Aim: Hysterectomy is one of the most common surgeries being performed in perimenopausal women. It can be done either vaginally, abdominally or laparoscopically. The laparoscopic surgery is now on rising trend since it is associated with less peroperative complications, less postoperative pain, has better wound healing and early recovery and returns to normal activities. Hence, this study is being conducted to compare abdominal and laparoscopic hysterectomy.
Materials and methods: A retrospective observational study is conducted at the tertiary hospital. Total 135 women underwent surgery, of which 100 had an abdominal hysterectomy (TAH) while 35 had a laparoscopic hysterectomy (TLH). In mobile uterus of size < 12 weeks, TLH was done. The comparison was done between two groups as per and postoperative complications.
Results: The mean age, parity, and BMI was comparable in two groups. Duration of hospital stay was significantly less in women who underwent TLH. Peroperative complications as bowel and bladder injury were found in 4 cases and all of them occurred during TAH. Wound sepsis was also seen during TAH only. However, postoperative blood transfusion was given in more number of women who underwent TLH than in TAH, although the difference was statistically insignificant.
Conclusion: Laparoscopic hysterectomy is preferred over open procedure as it is associated with less per-operative complications, shorter hospital stay, and wound complications.
Laparoscopic surgery is more beneficial to the patient than abdominal hysterectomy. However, the decision regarding the mode of surgery shall be based on patient consent and surgical expertise.
Background: In Nepal, it is quite common to find patients with large stone burden and thick gallbladderwall which often leads to incision extension. We have used this extended incision to our advantage. The present technique of 2 port Laparoscopic cholecystectomy not only helps overcoming thespecimen extraction difficulties but also contributes to better cosmesis.
Patients and methods: Total of 25 patients were underwent the surgery in 2008–2010.
Results: The mean operating time was 50 minutes. None had significant procedural blood loss, iatrogenic injury, perforation of gallbladder, bile spillage, significant gas leak or subcutaneousemphysema at either port site. All patients were comfortable in the postoperative period and were routinely discharged on 2nd postoperative day except for 2 patients who has surgical site infection and fever respectively. Although 3 cases were converted to standard 4 port technique, none required conversion to open cholecystectomy. Out of 25 patients, 7 cases have completed 3 months follow up and did not show any complication like port site hernia.
Conclusion: The described method of performing 2 port laparoscopic cholecystectomy is safe, simple and inexpensive yet cosmetically rewarding.
Meenakshi E Yeola (Pate),
Akshay K Bora
Accurate diagnosis and staging are crucial in defining an effective plan of management in intra-abdominal malignancies. Despite the availability of a wide array of imaging techniques, a high incidence of nontherapeutic procedures have been observed. Laparoscopy finds its utility in reducing this discrepancy by an accurate assessment of the extent of the disease. This review article explores applications of laparoscopy in the staging and diagnosis of abdominal malignancy and its comparative advantages against imaging studies and conventional laparotomy.
Ishfaq A Gilkar,
Javid A Peer,
Background: Varicocele is a collection of abnormally dilated, tortuous veins. A clinical varicocele is found in about 15% of all adult males, up to 35% of men who present for infertility evaluation and as many as 81% of men with secondary infertility, with a marked left-sided predominance. It is the most common correctable cause of male infertility.
Methodology: This study was conducted in the postgraduate department of surgery, Government Medical College, Srinagar for 2 years from December 2010 till May 2013. This was a prospective study and a total of 100 patients with clinically significant varicocele were included in this study. Patients were divided into two groups. Group A comprised of 50 patients who underwent open surgery, and group B comprised of 50 patients who underwent a laparoscopic approach.
Results: In our series of 100 patients, the minimum age was 10 and maximum was 50 years, eighty six had scrotal pain, 81 had testicular swelling and 25 patients presented with infertility, the operation time for laparoscopic varicocelectomy 48 minutes (mean) and in open surgery was 57 minutes (mean), We observed that postoperative analgesic requirement was almost equal in both groups, average hospital stay of 35.6 hours and 50.6 hours were observed in laparoscopic and open groups respectively.
Conclusion: In our study of 100 patients it was observed that the results of laparoscopic varicocelectomy were comparable to open technique with minimum morbidity, shorter hospital stay and with the advantage of treating bilateral varicoceles without any additional incisions. Also, laparoscopic varicocelectomy produces better overall patient satisfaction and hence can be considered as a preferred surgical technique although sperm analysis results were the same in both methods.
Aim: To evaluate the laparoscopic approach to adrenalectomy throughout a decade in a single area, focussing on complication rates and the effect of surgeon experience. Given the relative rareness and pathological heterogeneity of adrenal tumors, there is still some debate as to whether the laparoscopic approach is suitable for all situations. Initially, laparoscopy was not recommended for pheochromocytomas, because of the possibility of adrenergic crisis. Subsequent questions were raised as to its appropriateness for large tumors (>6 cm) and metastatic deposits due to the technical difficulty of dissection. There has also been an increased number of incidental tumors (‘incidentalomas’) discovered while imaging for other reasons (e.g., on CT or MRI).
Materials and methods: De-identified data was collected of all laparoscopic adrenalectomies within the last decade via electronic and physical chart review, in addition to review of pathology reports.
Results: Ninety-seven adrenalectomies were performed. The complication rate was 8%, and 40% of cases were incidentalomas. Tumor pathologies noted were: non-secretory adenomas (35%), aldosterone-secreting adenomas (18.6%), adrenal metastases (17.5%), pheochromocytomas (13.4%), simple cysts (4.1%) and other pathologies (11.3%). The most significant decrease in operative time was between 2005–2008 and 2009 (p <0.0001). No significant relationship between complications and size of a tumor, nor pathology of a tumor was found.
Conclusion and clinical significance: Laparoscopic adrenalectomy in this center has a complication rate similar to other published rates and appears to be a safe procedure for large tumors and various pathologies. There is also a demonstrable effect of surgeon experience on operative time.
DOI: 10.5005/jp-journals-10033-1341 |
Open Access |
How to cite |
How To Cite
How to cite this article:
Kumar J, Raina R. Laparoscopic Repair of Non-midline Abdominal Wall Hernia: Retrospective Analysis of Cases done by a Single Surgeon in the Past Four Years. World J Lap Surg 2018; 11 (2):85-89.
Aim: Abdominal wall ventral hernias are either midline or nonmidline. Non-midline abdominal wall hernias are not a common entity and even rarer is a lateral ventral hernia. Laparoscopic management of these hernias are surgically challenging, and outcomes are unpredictable. This study aims to evaluate and analyze the results of laparoscopic repair of comparatively rare non-midline hernias done at the tertiary teaching hospital in the span of last four years.
Material and methods: For this retrospective descriptive study, from record file, all cases of laparoscopic ventral hernia repair done in the last four years (from 01/01/2012 to 01/01/2016) by the main author at Lady Hardinge Medical College screened and out of these, total of thirteen cases (n-13) of non-midline ventral hernia selected for their data analysis.
Results: Out of total thirteen cases (n = 13), a large percentage was of female gender (76.92%), their mean age of the patients were 43 +/- 9.30 years. (SD = 11.41). Range 24–64 years. Most of the patients were overweight with mean weight was 72.846 kg. (SD = 13.369). Mean operating time were 78.84 minutes (SD = 22.62) (range 60-120 minutes). One patient (7.69%) had developed chronic infected discharging sinus which ultimately required removal of mesh. Same and only patient in our series reported recurrence which makes an overall percentage of recurrence 07.69%.
Conclusion: Even though non-midline abdominal wall hernias are comparatively atypical in its presentation and challenging for the laparoscopic surgeon, overall patient's epidemiology, the surgical outcome in term of recurrence and complications are not much different.
Clinical significance: Presentation of a non-midline hernia is atypical and surgically complex which require an experience to handle it.
Minimally invasive surgeries have dawned a new era in surgical practice, cosmesis and safety. These have been heralded as one of the best surgical methods to treat a multitude of surgical disorders. Though the term minimally invasive seems attractive, in the real sense of the word, these surgeries are minimal access surgeries and do require incisions for trocars. The wounds must be closed appropriately to prevent the incidence of port-site hernia. Though rare, port-site hernias can cause considerable morbidity. Most of these are seen in the midline, particularly around the umbilicus, but there are reports of herniation at laterally placed ports. The accepted surgical practice is to close the fascial layers at all midline laparoscopic ports. There is a multitude of ways in which the ports can be closed. This article aims to review the various port closure techniques practiced by different surgeons and institutions to and reflect upon the pathophysiology of port-site hernia and recommendations to minimize them. Systematic research of the literature was performed using PubMed, Cochrane database, Google scholar and ClinicalKey. Different port-site closure techniques are described and analyzed. Though not one technique has been found to be superior to the other, all of them have their pros and cons. All of them produce similar results, and it is upon the discretion of the surgeon to accept any one of these methods. The authors have also tried to provide recommendations to minimize the incidence of port-site hernias.
Vimal K Jain,
Ashishkumar G Hadiyal,
Shalit A Jolly,
The incidence of a falciform ligament is very rare. Because of the rarity of the condition and sparsity of available literature, it's very difficult to diagnose this condition preoperatively. In this case, a 65-year-old lady had presented with pain in epigastrium and vomitings for 3 days. All blood investigations were normal except serum Alkaline phosphatase (ALP) and serum gamma-glutamyl transferase (GGT) which were 141 IU/L and 275 U/L respectively. USG revealed only chronic cholecystitis. On diagnostic laparoscopy, falciform ligament abscess was detected which was adequately drained. The patient responded well with the drainage without recurrence till date. Laparoscopic cholecystectomy was also done in the same sitting.
Vesicouterine fistula (VUF) is a rare variety of female genitourinary fistula. It comprises 1–4% of all urogenital fistulas. Most of these fistulas are due to complications of the lower segment cesarean section (LSCS). The incidence of this fistula is increasing all over the world because of the increasing prevalence of cesarean section. Patients may present with urinary incontinence, hematuria, cyclic menouria, amenorrhea and also first trimester abortions. Two early diagnosis and repair of VUF has become the need of the hour. Different approaches for surgical repair of VUF include transabdominal (including transvesical and transperitoneal); transvaginal approach; laparoscopic and robotic. Laparoscopic VUF repair results in reduced patient morbidity and shorter hospital stay without compromising the results. So laparoscopic repair may be a more attractive treatment option for patients with postcesarean VUF.