Aim: Our aim was to study the feasibility of a laparoscopic approach in the management of polypoidal lesions of the stomach.
Materials and methods: We present a review of laparoscopic management in polypoidal lesions of the stomach in four patients. All patients underwent routine preoperative workup along with esophagogastroduodenoscopy, biopsy, and contrast-enhanced computed tomography (CECT) scan of the abdomen. Three patients underwent wedge resection of the stomach using a laparoscopic linear stapler and one underwent laparoscopic anterior wall gastrotomy with polypectomy.
Results: Of four patients, three were males and one was female in the age range of 40–60 years. Presenting symptoms ranged from generalized weakness, episodes of intermittent vomiting, dyspepsia, and weight loss. Common sites involved were fundus and body of the stomach in three patients and antrum in one patient. Surgery via a laparoscopic approach was the mainstay of the treatment. Final histopathology revealed gastrointestinal stromal tumor (GIST) in three patients and adenomatous polyp in one patient. Patients diagnosed with GIST were further referred to a medical oncologist for mutational analysis and adjuvant therapy. All patients are on regular follow-up postoperatively.
Conclusion: Asymptomatic, polypoidal lesions of the stomach can present with occult GI bleeding or gastric outlet obstruction. The main point to be taken into consideration in treating large-sized polyps is the selection of management option (endoscopic vs laparoscopic). Laparoscopic excision is a better alternative to treat giant polyps considering the size, location, and potential for malignancy, as opposed to an endoscopic approach.
Meenakshi E Yeola (Pate),
Akshay K Bora
DOI: 10.5005/jp-journals-10033-1350 |
Open Access |
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How To Cite
How to cite this article:
Yeola (Pate) ME, Gode D, Bora AK. Evaluation of Abdominal Malignancies by Minimal Access Surgery: Our Experience in a Rural Setup in Central India. World J Lap Surg 2018; 11 (3):115-120.
Introduction: A diagnostic surprise or finding a tumor unresectable at laparotomy is an undesirable situation for every surgeon. A surgeon should never regret for having done a laparotomy on a patient which otherwise was avoidable. Many surgeons worldwide have had challenging experiences of facing an uncertain diagnosis or staging of abdominal malignancies. History-taking, physical examination, laboratory tests, and advanced noninvasive imaging studies might provide some help but are insufficient for accurate diagnosis and staging of abdominal tumors.
Aim: To assess the role of diagnostic staging laparoscopy in abdominal malignancies.
Objectives: To evaluate the role of laparoscopy as a diagnostic tool in abdominal malignancies. To compare the findings of laparoscopy with noninvasive imaging modalities. To assess the efficacy of laparoscopy as a definitive tool in the evaluation of staging and operability before definitive intervention.
Materials and methods: This is a prospective observational study with a sample size of 250 patients. The study duration was 3.5 years from July 2013 to October 2016 and was conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe), Wardha.
Results: Due to the use of diagnostic laparoscopy, out of 250 cases of abdominal malignancies, in 120 (48%) patients, nontherapeutic laparotomy could be avoided.
Conclusion: This study highlights the emphatic utility of diagnostic laparoscopy procedures in staging and management of abdominal malignancy. Laparoscopic evaluation of a patient with intra-abdominal malignancies is a desirable tool against imaging modalities in improving the detection of metastatic disease and accurate staging of the disease process.
Background: Hemorrhoidal disease is one of the most frequently encountered anorectal conditions in the clinical practice. A variety of instruments including circular staplers, harmonic scalpel, laser, and bipolar electrothermal devices are currently used when performing hemorrhoidectomy grades III and IV.
Objective: This study compares outcomes between hemorrhoidectomy performed with harmonic scalpel and conventional methods.
Materials and methods: A prospective randomized study of consecutive 50 patients who underwent hemorrhoidectomy between January 2017 and October 2017. Patients were randomly enrolled in two different groups. Group I consisted of 25 patients who underwent hemorrhoidectomy using an ultrasonic scalpel device (harmonic) and group II with 25 patients who had conventional hemorrhoidectomy.
Results: The patients’ demographics data and clinical characteristics were similar in both groups. The harmonic group had a shorter operation time, less postoperative pain, less postoperative bleeding, and shorter hospital stay.
Conclusion: Harmonic scalpel hemorrhoidectomy appears to be a better procedure for symptomatic grades III and IV hemorrhoids with ease of operating due to less bleeding, less postoperative pain, and patient acceptance. Long-term follow-up with larger scale studies is required.
Aim: To evaluate the impact of age, type of hernia, size of the mesh used, and fixation of the mesh on the competence of laparoscopic repair of inguinal hernia.
Materials and methods: Randomized controlled clinical study carried out from November 2016 to July 2017 in 98 patients with inguinal hernias admitted to surgery Department of Minia University Hospital. Patients were divided into two groups randomly. Group I includes 49 patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty and group II includes 49 patients who underwent laparoscopic totally extra peritoneal (TEP) hernioplasty with and without fixation of the mesh.
Results: Operative time in group I ranges between 40 minutes and 110 minutes with mean time of about 66.85 minutes, while in group II ranges between 20 minutes and 105 minutes with mean time of about 52.65 minutes. This difference was statistically significant. Pain was 8.2% in group I and 10.2% in group II. Scrotal edema was 0% in all patients in both groups. Urinary retention was 2% in group I and 4.1% in group II. Seroma was the same (6.1%) in both groups. Recurrence after 6-month follow-up was 2% in both groups. All recurrent cases are nonfixed.
Conclusion: There is no difference between TEP and TAPP, but TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.
Clinical significance: The TEP approach can be offered to patients with bilateral and recurrent hernias. TEP procedure was associated with more adverse events during surgery but less postoperative pain, faster recovery of daily activities, quicker return to work, and less impairment of sensibility after 1 year.
Mohamed F Amin,
Morsi M Morsi,
Mostafa M Elaidy,
Mohamed S Badr,
Ahmed M Farag,
Safaa A Ibrahim
Introduction: Laparoscopic surgery during pregnancy is contraindicated absolutely or relatively through the last decade; however, laparoscopic appendectomy (LA) is still performed in pregnant women.
Materials and methods: Thirty-one pregnant females with a diagnosis of acute appendicitis and managed with LA or OA in the emergency unit of the department of general surgery from June 2015 to December 2017.
Results: Eighteen patients underwent LA, while 13 patients underwent OA. No difference was noticed between both groups regarding the operative duration, and fetal and maternal outcomes. However, the group of LA had faster first flatus and shorter inpatient duration than the OA group.
Conclusion: Laparoscopic appendectomy is distinguished with efficacy and safety procedure throughout pregnancy and should be considered a good replacement for open appendectomy.
Aim: This study compares the outcome of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) in terms of the duration of surgery, the length of hospital stay, the postoperative analgesia, and the postoperative complications, in order to determine the safety of LC in our center.
Materials and methods: This is a retrospective study. All patients who had cholecystectomy in Federal Teaching Hospital, Gombe, Nigeria, between January 2012 and December 2016 were studied. Their relevant data were obtained from the records and analyzed using SPSS version 20.0. t test was employed and a p value of <0.05 was considered to be significant.
Results: A total of 26 patients had cholecystectomy during the period—four of them were excluded, three had additional procedures while one had incomplete records. The female-to-male ratio was 1.2:1 and the mean age was 39 years. The indications for surgery were symptomatic gallstones in all patients except in one, which was for an acalculous cholecystitis. Fifteen (68%) patients had LC while seven (32%) had OC. The mean age for LC was 38 years and for OC it was 41 years. The mean duration of procedure was 73 (±17.4) minutes for LC and 92 (±28.0) minutes for OC. This was not statistically significant (p value = 0.066). The mean length of hospital stay for LC was 5.8 (±5.5) days and 10 (±8.5) days for OC, and was equally not statistically significant (p value = 0.433). There was no difference in postoperative analgesia, no surgical site infection or mortality recorded.
Conclusion: LC is very safe and has a good outcome in our environment despite our challenges.
Clinical significance: LC is still nascent and has not been studied in our environment. This study affirms the safety of this procedure, but fails to establish its superiority over OC.
Aim: This article aimed to study the role of robotic surgery in gynecologic oncology in India over the past decade.
Background: Different randomized and observational, retrospective and prospective studies that met the eligibility criteria were included. Various parameters were compared between robotic and laparoscopic surgeries. The different parameters evaluated in the studies were operative time, estimated blood loss, hospital stay, complications, conversion rates, so on and so forth. Nodal yield, vaginal margin and paracervical clearance were studied in a few of them. PubMed was the main search engine utilized for searching the study data.
Review results: After careful analysis of the data, it was noted that the complication rate, blood loss, and postsurgery hospitalization were significantly lower with robotics, whereas some inconsistencies were noted regarding the operating time.
Conclusion: India is notably at the brink of a revolution. The need of the hour is to make this new surgically innovative technology accessible to all—to the surgeons as well as the patients.
Clinical significance: Critical analysis of robotic surgeries in gynecology in Indian setting has been done. This would help in planning adoption and training of this upcoming domain.
Objective: Whether a laparoscopic salpingostomy should be done or a salpingectomy for surgical treatment of ectopic pregnancy. Materials and methods: Literature examining and review the impact of recent advances in the diagnosis and laparoscopic conservative treatment of ectopic tubal pregnancy. Articles published in English language using the following search engines: Medline, Pubmed, Medscape, and Cochrane Database of Systematic Reviews. Results: The choice of salpingostomy or salpingectomy relies upon many factors and includes shared decision-making between the surgeon and patient. Laparoscopic surgery remains the “gold standard” in majority of women. Conclusion: There is some evidence to suggest that future fertility outcomes are slightly improved after tubal conservation at surgery in comparison with salpingectomy. As the incidence of ectopic pregnancy continues to rise in a population that will likely desire future fertility, early diagnosis is key in facilitating safe utilization of more conservative management in the hope of preserving tubal function and reproductive potential.
Background: Natural orifice surgery represents a greatstep to the future. Difficulties arose on our current practice. Reviewing the literature does not solve all the debates.
Report: The author suggests a simple algorithm for transanal natural orifice specimen extraction (NOSE).
Conclusion: Transanal extraction of colectomy and/or proctectomy specimen is a readdily feasible technique.
Introduction: Operative laparoscopy has advanced progressively since 1987 after laparoscopic cholecystectomy by means of four trocars. One of the main advantages of laparoscopic surgery over traditional open surgery is that it often requires a shorter hospital stay than traditional open surgery. Compared to conventional laparoscopic surgery, single incision laparoscopic surgery (SILS) has more benefits. In this article, we review laparoscopic surgery with single incision.
Materials and methods: Literature review was performed on newly minimal invasive approach for laparoscopic surgery.
Results: Single incision laparoscopic surgery has advantages in minimizing the invasiveness of surgical incision, reducing the number of incisions and the associated possible wound morbidities. This includes the reduced risks of wound infection, pain, bleeding, organ injury, and port site hernia. Even though SILS is recognized to be a more complicated procedure and costly, patients are experiencing less pain and almost scarless wound.
Conclusion: Single incision laparoscopic surgery is an exciting new approach in the field of laparoscopic surgery.