Retroperitoneal pyelolithotomy (RPL) can be used as an alternative to open pyelolithotomy (OP) when other modalities of stone removal fail. This procedure even has potential to replace noninvasive techniques in selective subsets of patients.

The aim of this study was to study the efficacy, safety, and outcome of retroperitoneal laparoscopic pyelolithotomy. The study compared the advantages and complications of RPL and OP.

This study was conducted in the Department of Surgery, Maharishi Markandeshwar Institute of Medical Science and Research, Maharishi Markandeshwar University, Ambala, from January 2012 to December 2015. A total of 280 patients of solitary renal pelvic stone were selected, out of whom 160 who underwent RPL were considered in group I and 120 patients who underwent OP were considered in group II. The patients included were of age group 12 to 80 years, with unilateral and bilateral solitary renal pelvis calculus and stone size of 10 mm to 3 cm. Patients with recurrent or residual stones after pyelolithotomy, intractable urinary tract infection, and having extrarenal pelvis and any anatomical renal abnormalities were excluded from the study.

In this study, mean age was 37.1 and 46.66 years in groups I and II respectively. Male to female ratio was 2.33:1. Mean operative time was 75.33 ± 16.90 and 65.83 ± 12.35 minutes respectively, in groups I and II respectively (p < 0.001). Pyelotomy closure time and Double-J (DJ) stent insertion time were 5.2 minutes (with standard deviation [SD] of 4.3) and 9.8 (with SD of 3.7) respectively, in group I as compared with 4.2 minutes (with SD of 2.7) and 6.1 (with SD of 2.9) in group II. Mean hospital stay was less in group I at 3.76 ± 0.85 days and, in group II, it was 5.36 ± 1.96 days (p < 0.001). Postoperative anesthesia requirement was 2.23 ± 0.62 days (339 ± 93 mg) and 5.36 ± 0.96 days (804 ± 144 mg) in groups I and II respectively (p < 0.001).

The RPL is a noninvasive and cost-effective method along with minimal scar mark. It has the advantages over OP of having fewer complications, less postoperative pain, better cosmesis, and less hospital stay.

Sharma BP, Singal R, Zaman M, Sandhu K, Sharma K, Yadav R, Grewal P, Mishra RK. Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College. World J Lap Surg 2017;10(1):1-7.

To compare laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH) in a retrospective analysis for the management of benign diseases.

A retrospective case–control study in Christian Medical College and Hospital, Ludhiana, was carried out comparing LAVH) and TAH for a period of 1 year between November 2014 and October 2015.

The LAVH is associated with shorter hospital stay as compared with TAH (3.3 and 5.8 days; p < 0.001), less amount of blood loss (176 and 420 mL; p < 0.022), and less number of postoperative complication rates (4.76 and 14.5%; p = 0.061).

The LAVH is a safe and reliable alternative to open surgery in the management of benign gynecological diseases, with significantly reduced hospital stay and complications.

Gupta G, Varte VK, Goyal S. Laparoscopic vs Abdominal Hysterectomy in the Management of Benign Gynecological Diseases: A Tertiary Hospital Experience in Punjab. World J Lap Surg 2017;10(1):8-11.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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

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.

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.

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.

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%.

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.

Complicated appendicitis is not a contraindication to laparoscopy.

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.

To evaluate analgesic effect of intraperitoneal tramadol in patients undergoing laparoscopic cholecystectomy.

Prospective, double blind, randomized study.

Hundred patients undergoing laparoscopic cholecystectomy were randomized into two groups, I and II, of 50 each: Group I received intraperitoneal tramadol 100 mg (diluted in 20 mL of distilled water) immediately after induction of pneumoperitoneum and just before removal of trocars. Similarly, group II received 20 mL of intraperitoneal normal saline. All patients had a standard anesthetic. Rescue analgesia was with diclofenac sodium. Postoperatively, visual analog scale, 1 and 24 hours diclofenac consumption, postoperative hospital course, and adverse effects were recorded.

Student's t-test and Epi Info statistical software were used for statistical analysis.

Pain intensity is significantly less in group I than in group II in first 4 hours, while requirement of analgesic postoperatively is significantly less in group I than in group II in first 8 hours except at 30 and 60 minutes. Better control of blood pressure and respiratory rate was seen in group I in first 4 hours. There was no significant difference between two groups regarding postoperative hospital course and incidence of adverse effect.

Intraperitoneally, tramadol provides superior postoperative analgesia in the early postoperative period after laparoscopic cholecystectomy compared with normal saline in patients undergoing laparoscopic cholecystectomy.

Jairath A, Gupta S, Singh K, Katyal S. Can Intraperitoneal Tramadol decrease Pain in Patients undergoing Laparoscopic Cholecystectomy in Postoperative Period? A Randomized Controlled Trial. World J Lap Surg 2017;10(1):26-29.

Obesity-related diseases (ORD) are associated with a decrease in the quality of life and life expectancy of patients. The remission of these pathologies after bariatric surgery is not the same in all patients.

To evaluate the remission of the principal ORD in patients who underwent bariatric surgery.

Retrospective analysis of patients with morbid obesity and ORD (hypertension, diabetes mellitus, dyslipidemia or obstructive sleep apnea and hypoapnea syndrome) who received bariatric surgery between January 2014 and January 2016. Patients had two surgical options: Laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Follow-up was performed after 1, 6, and 12 months per the first year after surgery, recording data, such as percentage of excess weight lost (%EWL), percentage of total body weight lost, and partial or total ORD remission.

Out of a total of 23 patients, 52% (12) were females and the average age was 44 ± 13 years, 17 (74%) received LSG and 6 (26%) LRYGB. The average initial body mass index was 43 ± 4.3 kg/m², the %EWL at 1, 6, and 12 months was 35.4 ± 15.2, 62.5 ± 17.5, and 79.1 ± 20.2 respectively. Comorbidities remission was found in 95.6% of patients (22), partial resolution in 32%, and complete in 68%. A total of 52.1% of remissions were reported in the first month postsurgery.

Bariatric surgery has proved to be the most effective method for reducing and sustaining weight loss in the long-term and comorbidities remission. A decrease of 50% of EWL has a positive impact in terms of discontinuing medications and normalizing the patient's biochemical profile.

Dorado EA, Lopez MV, Martin VO. Obesity-related Metabolic Comorbidities Remission in Postbariatric Surgery Patients. World J Lap Surg 2017;10(1):30-34.

Ayegbusi OE. Laparoscopic Cerclage in Pregnant and Nonpregnant Uterus: Emerging Need to change Conventional Management Approach. World J Lap Surg 2017;10(1):35-39.

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.

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.

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.

Patolia S, Hazza I. Laparoscopic Management of Stomach Sleeve Obstruction after Sleeve Gastrectomy. World J Lap Surg 2017;10(1):40-43.