World Journal of Laparoscopic Surgery

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2019 | January-April | Volume 12 | Issue 1

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[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/wjols-12-1-v  |  Open Access |  How to cite  | 


Original Article

Adem Yuksel, Murat Coskun

A Simple and Safe Technique in Extracting Specimen after Sleeve Gastrectomy

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Laparoscopic sleeve gastrectomy, Port hernia, Specimen extraction

   DOI: 10.5005/jp-journals-10033-1357  |  Open Access |  How to cite  | 


Introduction: Today, minimally invasive surgery (laparoscopic, robotic) methods are becoming increasingly common. In the procedures in which the resection was performed with a minimally invasive surgical method, specimen removal can be time-consuming and complicated. In this study, we aimed to evaluate the results of laparoscopic sleeve gastrectomy specimens removed from a 12-mm trocar area without additional tools. Materials and methods: Between January 2016 and December 2017, 129 patients underwent a laparoscopic sleeve gastrectomy for morbid obesity. In all patients, the specimen was removed from the abdomen from a 12-mm trocar area without additional tools. Results: The mean specimen removal time was 2.38 ± 1.9 minutes. During the follow-up period, no wound infection and trocar hernia were observed in any patient. Conclusion: The technique applied is minimally invasive, not time-consuming, and simple when compared to other techniques reported.


Original Article

Maliheh Arab, Jatinder Sigh Chowhan, Shahla N Ardebili, Behnaz Ghavami, Nasrin Yousefi

Follow-up Study Comparing Open Hysterectomy of Expert Surgeon and Laparoscopic Approach (Learning Curve) of the Same Surgeon

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:5 - 8]

Keywords: Complications, Hysterectomy, Laparoscopy, Laparotomy, Learning curve

   DOI: 10.5005/jp-journals-10033-1359  |  Open Access |  How to cite  | 


Introduction: The goal of minimal access surgery is to minimize damage to the patient without impairment of immunity and the effect of treatment compared to traditional open surgical techniques. Laparoscopic hysterectomy requires more surgical skills and the learning curve is steep. The goal of this study is to compare hysterectomy in learning curve (including about 50 first surgeries) with open hysterectomy of the same surgeon, expert in open surgery, for complications, hospital stay duration, transfusion, operative time, and readmission. Materials and methods: In a prospective cohort study, patients undergoing hysterectomy at an academic medical center located in Tehran were randomly assigned into laparoscopic (in learning curve) and laparotomy groups from 2016 to 2018. Study cases data were recorded regarding complications, hospital stay, operative time, and blood transfusion. Results: There was no significant difference regarding intra- and postoperative transfusion, hospital stay duration, postoperative complications, and readmission in laparoscopy and laparotomy groups of hysterectomy. However, operative time was significantly different in laparoscopy and laparotomy subgroups of hysterectomy and longer in the laparoscopic group (277 minutes in laparoscopy vs 196 minutes in laparotomy). Conclusion: This study encourages starting laparoscopy method instead of open surgery, even in the setting of expert open surgeons, and even in the advanced (level 4) surgery such as hysterectomy.


Original Article

Anil P Bellad, Amar A Murgod

Role of Diagnostic Laparoscopy in Chronic Abdominal Pain with Uncertain Diagnosis: A 1-year Cross-sectional Study

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:6] [Pages No:9 - 14]

Keywords: Adhesiolysis, Appendectomy, Chronic abdominal pain, Diagnostic laparoscopy

   DOI: 10.5005/jp-journals-10033-1362  |  Open Access |  How to cite  | 


Aim: Diagnosis of chronic abdominal pain is a significant clinical challenge. Laparoscopy, a minimally invasive technique, could potentially be diagnostic as well as therapeutic in patients with chronic undiagnosed abdominal pain. This study was aimed to evaluate the role of laparoscopy as an investigative modality in the diagnosis and management of patients with chronic abdominal pain. Materials and methods: Demographics, clinical data, and medical and surgical history of the patients (55 patients) with chronic abdominal pain were noted. Details of pain such as, severity of pain based on visual analog scale (VAS) score, duration of pain, site of pain, and nature of pain were recorded. Routine along with radiological investigations were also performed. After preoperative investigations, the patients were subjected to diagnostic laparoscopy, either by open or closed technique under general anesthesia. Postoperative assessment of pain was done using VAS score. Results: Most of the patients (65.45%) had a duration of pain between 8 weeks and 12 weeks and mean duration of pain was 10.80 ± 2.78 weeks. Fever was present in 41.82% of the patients. A history of lower segment cesarean section was observed in 5.45% patients. The most common surgical procedure performed was adhesiolysis (30.91%) followed by appendectomy (29.09%). Postoperative pain relief was statistically significant (p < 0.001). Conclusion: Laparoscopy offers an effective diagnostic modality and excellent pain relief in the management of patients with chronic abdominal pain. Furthermore, adhesions and inflamed appendix are important causes of chronic abdominal pain. However, studies with a large sample size are required to validate the findings. Clinical significance: Laparoscopy is an investigative modality in the diagnosis and management of patients with chronic abdominal pain.


Original Article

Pankajkumar J Zanwar, Jitendra T Sankpal, Mukund B Tayade, Ajay H Bhandarwar, Shubham D Gupta, Jasmine R Agarwal

Study of Feasibility of Single Incision Laparoscopic Surgery with Conventional Instruments

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:15 - 18]

Keywords: Laparoscopy instrument set, Single incision laparoscopic surgery, Visual analog scale

   DOI: 10.5005/jp-journals-10033-1365  |  Open Access |  How to cite  | 


Aim: To evaluate the feasibility and safety of single incision laparoscopic surgery using conventional laparoscopy instrument set. Materials and methods: Patients admitted in General Surgery Department of Gokuldas Tejpal Hospital, affiliated to Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, during January 2015 to June 2016 for appendicitis and symptomatic gallstone disease were included in study. Forty cases were enrolled in study and prospective observational study was performed. Results: Total 40 cases included, 21 cases of appendicitis and 19 cases of symptomatic cholelithiasis. Mean age of appendectomy group was 28.71 ± 9.69 years and mean age of cholecystectomy group was 36.71 ± 10.48 years. In our study, mean operative time for single-incision laparoscopic (SIL) appendectomy was 42.04 ± 5.74 minutes. Postoperative fever was noted in three cases (14.25%). Mean postoperative pain as per visual analog scale (VAS) score taken after 24 hours on POD 2 was 2.14. Average postoperative stay in hospital was 2.14 days, and port-site infection occurred in one case (4.17%). Patient satisfaction score obtained on the scale of 1–10 on 1-month follow-up was 7.95, while scar cosmesis score was 7.9. In our study, 19 cases underwent SIL cholecystectomy, of which 7 were male (36.8%) and 12 were female (41.2%), and mean age of patients was 36.71 years. Mean operative time in our study was 75.21 min, mean postoperative pain taken on POD 2 as per VAS score was 2.91, mean postoperative hospital stay was 2.1 days, and port-site infections occurred in 2 cases. Postoperative fever was noted in 2 cases, and postoperative patient satisfaction score obtained at 1-month follow-up was 7.73 and scar score of 7.84 on the scale of 0–10. No case required drain placement and conversion. Conclusion: single-incision laparoscopic surgery (SILS) can be performed using conventional laparoscopic instruments, though it has more operative time, comparable postoperative hospital stay, causes less pain, and has significantly more patient satisfaction regarding postoperative scar and cosmesis. Clinical significance: Since SILS has more patient acceptance and satisfaction, it can be offered to all patients undergoing laparoscopic surgery, irrespective of unavailability of special instruments and financial constraints, as it can be performed using conventional laparoscopic instruments.



Jagadeesan G Mani

Comparative Analysis of Surgical and Pathological Outcomes between Laparoscopic and Open Rectal Cancer Surgeries: Single Institution Experience

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:6] [Pages No:19 - 24]

Keywords: Laparoscopic resections, Pathological outcomes, Perioperative outcomes, Rectal cancers, Retrospective comparative study

   DOI: 10.5005/jp-journals-10033-1361  |  Open Access |  How to cite  | 


Background: The purpose of our review is to analyze and compare the perioperative and clinicopathologic outcomes of laparoscopic-assisted rectal surgeries (LARS) and open rectal surgeries (ORS) for rectal malignancies. Patients and methods: A retrospective analysis of data available from June 2015 to October 2018 was performed. Patient's demographic profile, tumor characteristics, perioperative, and short-term clinicopathological outcomes were compiled and contrasted. Statistical tests used were Student's t test and Fischer's exact test. Results: During the study period, 34 and 24 patients underwent laparoscopic and open rectal cancer surgeries, respectively. Of 58 patients, there were 30 men (51.7%) and 28 women (48.3%) with average age group of 51.7 years. The median tumor distance was 4 cm and 6 cm from the anal verge in the laparoscopic and open groups, respectively (p = 0.03). 70.1% of patients underwent preoperative chemoradiation. Conversion rate noted was 14.7%. Operative duration was prolonged for laparoscopic resection (194.7 vs 178.3 minutes, p = 0.168). Blood loss (395.58 vs 506.66 mL), postoperative hospital stay (8.3 vs 11.5 days: mean difference, 3.2 days), 30-day mortality (3% vs 0% p = 0.81), and major complications (11.8% vs 16.7%) failed to differ significantly. Negative circumferential radial margin was noticed in 98.4% of the overall group (94.1% laparoscopic resection and 95.8% open resection; p = 0.93). Conclusion: There were certainly no significant differences between laparoscopic and open surgeries in operative time period, complications, and duration of hospital stay. Hence, laparoscopic surgery is oncologically safe in rectal cancer patients. Clinical significance: Laparoscopic rectal cancer surgeries could be feasible with equivalent short-term outcomes as with open surgeries with less morbidity, even among patients treated with preoperative chemoradiation.



Majid Mushtaque, Samina A Khanday, Junaid Sheikh, Arshad R Kema, Ibrahim R Guru, Tajamul N Malik

Laparoscopic Cholecystectomy at Cesarean Section

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:25 - 28]

Keywords: Combined approach, Gallbladder disease, Laparoscopic cholecystectomy, Lower segment cesarean section, Pregnancy

   DOI: 10.5005/jp-journals-10033-1348  |  Open Access |  How to cite  | 


Objective: To study the outcome of laparoscopic cholecystectomy at the time of cesarean section. Materials and methods: Eight patients were subjected to laparoscopic cholecystectomy at the time of cesarean section. All of them were diagnosed with cholelithiasis at the first antenatal scan. Laparoscopic cholecystectomy was performed by a standard technique, after assessing the anatomy via the cesarean wound. Results: Laparoscopic cholecystectomy was combined with lower segment cesarean section (LSCS) under general anesthesia in all patients. Surgeries were completed in a mean operating time of 82 minutes. There were no intraoperative or major postoperative complications. No extra antibiotics or analgesics doses were needed. Patients were discharged on the third and the fourth postoperative day. Conclusion: A combination approach of laparoscopic cholecystectomy at the time of LSCS confers the benefits of minimal access for gallstone disease apart from being safe, effective, and well accepted. With an additional small port site incision, single anesthesia, and single hospital stay, the combined procedure confers valuable advantages in terms of time, hospital stay, cost, and convenience. It also prevents the possibility of developing acute cholecystitis while the patient is waiting for cholecystectomy apart from avoiding the separation of mother from newborn entailed by reoperation.



George Chilaka Obonna, Martin C Obonna

Comparison between Roux-en-Y Gastric Bypass and Mini-gastric Bypass in Patients of Developing Countries

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:29 - 32]

Keywords: Laparoscopy, Mini-gastric bypass, Roux-en-Y gastric bypass

   DOI: 10.5005/jp-journals-10033-1360  |  Open Access |  How to cite  | 


Background: The disease of obesity mostly common in the developed countries is also predominantly seen in the developing countries in recent times. This is therefore a cause to worry. Aim: To review literature comparing Roux-en-Y gastric bypass (RYGB) and mini-gastric bypass (MGB) to ascertain the more effective and safe bariatric and metabolic operation. Materials and methods: Detailed literature review online was perfected via Springer Link, International Bariatric Club, and the World Health Organization. Of immense use was a database of 1,000 bariatric surgeries collated from multiple hospitals in the developing countries. Conclusion: Both bariatric procedures are effective in the treatment of morbid obesity by restriction and malabsorption. They resolve obesity-related metabolic complications and hence increase quality of life for morbidly obese patients. However, in their comparison, MGB take lesser time to perform than RYGB. Also, MGB has shown to be simpler and safer surgery than RYGB. Thus, in the developing country, with its high population and increasing prevalence of morbidly obese individuals, MGB procedure can be used to treat more patients and also reduce the time and energy taken to manage the patient because of its technical ease, efficacy, revisibility, and reversibility. Overall, a zero mortality in MGB makes it the gold standard in bariatric surgery.



Vaaiga Autagavaia, Jamie-Lee Rahiri, Melanie Lauti, Lydia Poole, Garth Poole, Andrew G Hill

Local Anesthetic Use for Pain Relief Following Laparoscopic Ventral Hernia Repair: A Systematic Review

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:6] [Pages No:33 - 38]

Keywords: Analgesia, Laparoscopy, Outcomes, Ventral hernia

   DOI: 10.5005/jp-journals-10033-1349  |  Open Access |  How to cite  | 


Aim: To assess the effectiveness of the addition of local anesthetic (LA) techniques in reducing pain and morphine consumption in the first 24 hours following laparoscopic ventral hernia repair (LVHR) in adults. Background: Ventral hernias (VH) are a common condition; with risk factors (including obesity), the incidence of VH is projected to increase. Surgical VH repair is required for symptom relief and to prevent related complications. LVHR has significant advantages over open repair, with reduced infectious complications, shorter hospital stays, and more favorable outcomes in obese patients. However, in comparisonto open repair LVHR patients often experience severe pain post-LVHR. LA is an important part of multimodal analgesia regimes and their use in the context of post-operative LVHR pain management is growing in importance. Review results: A systematic review was performed according to PRISMA using search terms related to LA, LVHR post-operative pain, and morphine consumption; studies were limited to adults (>18 years) and randomized control trials (RCT). Four RCT met the inclusion criteria. All studies compared bupivacaine with normal saline, one also used bupivacaine with epinephrine; varying LA interventions were used. One study showed a statistically significant, but small (0.08 mg) reduction in pain scores at 24 hours, which is likely to be clinically insignificant. Three studies showed an overall reduction in morphine consumption at 24 hours, with only one reaching statistical and clinical significance. Conclusion: Bupivicaine LA interventions post-LVHR did not reduce pain scores at 24 hours, but morphine consumption appeared to have been reduced. Clinical significance: Despite some evidence of reduction in morphine consumption in the first 24 hours post-LVHR, further investigation is required regarding post-operative LVHR pain management using LA, including agent and mode of delivery.



Eppa Vimalakar Reddy, Gourang Shroff, Vemula Bala Reddy, Akella V Phanendra Somayajulu

Laparoscopic Management of Median Arcuate Ligament Syndrome: Single Center Experience

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:4] [Pages No:39 - 42]

Keywords: Celiac artery compression syndrome, Dunbar syndrome, Laparoscopy, Median arcuate ligament syndrome, Minimal invasive

   DOI: 10.5005/jp-journals-10033-1358  |  Open Access |  How to cite  | 


Median arcuate ligament syndrome (MALS) is a rare disease caused as a result of extrinsic compression by diaphragmatic fibers arching on the celiac artery at its point of origin from the abdominal aorta. Patients suffering from MALS presented with weight loss, nausea, vomiting, and postprandial epigastric pain. Often misdiagnosed with dyspepsia or acid peptic disease, this syndrome is a diagnosis by exclusion, after excluding commoner causes of the upper abdomen pain. It is diagnosed with computed tomographic (CT) angiography and treated with various modalities, including laparoscopic or open division of fibers of MAL, which cause extrinsic pressure. We report a series of three cases of MALS diagnosed and managed at our center, using laparoscopic division of the fibers and release of the celiac artery.



Jasmine R Agarwal, Jitendra T Sankpal, Ratnaprabha P Jadhav, Shubham D Gupta, Supriya S Bhondve, Ruchira R Bhattacharya

Review of Outcome of Laparoscopic Cholecystectomy Done by Consultants vs Surgery Residents at Tertiary Care Teaching Hospital

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:2] [Pages No:43 - 44]

Keywords: Cholecystecomy, Cholelithiasis, Complications, Laparoscopy, Outcome, Surgical training

   DOI: 10.5005/jp-journals-10033-1363  |  Open Access |  How to cite  | 


Objective: The aim of this study was to assess morbidity, mortality, and outcome in selected patients after laparoscopic cholecystectomy (LC) performed by consultants or by surgical residents at Gokuldas Tejpal Hospital affiliated to Grant Government Medical College and Sir JJ group of Government Hospitals in Mumbai, India Materials and methods: Between January 1, 2013 and December 31, 2016, 342 laparoscopic cholecystectomies were performed, 111 by residents and 231 by consultants. The routine blood investigations of all the patients were sent and they all had electrocardiography, chest X-ray, and abdominal ultrasound scan done preoperatively. All patients were induced with general anesthesia. Results: Six conversions were required to an open procedure (four in the resident group and two in the group of consultants) because of impossible recognition of anatomy around Calot's triangle. The mean operative time was 59 minutes for the residents while for the consultants it was 47 minutes. Mortality rate was 0% in both groups. There were 27 major complications, 12 in the resident group and 15 in the consultant group. The mean hospital stay was 3.5 days and 2.3 days for patients operated by the residents and the consultants, respectively, while all the patients resumed their normal activities after 16.7 days and 15.1 days respectively. Conclusion: Supervised LC performed by surgical residents does not increase surgical morbidity and does not compromise patient outcome.



Jalbaji P More, Shirish R Bhagvat, Prachiti Gokhe, Amol Wagh, Ajay H Bhandarwar

Minimal Invasive Management of Gallbladder Perforation

[Year:2019] [Month:January-April] [Volume:12] [Number:1] [Pages:3] [Pages No:45 - 47]

Keywords: Gallbladder perforation, Laparoscopic cholecystectomy, Niemeier classification

   DOI: 10.5005/jp-journals-10033-1364  |  Open Access |  How to cite  | 


Background: Gallbladder perforation (GBP) is a rare clinical entity but life-threatening complication of cholecystitis with or without stones and associated with increased rate of mortality and morbidity due to late diagnosis. Case description: We describe the case of a 51-year-old male patient who presented with abdominal pain and a Niemeier type II GBP. CT scan revealed a GBP with subhepatic collection and surrounding inflammatory changes. It was communicating through a thin hypodense band with the cystic duct, distal to an impacted stone. Through laparoscopy, the collection was confirmed to be a subhepatic secondary to GBP. The cholecystectomy and the abscess cavity treatment were completely handled via laparoscopic approach. Discussion and conclusion: The case report demonstrates that laparoscopic approach can be a safe and feasible method in order to treat both the cause and the complication in this situation. Early diagnosis and appropriate minimally invasive approach are the key to manage this condition.


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