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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 : 741]
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.  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 : 1298]
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

 
3.  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 : 719]
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

 
4.  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 : 565]
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

 
5.  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 : 531]
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

 
6.  Review Article
Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance
Sefik Hasukic
[Year:2014] [Month:January-April] [Volume:7 ] [Number:1] [Pages:47] [Pages No:33-40] [No of Hits : 2631]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1214 | FREE

ABSTRACT

Background: Knowledge of the pathophysiological basis of laparoscopic procedures, in particular the impact of CO2- pneumoperitoneum (PNP) on the body, can prevent onset of complications during laparoscopy.

Design and Methods: Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12 to 15 mm Hg. The direct effect of CO2-pneumoperitoneum is a consequence of the mechanical action of the gas, and increased intra-abdominal pressure. The indirect effect of CO2-pneumoperitoneum caused by the absorption of gas from the abdomen. Analysis of articles that evaluated the effects of CO2-pneumoperitoneum on the body and intra-abdominal organs contributes to an even better use of the laparoscopic method.

Results: The results of numerous experimental and clinical studies have confirmed that increased IAP and CO2-pneumoperitoneum intraoperatively causing reduction the portal venous blood flow, increasing venous stasis, reduced glomerular filtration, reduced Tiffeneau-index and pulmonary compliance what it can lead to hemodynamic and cardiac disorders. Consecutive intraoperative acidosis and hipercarbia impact the function of intra-abdominal organs and heart.

Conclusion: To avoid the side effects of CO2-pneumoperitoneum, which is important in patients with ASA II and more often as necessary to be operate with low pressure (IAP: 6-8 mm Hg) or use gasless laparoscopy.

Keywords: Laparoscopic surgery, CO2-pneumoperitoneum, Hepatic, Renal, Pulmonary and cardial changes, Venous stasis.

How to cite this article: Hasukic š. CO2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance. World J Lap Surg 2014;7(1):33-40.

Source of support: Nil

Conflict of interest: None

 
7.  Review Article
Differences between Thunderbeat, Ligasure and Harmonic Scalpel Energy System in Minimally Invasive Surgery
George Chilaka Obonna, RK Mishra
[Year:2014] [Month:January-April] [Volume:7 ] [Number:1] [Pages:47] [Pages No:41-44] [No of Hits : 2425]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1215 | FREE

ABSTRACT

Background: An essential part of surgery is dissection and securing hemostasis. This is easily done by the use of energy. Thunderbeat energy source has superseded the Ligasure and harmonic energy sources in this respect.

Aim: To review literature on the differences between thunderbeat, LigaSure and harmonic energy systems.

Materials and methods: These were drawn from previous research materials online in pubMed, researchgate, Wikipedia and YouTube.

Conclusion: Thunderbeat has a higher versatility than other instruments. This new energy device is an appealing, safe alternative for cutting, coagulation, and tissue dissection during surgery and decreases time and increases versatility during surgical procedures.

Keywords: Thunderbeat, Ligasure, Harmonic, Energy systems, Versatility.

How to cite this article: Obonna GC, Mishra RK. Differences between Thunderbeat, Ligasure and Harmonic Scalpel Energy System in Minimally Invasive Surgery. World J Lap Surg 2014; 7(1):41-44.

Source of support: Nil

Conflict of interest: None

 
8.  Review Article
Polycystic Ovarian Syndrome: Pathophysiology and Infertility
Bassim Alsadi
[Year:2014] [Month:January-April] [Volume:7 ] [Number:1] [Pages:47] [Pages No:23-27] [No of Hits : 2187]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1212 | FREE

ABSTRACT

Polycystic ovarian syndrome (PCOS) is recognized as the commonest endocrinopathy of women in the reproductive age. The definition, heterogeneity of clinical presentation, variability of symptoms in different age groups, overlapping instrumental and laboratory diagnostic criteria with physiological situations and the etiological hypotheses of PCOS are continuously evolving to accommodate expanding knowledge on the syndrome, which is now known to be more complex than purely a reproductive disorder. This article reviews the pathophysiology aspects known to underlie the ovarian and metabolic abnormalities characterizing PCOS. The interdependence between reproductive and metabolic aspects of PCOS and therapeutic implications for the management of PCOS are also discussed.

Materials and methods: extensive review of literature of articles published in English language was conducted using the following engines: Google, Yahoo, Medline, PubMed and Medscape.

Keywords: Polycystic ovary, Polycystic ovarian syndrome, Infertility.

How to cite this article: Alsadi B. Polycystic Ovarian Syndrome: Pathophysiology and Infertility. World J Lap Surg 2014;7(1):23-27.

Source of support: Nil

Conflict of interest: None

 
9.  Review Article
Comparing Extracorporeal Knots in Laparoscopy using Knot and Loop Securities
Rasaq Akintunde Akindele, Adeniyi Olanipekun Fasanu, Suresh Chandra Mondal, Johnson Olusanmi Komolafe, Rajneesh Kumar Mishra
[Year:2014] [Month:January-April] [Volume:7 ] [Number:1] [Pages:47] [Pages No:28-32] [No of Hits : 1863]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1213 | FREE

ABSTRACT

Background: Laparoscopic knot tying is a basic surgical skill that has been practiced for centuries having their roots in fishing and sailing.1-4 The advent of endoscopic surgery placed more challenges on the surgeons and this ever growing skills need to be acquired. Since endoscopic and arthroscopic knots must be delivered over a distance to a tissue with minimal access maintaining tension is more important than the knot configuration chosen.5,6 The aim of this article review is to determine which hand tied knot configuration and possibly, suture size, and suture type that would be safe in laparoscopic surgery.

Materials and methods: A literature review was performed using Pubmed, Springerlink, Highwire press and search engines, like Google and Yahoo. The following search terms were used: extracorporeal knot, arthroscopic knots, Roeder's knot, Meltzer's knot, Mishra's knot, Duncan knot, Nicky's knot, SMC knot, Weston knot and Tennessee extracorporeal knot. A total of 48,100 citations were found. Selected papers were screened for further references. Publications that featured illustrations of sliding knots with statistical methods of analysis were selected. More than 20 different sliding knots were used for this review.

Result: Eighty-one articles were reviewed. Most studies have evaluated knot security only and few studies have evaluated simultaneous both loop and knot security and also only a few compared knot and loop securities to the type of suture materials and their sizes. The addition of three RHAPs improves knot security of all sliding knots tested and improves the loop security of most of the sliding knots tested.

Conclusion: the safety of extracorporeal knot depends on knot configuration, especially when further RHAPs are included.

Keywords: Extracorporeal knot, Tissue approximation, Laparoscopic suturing.

How to cite this article: Akindele RA, Fasanu AO, Mondal SC, Komolafe JO, Mishra RK. Comparing Extracorporeal Knots in Laparoscopy using Knot and Loop Securities. World J Lap Surg 2014;7(1):28-32.

Source of support: Nil

Conflict of interest: None

 
10.  Original Article
A Comparative Randomized Parallel Group Study between the Classical TAPP Repair and Modified TAPP Surgical Method for Inguinal Hernia Repair
Sumanta Kumar Ghosh
[Year:2014] [Month:January-April] [Volume:7 ] [Number:1] [Pages:47] [Pages No:16-22] [No of Hits : 1844]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10033-1211 | FREE

ABSTRACT

Objective: To compare equality of clinical outcome of simultaneous bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernia by classical TAPP, with meticulous closure of peritoneal flap and modified TAPP, with peritoneal nonclosure and controlled release of pneumoperitoneum. Study to answer the research question-‘is meticulous closure of peritoneal flap, the only way to provide adequate cover for the mesh in TAPP repair?’

Summary and background data: The objective of meticulous closure of peritoneum is to prevent internal herniation while covering the mesh adequately to avoid contact between mesh and abdominal viscera. The study proposes same objective can also be achieved with nonclosure of peritoneum.

Patients and methods: Between August 2011 and July 2012, 130 inguinal hernias of 65 patients who underwent TAPP repair were randomized in two groups. One group (n = 65) of hernias received classical repair with peritoneal closure (control), while the other (n = 65) without closure (study). The primary end points were bowel related complications and recurrence.

Results: The two groups were comparable in age and types of hernia. Transabdominal preperitoneal was successfully done in all cases. No bowel-related complication and recurrence occurred in either group. Mean operating time was significantly less with modified TAPP (65 mins vs 76 mins, p < 0.05). Lower incidence of chronic pain (3 vs 13.84%, p = 0.007) and seroma (7.69 vs 15.38%) was achieved during mean follow-up of 628 days.

Conclusion: The randomized prospective parallel group study demonstrated equality in clinical outcome on both primary end points by providing equivalent peritoneal cover for the mesh as meticulous peritoneal closure does in classical TAPP.

Keywords: Laparoscopic repair, inguinal hernia, Preperitoneal, Transperitoneal, Complication, Intestinal.

How to cite this article: Ghosh SK. A Comparative Randomized Parallel Group Study between the Classical TAPP Repair and Modified TAPP Surgical Method for Inguinal Hernia Repair. World J Lap Surg 2014;7(1):16-22.

Source of support: Nil

Conflict of interest: None

 
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