World Journal of Laparoscopic Surgery

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Volume 17, Number 1, January-April 2024
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EDITORIAL

RK Mishra

Editorial

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/wjols-17-1-iv  |  Open Access | 

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Original Article

Rekha Khyalappa, Vaibhav Vimalnath Mudhale, Suraj Dige, Shubham Gupta

Effectiveness of Simulation Training for Minimal Access Surgery (MAS) in PG Students

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Clinical skills, Diagnostic laparoscopy, Laparoscopic, Medical education, Medical simulation, Surgery, Surgical Procedure, Simulators

   DOI: 10.5005/jp-journals-10033-1585  |  Open Access |  How to cite  | 

Abstract

The use of simulation-based medical education and learning is one of the most crucial phases in curriculum development. A synthetic depiction of a real-world procedure used to accomplish educational objectives through hands-on learning is referred to as simulation. Any educational activity that uses simulation aids to mimic clinical circumstances is referred to as simulation-based medical education. Instead of studying like an apprentice, medical simulation enables the purposeful practice of clinical skills acquisition. Real patients can be substituted using simulation technologies. A trainee does not have to worry about hurting the patient in order to make errors and grow from them. Simulators come in a variety of forms and classifications, and their prices vary based on how closely they mimic reality, or “fidelity”. The cost of simulation-based learning is high. But when used correctly, it's economical. It has been discovered that medical simulation improves clinical competency for both undergraduate and graduate students. It has also been discovered to have several benefits, including raising medical providers’ competency levels, which can lower medical expenses and increase patient safety. This narrative review article's goal is to emphasize the value of simulation as a cutting-edge teaching strategy for graduate and undergraduate students.

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Original Article

Jyotirmaya Nayak, Ashish Kumar Behera, Rupashree Sahoo

Laparoscopic Inguinal Hernia Repair for Children is the Final Frontier: Experience from a Tertiary Care Center

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:4] [Pages No:5 - 8]

Keywords: Herniotomy, Inguinal hernia, Laparoscopic

   DOI: 10.5005/jp-journals-10033-1600  |  Open Access |  How to cite  | 

Abstract

Background: Pregnancy-induced hypertension (PIH) has been conventionally managed by open surgery and herniotomy which is the standard of care. But in the era of minimal access surgery, laparoscopic surgery for pediatric inguinal hernia has emerged as an alternative and is being routinely performed at many centers. Laparoscopic herniotomy is a safe and feasible option for pediatric inguinal hernia in present times. It has shown results similar to well-performed conventional herniotomy procedure with respect to marked reduction in operative time, and postoperative complications, postoperative pain, postoperative hospital stay, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of testis, no postoperative hydrocele formation and excellent cosmesis. It provides a superior tool to diagnose contralateral patency of processus vaginalis (CPPV) or rare hernias that can be managed in the same session with minimal dissection, lesser postoperative complications, and better cosmesis thus favoring its wider adoption among surgeons globally in management of pediatric inguinal hernia. Method: Data for all elective cases of PIH who underwent initial laparoscopic herniotomy repair in routine operation theater at our tertiary care center, during the period from 1st March 2010 to 1st March 2023 have been collected. Results: A total of 53 laparoscopic inguinal herniotomies were performed on 50 patients. The median age of patients at the date of operation was 6.2 years. Of all patients, 47 cases were unilateral and 3 were bilateral inguinal hernias (IHs). Conclusion: Laparoscopic inguinal herniotomy is a technically easier and safer technique than conventional open methods as there is no need for dissection of vas deferens and vessels. Laparoscopic herniotomy allows for the excellent visualization of cord structures and their proper safeguarding during the procedure. Simultaneous identification of CPPV in cases of unilateral IH and its repair reduces the risk of metachronous hernia as well. Less postoperative pain, early recovery, and better cosmesis make laparoscopic surgery the final frontier in the management of PIH, thus cementing its role as a viable and probably a better alternative to conventional repair.

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Original Article

Shams Ul Bari

Laparoscopic Management of Hepatic Hydatid Cyst: A Single Institute Based Experience

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:5] [Pages No:9 - 13]

Keywords: Advanced laparoscopic surgery, Diagnostic laparoscopy, Direct trocar entry

   DOI: 10.5005/jp-journals-10033-1594  |  Open Access |  How to cite  | 

Abstract

Background: Various modalities of treatment for hydatid cyst of liver include drug therapy, conventional open surgery and laparoscopic surgery. Laparoscopic approach is preferred in view of its minimal invasiveness, short hospital stay, early recovery, and lesser wound-related complications. Aims and objectives: To study the safety and feasibility of laparoscopic surgery in hydatid disease of liver in selected patients. Materials and methods: The study entitled, “laparoscopic management of hepatic hydatid cyst—A single institute-based experience” was conducted in the Department of General and Minimal Invasive Surgery SKIMS Medical College Bemina, Srinagar, Kashmir, India from November 2019 to August 2021 with a further follow-up for a period of 1 year from September 2021 to August 2022 and the total number of patient studied was 35. Cysts located in segment 3, 4, 5, 6, and 8, with no evidence of calcifications or infection or major biliary communication were included in the study. Cyst located in segment 1, 2, and 7, cyst located near vascular hilum, deep seated cyst, recurrent cysts, and ruptured hydatid cyst were excluded from the study. Results: The study included 35 patients which included 17 males and 18 females. Twenty eight (80%) patients had a single univesicular cyst located in right lobe of liver, while as three patients had a cyst in right lobe as well as left lobe. Four patient had two cysts in the right lobe. Deroofing of the cyst with evacuation of contents was done in 23 (65.71%) patients while as partial pericystectomy was done in 12 (34.28%) patients. External tube drainage was done in 19 (54.28%) patients while as omentopexy was done in 16 (45.71%) patients. The average operative time was 89.80 minutes (60–120 minutes). Postoperative biliary leak was seen in three patients, which ceased spontaneously within 7–10 days in two patients. One patient needed ERCP with sphincterotomy. Time for return to work was 8.10 days (6–12 days). One of the patients had recurrence after 18 months. Conclusion: Laparoscopic hydatid surgery is safe and feasible in selected patients. The main advantage being the lower postoperative morbidity, shorter hospital stay, early return to routine work and low recurrence rate.

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Original Article

Le Huy Luu, Tran Van Hoi, Nguyen Van Hai, Nguyen Anh Dung, Nguyen Lam Vuong, Do Dinh Cong

Is Prophylactic Abdominal Drainage Necessary after Laparoscopic Colectomy for Colon Cancer? A Propensity Score-matched Analysis

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:6] [Pages No:14 - 19]

Keywords: Colectomy, Laparoscopic surgery, Routine drainage

   DOI: 10.5005/jp-journals-10033-1596  |  Open Access |  How to cite  | 

Abstract

Aim: In 2018, the Enhanced Recovery after Surgery (ERAS) Society recommended against routine drainage after colorectal surgery. However, the evidence is relatively old and few studies were performed in low-to-middle income country (LMIC) setting. This study aimed to compare outcomes of laparoscopic colectomy with and without prophylactic drainage for colon cancer. Methods: A retrospective study was performed from 2018 to 2021 with patients who underwent laparoscopic colectomy with D3 lymphadenectomy for colon cancer. The use of prophylactic drainage was depended on routine practice of surgeons. Outcomes were postoperative complications and postoperative hospital length of stay. The drain and no-drain groups were compared using propensity score-matched (PSM) analysis. Results: The study included 143 patients (59 in the drain group and 84 in the no-drain group). The PSM resulted in 94 patients (47 in each group). Median age was 62 years. The most frequent was right hemicolectomy (33.6%), followed by left hemicolectomy (32.2%), sigmoid colectomy (21%), extended right hemicolectomy (9.8%), transverse hemicolectomy (2.1%), and total colectomy (1.4%). Postoperative hospital stay was significantly shorter in the no-drain group (median of 5 vs 6 days). The no-drain group also had lower rate of complications (23.8 vs 30.5% and 23.4 vs 34% before and after matching, respectively) and less severe complications based on Clavien-Dindo classification, but the difference was not significant. Conclusion: Laparoscopic colectomy without prophylactic drainage is safe in the treatment of colon cancer. This approach can shorten postoperative hospital stay and should be applied even in the LMIC setting.

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Original Article

Patrick Okechukwu Igwe

Nebulizer Underwater Sealed Chest Tube Drain Assembly: An Innovation for Irrigation in Laparoscopy and Endoscopy Procedures

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:3] [Pages No:20 - 22]

Keywords: Irrigation, Laparoscopy and endoscopy, Nebulizer, Underwater sealed chest tube drain

   DOI: 10.5005/jp-journals-10033-1581  |  Open Access |  How to cite  | 

Abstract

Background: The conventional method of irrigation during laparoscopy and endoscopy is well documented in literature. The use of nebulizer or underwater sealed chest tube drain to achieve this has not been designed or studied in literature. Aim: To showcase an innovation using nebulizer and underwater sealed chest tube drain assembled for irrigation during laparoscopy and endoscopy procedures. Materials and methods: A prospective preliminary experimental study was conducted using a newly designed method of irrigation in laparoscopic and endoscopic surgeries performed from March 2021 to March 2022 in a tertiary center and a private hospital in South Southern, Nigeria. Ethical approval was obtained from the hospital ethics committee and informed consent was obtained from patients. The effectiveness of this new method was compared with standard irrigation machine as control. The patients were blocked into laparoscopy and colonoscopy procedures, respectively. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 26). Results: The results showed that the use of nebulizer underwater sealed chest tube drain assembly was very effective in laparoscopy and colonoscopy procedures. In three cases of fundoplication operations, five cases of cholecystectomies and 30 cases of hydro-jet insufflation colonoscopies were performed with good outcomes. Conclusion: This new novel method will serve a very good alternative irrigation method in laparoscopy and endoscopy procedures. It is currently being studied in other methods, such as hysteroscopy, cystoscopy, and therapeutic endoscopies.

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Original Article

Sayed Mohammed Asfaque Aamir, Sattwik Acharya

Evaluation of Perioperative Factors for Prediction of Postcholecystectomy Syndromes

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:5] [Pages No:23 - 27]

Keywords: Abdominal pain, Acute cholecystitis, Analysis, Bile duct injury, Calot's triangle, Cholecystostomy, Cholelithiasis, Gallstone, Laparoscopic cholecystectomy, Tokyo guidelines

   DOI: 10.5005/jp-journals-10033-1605  |  Open Access |  How to cite  | 

Abstract

Aim: To find the factors contributing to postcholecystectomy symptoms after laparoscopic cholecystectomy. Methodology: A retrospective observational study with 50 symptomatic patients visiting the outpatient department (OPD) of the Department of Surgery and Department of Casualty following laparoscopic cholecystectomy whose perioperative clinical factors were evaluated to predict the development of postcholecystectomy syndromes using a Chi-square test. Conclusion: • Pain was the predominant symptom seen in all (100%) of the patients. • Female sex (70%) and body mass index (BMI; 30%) were a strong significant predictor. • Previous history of hospitalization (p < 0.0008) for acute cholecystitis (32%), acute pancreatitis (4%), obstructive jaundice (18%), cirrhosis (14%) were significant predictors of pelvic congestion syndrome (PCS). • Ultrasonography (USG) findings (p < 0.0471) of thickened gallbladder (GB) wall (40%) and pericholecystic collection (16%) were strong predictors of difficult surgery and contributed to PCS. • The most common type of early PCS was bile leak (16%). • Age and previous abdominal surgeries were not significant predictors.

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Original Article

Vinita Sarbhai, Preeti

Hysteroscopy, an Essential Adjunct to Laparoscopy, in Evaluation of Women with Chronic Pelvic Pain

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:5] [Pages No:28 - 32]

Keywords: Chronic pelvic pain, Diagnostic laparoscopy, Hysterectomy, Hysterolaparoscopy, Hysteroscopy, Laparoscopic surgery, Polyp, Uterine abnormality

   DOI: 10.5005/jp-journals-10033-1597  |  Open Access |  How to cite  | 

Abstract

Introduction: Chronic pelvic pain (CPP) is a significant contributor to morbidity in women, accounting for 10–20% of all visits to gynecology outpatient department (OPD). Evaluating CPP remains a challenge due to its broad and multifactorial etiology. While laparoscopy is considered the gold standard for diagnosing CPP, it may overlook intrauterine causes. Hysteroscopy, on the other hand, provides an internal view for diagnosing intrauterine pathologies. Aim and objectives: This study aims to assess the role of hysteroscopy as a complementary procedure with laparoscopy in the evaluation of women with CPP. Materials and methods: This study was conducted at the Department of Obstetrics and Gynaecology in Kasturba Hospital, New Delhi, India. From January 2017 to March 2020, 50 women with CPP lasting more than six months underwent hysteroscopy in conjunction with laparoscopy. They were assessed for the causes of CPP and potential treatment options. Results: Hysteroscopy identified abnormalities in 24 (48%) of the patients. Among them, 9 (18%) had intrauterine adhesions, 6 (12%) had a partial septum, 4 (8%) had internal os stenosis, 4 (8%) had fibroids, 3 (6%) had polyps, and 2 (4%) had chronic pelvic inflammatory disease (PID) (with overlapping findings). These pathologies went undetected during laparoscopy. However, laparoscopy successfully diagnosed other intra-abdominal causes of CPP, including adhesions in 34%, endometriosis in 28%, chronic PID in 24%, fibroids in 12%, genital/abdominal Koch's in 6%, dermoid cysts, and other ovarian cysts in 4% each, and paraovarian cysts in 2%. In the same procedure, concurrent therapeutic interventions such as adhesiolysis (18%), cervical dilatation (8%), septal resection (6%), and polypectomy (4%) were performed using an operative hysteroscope. Conclusion: Hysteroscopy proved effective in identifying various intrauterine causes of CPP. It serves as a valuable adjunct to laparoscopy for diagnosing conditions affecting the cervix and uterine cavity, which can often coexist with the underlying causes of CPP.

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Original Article

Sachin Jain, Naveen Sharma, Seema Singh

Port Site Infiltration and Extraperitoneal Instillation of Ropivacaine in Totally Extraperitoneal Hernia Repair: A Randomized Controlled Trial

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:5] [Pages No:33 - 37]

Keywords: Abdominal pain, Hernia, Hernioplasty, Inguinal hernia, Inguinal hernia repair, Laparoscopic, Laparoscopic hernia repair, Laparoscopic inguinal hernia repair, Postoperative pain, Randomized controlled trial

   DOI: 10.5005/jp-journals-10033-1602  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the role of intraoperative local anesthetic use in the reduction of postoperative pain after totally extraperitoneal (TEP) hernia repair. Settings and design: Teaching hospital in Delhi, RCT. Materials and methods: 18–60-year-old men with unilateral inguinal hernia were randomized to either ropivacaine group (30) or placebo group (30) using a randomization sequence generated online. Port sites and preperitoneal space received either 0.75% ropivacaine or 0.9% saline (placebo). The primary outcome was numerical response scale (NRS) pain score at 6 hours after surgery. The secondary outcomes include NRS at 2 hours, 24 hours, and total analgesic requirement during the first postoperative week. The same surgeon using the same type of mesh performed all procedures using three midline ports and without mesh fixation. The patient, surgery team, and observer were blinded. Statistical analysis used: Shapiro–Wilk test of normality, median test for independent samples. Results: All patients underwent allocated procedure. There were no conversions. The baseline parameters were comparable in the two groups. The Shapiro–Wilk test of normality revealed that the data were not distributed normally. The median NRS at 6 hours was 3 (IQR 1, 3) in the ropivacaine group compared with 3 (IQR 1, 4) in the placebo group (p = 0.981, Independent samples median test). Similar comparable pain scores were obtained at 2 and 24 hours. No significant difference was noted in analgesic requirement in the first 24 hours, till postoperative day 7, time to ambulation or micturition between groups. Conclusions: Infiltration of port sites and preperitoneal space with ropivacaine does not reduce postoperative pain or analgesic requirement in TEP. Clinical significance: The use of local anesthetic agents intraoperatively has no added benefit in reducing postoperative pain in TEP hernia repair.

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Original Article

Loay M Gertallah, Ahmed M Abdelaziz, Ahmed I Elagrody, Ahmed S Allam, Mohamed Elbaz, Mahmod Ghoname, Mahmoud Sherbeiny, Ahmed L Sharaf, Ola A Harb, Mahmoud Abdelaziz, Mohamed Negm

Laparoscopic vs Open Colorectal Surgeries in Urgent Surgical Situations

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:6] [Pages No:38 - 43]

Keywords: Advanced laparoscopic surgery, Laparoscopic, Open, Minimally invasive surgeries, Open surgery, Urgent colectomy

   DOI: 10.5005/jp-journals-10033-1607  |  Open Access |  How to cite  | 

Abstract

Background: Using minimally invasive surgeries (MISs) in non-elective and urgent cases was assessed by many previous studies and found to be nearly similar to and even better than open surgeries. There was no sufficient data regarding long-term, follow-up, tumor recurrence, or survival data of studied patients in those studies. Aim of our study is to compare performing MIS and open colectomy in patients undergoing urgent (nonemergency, non-elective) colectomies, regarding primary outcomes of 30-day morbidity and mortality, secondary short-term outcomes, long-term and follow-up findings of included patients. Patients and methods: A total of 200 patients were included, and we divided them into two groups according to the performed surgical approach: The first group included 100 patients who underwent MISs and the second group underwent open surgery and included 100 patients. We evaluated the primary patients’ outcome which was 30-day postoperative morbidity and mortality. Secondary evaluated patients’ outcomes included; ICU admissions, surgical reintervention, wound infection or dehiscence, postoperative ileus, postoperative leakage at an anastomotic site, and occurrence of intra-abdominal infections. Long-term evaluated patients’ outcomes included the occurrence of incisional hernias and oncological outcomes as overall survival rates and recurrence rates. Results: Regarding demographic and baseline data, patients who underwent open surgery were older (65 years vs 58 years, p < 0.001). More females underwent open surgery (54% vs 50%, p = 0.002). Overweight and obese patients were more likely to have MIS colectomy (p < 0. 001). There is a statistically significant relation between approach and all histopathological types (24.2% within the laparoscopic approach vs 11.6% within the open approach had mucoid carcinoma), N stage (82.8% within the laparoscopic approach vs 43.8% within open the approach had N stage 0), American Joint Committee on Cancer (AJCC) stage (63.8% within laparoscopic approach vs 20.8% within open approach had AJCC stage II) Open colectomy were liable to be diagnosed with acute diverticulitis and volvulus (p < 0.001). Operative time is longer in MIS patients in comparison to open colectomy patients the median time to complete an MIS colectomy was 21 minutes longer (p < 0.001). Postoperative mortality is less in MIS patients than the open surgery patients. On univariable analysis, 30-day postoperative mortality following MIS colectomy was lower than that after open surgery (p < 0.05). Conclusions: Using MIS in urgent colectomy is associated with less postoperative, morbidity, mortality, short-term complications, and long-term complications than open colectomy.

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RESEARCH ARTICLE

Syed Ali Haider, Muhammad Zubair, Sumera Qazi

Laparoscopic Surgery Practice in the Era of COVID-19: The Pakistani Perspective

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:8] [Pages No:44 - 51]

Keywords: Coronavirus disease-19, Health care professionals, Laparoscopic surgery, Minimally invasive surgery, Surgical smoke

   DOI: 10.5005/jp-journals-10033-1591  |  Open Access |  How to cite  | 

Abstract

Aims: The SARS-CoV-2 coronavirus disease-19 (COVID-19) pandemic has wreaked havoc worldwide. Not only has it severely impacted the way of life, but also damaged global economies and worsened social disparities, including those in healthcare. The pandemic, having imposed an enormous burden on global healthcare infrastructure, has led to drastic changes in medical and surgical practices, including those of laparoscopic and minimally invasive surgery. This study aimed to explore the practice of laparoscopic surgeons during the COVID-19 era in Pakistan. Materials and methods: Surgeons involved in laparoscopic surgery (LS) were approached via e-mail practicing in different surgical setups and cities of Pakistan. After taking Institutional Review Board (IRB) approval and informed consent a questionnaire was filled out by all participating laparoscopic surgeons. The data was then analyzed in SPSS version 26. Results: A total of 168 surgeons involved in LS from different disciplines responded to the invitation and filled out the online questionnaire. The mean age of the surgeons was 48.72 ± 8.04 years and most of them were married and the majority belonged to the major cities of the country, i.e., Karachi, Lahore, Multan, Islamabad, and Rawalpindi. Surgeons who participated had a mean practice experience of 12.12 ± 6.88 years (minimum 3 and maximum 31 years). Most of the respondents were General Surgeons (GS), followed by minimal invasive surgeons (MIS) having advanced training in laparoscopy, Obstetricians and Gynecologists (OB-GYN), and Urologists. Conclusion: The LS practice in Pakistan during the COVID-19 era is widely variable. There is a dire need to formulate apt local guidelines, that are practical and implementable in developing countries.

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CASE REPORT

Shashank Shah, Sushil Kumar Kharat, Elmutaz Abdalla Mekki Kanani, Adrian Gerard

Co-existent Classical Maydl's and Amyand's Hernias: A Rare Case Report

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:3] [Pages No:52 - 54]

Keywords: Amyand, Case report, Inguinal hernia, Laparoscopy, Maydl

   DOI: 10.5005/jp-journals-10033-1601  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this case report is to highlight the advantages of laparoscopy in the management of incarcerated, obstructed, and strangulated hernia. Background: Inguinal hernias account for three-quarters of all abdominal wall hernias. They may present as emergencies and require quick and accurate diagnosis followed by prompt management in order to prevent undesirable consequences. The surgeon has to select the appropriate treatment approach from limited options. In this case report we are aiming to solidify the laparoscopy as an additional weapon in the surgeon's armamentarium. Case description: This is a case of an unusual type of obstructed indirect inguinal hernia with impending strangulation. Diagnostic laparoscopy findings revealed a Maydl's hernia and an adherent inflamed appendix in a long-standing congenital inguinal indirect hernia. In addition to this, extensive small bowel adhesions were also seen. Conclusion: This case highlights the superiority of laparoscopy compared to clinical/image judgment in incarcerated, obstructed, or strangulated hernia.

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CASE REPORT

Georgia Roberts, Michael Bozin, Bruce D Wilkie, Phil Chan, Cuong Duong

Perforated Strangulated Roux Limb in Diaphragmatic Hernia—A Rare Complication after Laparoscopic Total Gastrectomy for Gastric Cancer: A Case Report

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:3] [Pages No:55 - 57]

Keywords: Case report, Diaphragmatic hernia, Gastric cancer, Laparoscopic gastrectomy

   DOI: 10.5005/jp-journals-10033-1570  |  Open Access |  How to cite  | 

Abstract

Aim: To report a case of a perforated strangulated roux limb in diaphragmatic hernia as a rare complication following laparoscopic total gastrectomy for gastric cancer. Background: As minimally invasive surgery (MIS) becomes increasingly performed for esophagogastric cancers, diaphragmatic hernias (DHs) pose new challenges for surgeons. Case description: We report the case of a 59-year-old patient who presented with hematemesis, epigastric pain, and hemodynamic instability. The patient had a history of gastric adenocarcinoma and had undergone a laparoscopic total gastrectomy 3 years before. The computed tomographic scan demonstrated a diaphragmatic hernia with a strangulated and perforated roux limb. The patient underwent staged resection of the necrotic roux limb to manage sepsis, followed by restoration of alimentary continuity. Conclusion: A diaphragmatic hernia (DH) is a challenging complication of MIS for esophagogastric cancers and may be difficult to prevent. A staged approach was invaluable, allowing for careful assessment, expert opinion, and reconstruction. Clinical significance: As MIS becomes increasingly performed, cases of complicated DH may become more apparent. Preventing DH may be difficult. A sutured crural repair with or without pexy of the roux limb may be performed if DH is identified at the time of gastrectomy. The value of mesh is unclear, and erosion remains a main concern.

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CASE REPORT

Lingam Sridhar, Rohit Phadnis, Faiz Hussain, Subrahmanya Narayan Dora Kurumella, Sarath Chandra Chappidi, Sindhu Singareddy

Waltman Walter Syndrome—A Rare Postcholecystectomy Presentation: A Case Report

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:3] [Pages No:58 - 60]

Keywords: Bile leak, Case report, Cystic duct stump leak, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy, Postlaparoscopic cholecystectomy complication, Subdiaphragmatic collection

   DOI: 10.5005/jp-journals-10033-1603  |  Open Access |  How to cite  | 

Abstract

Waltman Walter syndrome after laparoscopic cholecystectomy (LC) is rarely reported. However, it needs to be recognized promptly and managed as otherwise it can lead to further metabolic and infective complications. We present the case of a 42-year-old male who was admitted with ultrasound-proven cholelithiasis with no signs of cholecystitis and with a history of acute calculous cholecystitis. His total leukocytic count (TLC) and liver function tests (LFTs) were within normal limits. He underwent an uneventful LC with drain placement in Morrison's pouch. Postoperatively, he had complaints of pain in the abdomen and fever, clinically icterus was present, tachycardia and multiple fever spikes with persistent hypotension, and ultrasonography (USG) abdomen was suggestive of fluid collection of 214 cc noted tracking along the subdiaphragmatic region extending into the gallbladder fossa. Endoscopic retrograde cholangiopancreatography (ERCP) was done and was suggestive of a cystic stump leak for which biliary duct sphincterotomy + common bile duct (CBD) stenting was done. An USG-guided aspiration was done and bilious fluid was aspirated from subdiaphragmatic region. On postoperative day (POD) 10, the patients improved symptomatically, with a normal LFT, and the drain was removed; on follow-up after 4 weeks, he had no complaints, and stent removal was done. The main “take-home” message is that although rare, Waltman Walter syndrome is an unusual and rarely reported complication of post-LC particularly postdrain placement due to accumulation of bile in the subdiaphragmatic region. Timely response in diagnosing and bile drainage helps in the prevention of mortality and morbidity.

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CASE REPORT

B Ramesh, Priyanka Sukumar, Kiran R Konda, Meghana Sreenivas

Abnormally Located Benign Nerve Sheath Tumor—Retroperitoneal Schwannoma Managed Laparoscopically: A Case Report

[Year:2024] [Month:January-April] [Volume:17] [Number:1] [Pages:4] [Pages No:61 - 64]

Keywords: Case report, Laparoscopy, Nerve sheath tumors, Retroperitoneal, Schwannoma

   DOI: 10.5005/jp-journals-10033-1608  |  Open Access |  How to cite  | 

Abstract

Aim and background: To demonstrate the clinical findings and management of a retroperitoneal Schwannoma, which presented as a gynecological mass. Nerve sheath tumors are benign tumors affecting the cranial and peripheral nerves. Schwannoma refers to tumors arising from the Schwann cells of neurons. Case description: A 56-year-old female presented to us with vague lower abdominal pain since 3 months. It was initially diagnosed as a inclusion cyst. Intraoperatively diagnosed with retroperitoneal benign looking mass, which turned out to be a schwannoma. We present a case of left-sided retroperitoneal schwannoma which masqueraded as a gynecological mass and operated by laparoscopy. Conclusion: Schwannomas are benign, encapsulated, slow-growing nerve sheath tumors. Rarely seen in the pelvis and retroperitoneum. Laparoscopy aids in better visualization with more accurate surgical removal of these masses and can be considered the treatment of choice for these tumors. Clinical significance: Often asymptomatic and may go unnoticed, but when presenting with symptoms or when discovered incidentally on scans for other reasons, they are mistaken for gynecological or urological masses and are more often presented to gynecologist/urologist.

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