World Journal of Laparoscopic Surgery

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2019 | September-December | Volume 12 | Issue 3

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[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/wjols-12-3-v  |  Open Access |  How to cite  | 


Original Article

Sunil Kumar, Amar AA Alnaqi, Yousuf A Khan, Aisha Khan, Vipul Gupta, Suad Abul, Abdulla Ali, Esmaeel Taqi, Ashraf Alkholy

Laparoscopic vs Open Surgical Management of Adhesive Bowel Obstruction in Children: A Retrospective Study Comparing the Outcomes at a Tertiary Care Center for Pediatric Surgery

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:4] [Pages No:89 - 92]

   DOI: 10.5005/jp-journals-10033-1382  |  Open Access |  How to cite  | 


Background: Laparoscopic approach for management of adhesive bowel obstruction has become an established technique both in adults and children. There is an increased need of reporting of the outcome using this method of treatment in pediatric practice. Aim: To compare the outcome of laparoscopic vs open surgery in children with adhesive bowel obstruction. Materials and methods: Data were collected on children with adhesive bowel obstruction who were managed at a tertiary care level center for pediatric surgery from January 2007 to September 2017. Patients who were successfully managed by conservative management were excluded. Also the cases in which laparoscopic procedure was converted into an open surgery were excluded. Factors such as operative time, need for total parenteral nutrition, time to resume oral feeds, postoperative length of hospital stay, and complications during or after surgery were studied in laparoscopic and open group. Results: Eighty children with adhesive intestinal obstruction were admitted. Eight were managed conservatively hence excluded. Forty-two were managed by open surgery and laparoscopic management was performed for 30. Four (10.3%) out of these were converted into open laparotomy. These were also excluded. Operative time was not significantly different between open (122 minutes) vs laparoscopic group (138 minutes). During dissection, complications like serosal tear were higher (20 vs 0) in the open group. Resection anastomosis (15 cases) and wound infections (6 cases) rate was also higher with open laparotomy. Mean time in days to start oral feeds (2.5 vs 5.9) and length of hospital stay (5.5 vs 11.3) was significantly shorter in laparoscopic group. Conclusion: Laparoscopic management of adhesive bowel obstruction in children is safe and is associated with early postoperative recovery, shorter hospital stay and lower complication rate in comparison with open surgical management of these cases.


Original Article

Sarbjeet Singh, Amandeep Singh, Ashwani Kumar, Rohit Kapoor, Sumit Mahajan

Laparoscopic Cholecystectomy: Challenges and Outcomes of the Procedure in Elderly Patients

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:3] [Pages No:93 - 95]

   DOI: 10.5005/jp-journals-10033-1383  |  Open Access |  How to cite  | 


Introduction: Gallstone disease is more prevalent in the elderly population besides having comorbid conditions and poor physiological reserves as compared with their younger counterpart. Laparoscopic procedures have certain inherent technical limitations and unique physiological demands. Hence, the procedures may have higher complications in elderly patients and need evaluation in this age-group of patients. Aim: This study is aimed to evaluate the safety of the procedure of laparoscopic cholecystectomy in elderly patients in terms of preoperative and intraoperative difficulties, postoperative complications, morbidity, and mortality. Materials and methods: The study was conducted retrospectively, collecting data from hospital record of a total of 390 patients (45 elderly patients) operated during a period from 2012 to 2017. Results: The mean age of elderly patients was 66.7 years. All the patients who underwent laparoscopic cholecystectomy had an American Society of Anesthesiologist (ASA) score of I or II. Intraoperative difficulties were encountered in 35.55% patients. Average hospital stay was 2.5 days. One patient had a minor bile leak. No mortality occurred. Conclusion: Procedure of laparoscopic cholecystectomy is safe in elderly patients.


Original Article

Ashish Ahuja, Jagdeep Choudhary, Preeti Bajaj

Effect of Bariatric Surgery on Anthropometric and Biochemical Parameters in Morbidly Obese Patients

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:5] [Pages No:96 - 100]

   DOI: 10.5005/jp-journals-10033-1386  |  Open Access |  How to cite  | 


Background: The aim of this study was to evaluate the effect of bariatric surgery on the anthropometric and biochemical parameters of patients. The effect of surgery on anthropometric parameters like weight, body mass index (BMI), waist circumference, hip circumference, and waist–hip ratio was studied. The biochemical parameters included glycated hemoglobin A (HbA1c) and lipid profile [serum cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL)]. Materials and methods: The study was conducted in a tertiary healthcare center in a 1.5-year period on male obese subjects who had undergone bariatric surgery for morbid obesity. Thorough preoperative evaluation was done by a bariatric team which included the bariatric surgeon, dietician, endocrinologist, chest physician, anesthesiologist, and cardiologist. A total of 17 patients who underwent surgery for morbid obesity and gave consent were included in the study and were followed up for 3 months thereafter. Results: Significant weight loss along with a significant decrease in BMI, waist circumference, hip circumference, and waist–hip ratio was observed at 4 weeks and 3 months after bariatric surgery. A statistically significant difference was seen in the fall in HbA1c levels. There was a significant effect on serum cholesterol, serum triglycerides, and serum HDL and LDL levels. No statistically significant difference was seen in serum VLDL levels. Conclusion: Significant weight loss after bariatric surgery in men results in improved clinical outcomes. Lipid profile and glycemic control also improved in patients over follow-up time. The improvement in metabolic parameters may serve as motivators for obese men considering surgery.


Original Article

Anwarul Islam, Rajneesh K Mishra

Evaluation of Various Port Positions for Minimal Access Cardiovascular and Thoracic Procedures

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:15] [Pages No:101 - 115]

   DOI: 10.5005/jp-journals-10033-1387  |  Open Access |  How to cite  | 


Background: Video-assisted thoracoscopic surgery (VATS) is used to diagnose or treat diseases of the chest. Most of those procedures traditionally performed with open thoracotomy can be done using smaller incisions with video assistance. Robot-assisted thoracic surgery (RATS) is a technologically upgraded system that uses computers to help surgeons for precise tremor-less instrument control in a confined space with utmost accuracy. For access to the chest minimally, two principles are followed: the baseball diamond principle (BDP) and the triangle target principle (TTP) of port position. Both can be used for minimal access cardiovascular and thoracic surgery. Different manipulation angles (30°, 60°, and 90°) are used to perform the task and find out time, errors, and surgeon's discomfort during the surgery. Objectives: To evaluate and compare task performance at different port positions during minimal access cardiovascular and thoracic procedures in a swine. Materials and methods: A prospective experimental animal study was granted and conducted at the World Laparoscopy Hospital, Gurugram, Delhi, India. Three thoracic and two cardiac procedures were selected for this study conducted on 30 swines over 11 months from January 15, 2018, to November 15, 2018. At the end, euthanasia was conducted humanly and carcasses disposed appropriately as per the regulation under the provisions of the Prevention of Cruelty to Animals Act, 1960, and the Acts of 1998 and 2001. Results: A total of 30 procedures were conducted in this study using TTP of port placement. The procedures are lung resection-6, thymectomy-6, closure of atrial septal defect (ASD)-6, internal mammary artery (IMA) harvesting for totally endoscopic coronary artery grafting (TECABG)-6, and esophagectomy-6. It is to evaluate the execution time (sum of the ports access time and the actual procedure time), error rates, and the surgeon's discomfort for each of the three angles of manipulation. Average timing of all tasks was shorter with 60° manipulation and all were reproducible. All the tasks were difficult at 30° and 90° angle. Closer manipulation of angle to 90° and above takes longer operative time. It may be due to fatigue from shoulder overstretching for increased elevation angle. It was demonstrated that the surgeon's discomfort level was least at the 60° port position. Conclusion: There is no fixed position for port placement in the cardiovascular and thoracic procedures. The average timing of all tasks was shorter, there were less errors, and surgeon's discomfort was less operating at 60° manipulation angle.



Marzieh Badakhsh, Andishe Hamedi, Salimeh Azizi

Effect of Metatarsus Reflexology Massage in Laparoscopic Cholecystectomy Nausea: A Randomized Clinical Trial

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:4] [Pages No:116 - 119]

   DOI: 10.5005/jp-journals-10033-1381  |  Open Access |  How to cite  | 


Background: Nausea after surgery is an important complication. The incidence of this complication is expressed to be 40–75% in laparoscopy. Due to the risks of nausea following surgery, various methods are used to control it. Metatarsus reflexology is a noninvasive, well-tolerated, inexpensive, convenient, and cost-effective method for treating many diseases. The aim of this study is to identify the effect of metatarsus reflexology massage in laparoscopic cholecystectomy nausea. Materials and methods: In this randomized clinical trial, 60 patients who were candidates for laparoscopic cholecystectomy were randomly divided into two groups. The control group received common drug therapy and the intervention group underwent foot reflexology massage for 10 minutes after common therapy. In recovery and at 6 and 12 hours after surgery, the severity of nausea, vomiting was evaluated in the two groups. The results were analyzed using independent t test, Chi-square, and repeated measures analysis of variance is true. Results: There were no significant differences between the two groups before intervention in terms of demographic characteristics including age, sex, duration of anesthesia, and severity of pain in recovery, However, during the study period (in both the intervention and control groups), the severity of nausea was decreased (p value < 0.001; F = 245.24). Conclusion: Foot reflexology has an important role in nausea control along with other common treatments and it can be done by nurses due to low cost.



Laligen Awale, Narendra Pandit, Shailesh Adhikary

Clipless Laparoscopic Cholecystectomy: Ultrasonic Dissection vs Conventional Method

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:6] [Pages No:120 - 125]

   DOI: 10.5005/jp-journals-10033-1384  |  Open Access |  How to cite  | 


Introduction: Laparoscopic cholecystectomy (LC) is now the gold standard treatment of gallstone disease, but with advancement in technology, there is always a scope for improvement. Ultrasonic shears has been shown to seal the duct and small-size vessel adequately but the fear of complication and sleepless nights has always hindered its use as the sole instrument for LC. Proper use of ultrasonic shears can provide improvement or refinement in LC. Materials and methods: It is a randomized controlled trial conducted at BP Koirala Institute of Health Sciences, Dharan, Nepal, from 2015 to 2016 (1 year). All the patients with symptomatic gallstone disease were assessed thoroughly and randomized into the harmonic scalpel [clipless laparoscopic cholecystectomy (CLC)] or conventional laparoscopic group (CL). Results: Over a period of 1 year, 112 patients were enrolled into CLC (53) and CL (59) groups. The demography of the patients in both the groups including age, sex, history of previous surgery, comorbid conditions, and history of acute cholecystitis was comparable. The mean operative time in our study was 38.65 ± 13.28 minutes. The operative time in the CLC group (35.91 ± 11.66 minutes vs 41.12 ± 14.23 minutes) was less though it was not statistically significant (p 0.054). However, when the “gallbladder (GB) was not perforated,” the operative time was significantly less in the CLC group (34.30 ± 9.30 minutes vs 38.70 ± 10.76 minutes, p 0.03). In our study, three (2.6%) patients required conversion to open cholecystectomy. One (1.85%) in CLC and 2 (3.2%) in the CL group (p 0.63). The visual analog score (VAS) for pain in the first 12 hours and median fall in hemoglobin was significantly less in the CLC group. In our study group, a total of seven (6.25%) patients had morbidity and there was no mortality. Conclusion: With the development of ultrasonic energy source and its ability to seal the vessel and cystic duct safely, it can be utilized during LC without the need of clips.



Miguel A Bergero, Patricio A Garcia Marchiñena, Guillermo Gueglio, Carlos David, Fernando Dipatto, Alberto Jurado

Laparoscopic Ureterolysis without Omentoplasty in the Management of the Uropathy Secondary to Idiopathic Retroperitoneal Fibrosis

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:4] [Pages No:126 - 129]

   DOI: 10.5005/jp-journals-10033-1377  |  Open Access |  How to cite  | 


Introduction: Obstructive uropathy (OU) secondary to idiopathic retroperitoneal fibrosis (IRF) is an infrequent disease, and the standard treatment has not been established. However, ureterolysis with ureteral intraperitonealization is an effective therapeutic alternative. We present the successful management of OU secondary to an IRF by laparoscopic ureterolysis without omentoplasty (LUWO). Materials and methods: A retrospective descriptive study of 5 patients with IRF treated with LUWO was performed. Results: The average age was 60.4 years. The average creatinine was 3.86 mg/dL. There were no intraoperative or major postoperative complications. In a follow-up period of 31.2 months, all patients are asymptomatic, with an average creatinine level of 1.52 without dialysis requirement. No patients required corticosteroid therapy after surgery. Conclusion: Laparoscopic ureterolysis without omentoplasty is a safe and feasible option to treat the OU caused by IRF that provides good results in the medium-term follow-up, as we describe it in our series of cases.



Borja Camacho Fernández-Pacheco, Eudaldo López-Tomassetti Fernández, David Fernández-San Millán, Juan Ramón Hernández Hernández

Single-port Splenectomy after Splenic Cyst Aspiration for Huge Splenic Cyst with High CA 19-9 Levels: The State of the Art

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:3] [Pages No:130 - 132]

   DOI: 10.5005/jp-journals-10033-1379  |  Open Access |  How to cite  | 


Aim: Description of a patient with an elevation of CA 19-9 levels caused by a giant benign splenic cyst, which was completely laparoscopically resected through a single port, despite the large size of the lesion. An increase in CA 19-9 in this type of cystic tumors does not indicate malignancy. Background: The cystic tumors of the spleen are rare diseases that may present a CA 19-9 increase, without indicating malignancy. There is a tendency to perform surgical intervention as less invasive and aggressive as possible. The current trend in the management of splenic cysts with a CA 19-9 increase and benign radiological characteristics, is a minimally invasive surgery, whenever possible. Case description: We present a case of a young patient with a giant splenic cyst of 20.5 × 14.5 × 23 cm and elevated CA 19-9 levels. Spleen was completely laparoscopically resected through a single port after the cyst puncture and aspiration, using the advantages of laparoscopic surgery and single port. Had a favorably postoperative course with resolution of the symptoms up to the current date. Conclusion: There is an actual tendency to perform minimally invasive surgical interventions. In pathologies such as the clinical case provided, we should try to make a surgical intervention as less invasive as possible, despite the large size of the lesion. In our case, we successfully performed the resection of a giant splenic cyst, using the advantages of laparoscopic surgery and the single port, which helped us in the extraction of the piece. Clinical significance: When facing this pathology, we must bear in mind that benign epithelial and mesothelial cysts can produce an increase of CA 19-9 blood levels, without indicating malignancy. So, we should try to make a surgical intervention as less invasive as possible.



Shafquat Zaman, Mona Kamal, Peter Waterland

Femoral Hernioscopy: A Minimally Invasive Procedure to Evaluate Bowel Viability

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:2] [Pages No:133 - 134]

   DOI: 10.5005/jp-journals-10033-1378  |  Open Access |  How to cite  | 


We highlight an important surgical technique that can be utilized to prevent unnecessary laparotomies in patients undergoing emergency femoral hernia repair. A 79-year-old female presented to our unit with an increasingly painful left-sided groin swelling. She was subsequently taken to the operation theater for an emergency operation and found to have a spontaneously reduced femoral hernia after induction of anesthesia. Femoral hernioscopy was performed successfully with the patient positioned in a steep Trendelenburg position. This allowed us to perform a diagnostic laparoscopy and assess bowel viability. Consequently, further unnecessary procedures were avoided together with their associated short- and long-term morbidity. Hernioscopy is a safe, feasible, and valuable technique that is potentially underutilized. We feel that this is a cornerstone in the application of minimal access surgery for a common general surgical emergency, and hence further research with application of this technique is required in this field.



Mubarak Alkandari, Samir Abdulaziz, Mohamed Alsulimy, Nagy Ismaeil, Mohamed Abdelmohsen

Portomesenteric Venous Thrombosis with Bowel Ischemia after Laparoscopic Sleeve Gastrectomy

[Year:2019] [Month:September-December] [Volume:12] [Number:3] [Pages:3] [Pages No:135 - 137]

   DOI: 10.5005/jp-journals-10033-1385  |  Open Access |  How to cite  | 


Laparoscopic sleeve gastrectomy has become an increasingly popular surgical option for morbidly obese patients. Portomesenteric venous thrombosis, as a complication of laparoscopic sleeve gastrectomy, has been rarely reported. We report one case of thrombosis of the portal vein and the superior mesenteric vein after sleeve gastrectomy. It is confirmed by CT scan. Thrombosis of the portomesenteric veins after bariatric surgery is a diagnosis that one should know how to raise in front of any postoperative abdominal pain. An obese patient with a history of thrombosis should receive a complete etiology of these thromboses before bariatric surgery. Abnormal blood dirt, an active smoking fat woman having oral contraceptive, or a patient with a history of recurrent venous thrombosis may be a relative contraindication against a complex bariatric surgery with digestive bypass.


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