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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 : 1226]
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 : 523]
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.  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 : 832]
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

 
4.  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 : 682]
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

 
5.  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 : 568]
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

 
6.  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 : 538]
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

 
7.  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 : 529]
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

 
8.  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 : 2671]
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

 
9.  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 : 983]
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

 
10.  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 : 806]
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

 
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