Stump cholecystitis.

How to cite this article: Jayachandran A. Stump Cholecystitis. World J Lap Surg 2016;9(1):34-37.

Source of support: Journal of Minimal Access Surgery, PUBMED, HINDAWI, Asian Journal of Endoscopic surgeon, Hepato-Pancreato- Biliary HPB) Surgery Cystic.

Conflict of interest: Remanant stones in CBD may lead to stump cholecystitis

 
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