World Journal of Laparoscopic Surgery

Register      Login

Table of Content

2022 | September-December | Volume 15 | Issue 3

Total Views

EDITORIAL

RK Mishra

Editorial

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/wjols-15-3-v  |  Open Access | 

201

Original Article

Mohab G Elbarbary, Alaa Elashry, Islam Hossam El-Din El-Abbassy

First Port Access Using an Optical Trocar in Advanced Upper Gastrointestinal Tract Laparoscopic Surgeries

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:189 - 192]

Keywords: Bowel injury, Open method, Optical port, Palmer's point, Veress needle

   DOI: 10.5005/jp-journals-10033-1521  |  Open Access |  How to cite  | 

Abstract

Background: Multiple techniques for creation of pneumoperitoneum and first port introduction in laparoscopic surgeries are being used with a variety of benefits and hazards. Our study was conducted to present the safety and simplicity of using an optical trocar for the establishment of pneumoperitoneum and first port access through Palmer's point for advanced upper gastrointestinal tract (GIT) surgeries. Materials and methods: All patients listed for advanced upper GIT laparoscopic procedures were included in the study, whereas patients who had splenomegaly, hepatomegaly or the previous left upper quadrant surgery were excluded. A 12-mm optical trocar was introduced with a 0°-degree camera through Palmer's point in a fully controlled way under complete direct vision, followed by the introduction of the required working ports to perform the targeted operation. The time of first port introduction, creating pneumoperitoneum, as well as complications during or after the procedure were recorded. Results: The study included 1,560 patients who had advanced laparoscopic upper GIT surgeries. Our technique was successful except in two patients (0.12%) due to massive adhesions of previous operations. The mean time to induce pneumoperitoneum and abdominal access was 120s. Port-site infection occurred in 0.19%, whereas enterotomy occurred in 0.12%. No port-site hematomas, hernias, or vascular injuries were noted. Conclusion: Using an optical port at Palmer's point in a fully controlled way allows a fast, easy and safe method for first port access and creating pneumoperitoneum in laparoscopic surgeries. However, special care is still required for patients with the previous abdominal surgeries to decrease the risk of bowel injuries.

560

Original Article

Shams Ul Bari, Aamir Farooq

Clinical Outcomes of Laparoscopic vs Mini-incision Open Appendectomy: A Comparative Study

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:193 - 198]

Keywords: Appendectomy, Appendicitis, Laparoscopy, Pneumoperitoneum, Visual analog scale

   DOI: 10.5005/jp-journals-10033-1479  |  Open Access |  How to cite  | 

Abstract

Introduction: Open appendectomy was first introduced by McBurney and has been considered as the treatment of choice for more than a century for acute appendicitis. However, recently, laparoscopic appendectomy (LA) has become the popular method of treatment for patients with acute appendicitis. Aims and objectives: The aim of this study was to compare results of LA with mini-incision open appendectomy in terms of various parameters such as time taken to complete the procedure, postoperative pain, need for analgesia, hospital stay, days to return to normal activity cosmetic results, and complications. Material and methods: This study was a prospective study conducted in the Department of Surgery, SKIMS Medical College, Bemina, Srinagar, Jammu and Kashmir, India, from July 2017 to June 2019. All patients more than 14 years in age admitted in the accident emergency department of the hospital with a clinical diagnosis of acute appendicitis were included in the study. Results and observations: Total number of patients studied was 101 and were randomly taken either for mini-incision open appendectomy or laparoscopic surgery. The two groups were comparable with respect to age and sex distribution with no statistically significant difference. The average operative time in mini-incision appendectomy (MIA) group was 32.7 ± 2.52 (30–35 years of age) compared to 26.9 ± 2.46 (24–30 years of age) in laparoscopic group, which was statistically significant. The patients with laparoscopic surgery experienced less pain and had less postoperative wound infection as compared to MIA group with p <0.001, which was statistically significant. Conclusion: Comparison done on the basis of statistical results between the two groups was suggestive of superiority of LA over MIA.

510

Original Article

Manzoor Ahmad, Ajay Thakral, Divya Prasad, Musharraf Husain

Laparoscopic Approach to Repair Hiatal Hernias: Our Experience in a Tertiary Care Hospital

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:199 - 201]

Keywords: Esophagogastroduodenoscopy, Gastroesophageal junction, Gastroesophageal reflux disease, Hiatus hernia, Laparoscopy

   DOI: 10.5005/jp-journals-10033-1533  |  Open Access |  How to cite  | 

Abstract

Introduction: Hiatal hernia is commonly associated with the symptomatic gastroesophageal reflux disease (GERD). Protrusion of any abdominal structure other than the esophagus into the thoracic cavity through the hiatus of the diaphragm. The relationship between hiatal hernia and gastroesophageal reflux and proposed surgical options to correct the defect as established by the Allison, namely returning the stomach to the abdomen and repairing the diaphragmatic hiatus. Proton pump inhibitors are a preferred treatment option for symptomatic relief. Surgical treatment usually follows medical treatment. Depending on the severity of symptoms and type of hernia involved, surgical treatment is decided. Laparoscopic repair is a good approach nowadays. It offers various benefits to both the patient and the surgeon. It is generally performed by a general abdominal surgeon because it usually involves an abdominal approach. Laparoscopic repair significantly decreases postoperative complications and is the procedure of choice in most centers. Materials and methods: The present study protocol was reviewed and approved by the Institutional Review Board of Hospital, which waived the requirement for informed patient consent based on the retrospective nature of the work. A single team of surgeon performed all the procedures. Eighteen patients with primary hiatal hernia who underwent laparoscopic surgery from 2016 to 2018 were examined. Results: The follow-up period was between 12 months and 24 months. The average follow-up period was around 18 months. • Thirty-nine patients underwent laparoscopic hernia repair with fundoplication, of which 26 were females and 13 males. • Most of the patients present with symptoms of heartburn or epigastric pain. Some of the patients presented with dyspepsia. Few patients were diagnosed incidentally. • The average age was 42 years (25–75). • Operative time was 150–250 minutes with a mean time of 194 minutes. No patient needed conversion from laparoscopic procedure to open technique. • The hospital stay was 4–7 days with an average stay of 4.5 days. These included one-day preoperative admission. • There were no deaths during or after the procedure. • Pain: A total of 15 patients complained of pain on post-op day 1 who needed round-the-clock analgesia. This number fell to 5 by day 3. At the time of discharge (maximum interval being 7 days and median being 5.5 days), none of the patients had complaints of pain. • Two patients had symptoms of dysphagia at the outpatient follow-up. These patients showed no notable findings on imaging examination and no difficulties with feeding, the symptoms were well-controlled with medication. Conclusion: We conclude that laparoscopic repair of hiatal hernia is a feasible technique with satisfactory surgical outcomes. Although it is a complex operation with a substantial learning curve, thoracic surgeons who have adequate experience with laparoscopy would be capable of performing the operation.

404

Original Article

Bahaa M El Wakeel, Wessam Mostafa Abdellatif, Ashraf Anas Zytoon, Nashwa Ghanem, Mohammed M Mogahed

The Anatomical Variations of Rouviere's Sulcus Observed during Laparoscopic Cholecystectomy in Egyptian Patients

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:202 - 206]

Keywords: Laparoscopic cholecystectomy, Liver cirrhosis, Rouviere's sulcus

   DOI: 10.5005/jp-journals-10033-1527  |  Open Access |  How to cite  | 

Abstract

Background: Laparoscopic cholecystectomy (LC) became one of the most common operations worldwide. Bile duct injury usually occurs due to a failure to recognize the critical structures in Calot's triangle. A proper knowledge about biliary structures, its anatomicl variations, and identification of various anatomical landmarks is essential to make LC easy and safe. Although Rouviere's sulcus (RS) was initially described by Henri Rouviere in 1924, it is not widely known and not often incorporated in LC. In cirrhotic patients, the incidence of gallstones is higher than in general population. Aim: To determine the frequency and types of RS as seen during LC and to assess the benefits of identifying Rouvier's sulcus as an anatomical landmark in avoidance of bile ducts injury during LC in Egyptian patients. Materials and methods: A prospective study was conducted on 290 patients with gallbladder diseases, 250 non-cirrhotic (group A) and 40 cirrhotic patients (group B) who scheduled for LC at National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt, in a period of 30 months. Results: Among group A, RS was clearly identified as a deep sulcus in 190 patients (76%), in 40 patients (16%), RS was identified as a scar, while it was absent in the remaining 20 patients (8%). Among group B, RS was clearly identified as a deep sulcus in 9 patients (22.5%), in 11 patients (27.5%), RS was identified as a scar, while it was absent in the remaining 20 patients (50%). Conclusion: Identification of RS provides an easy landmark for starting dissection of Calot's triangle for safe LC as it facilitates the identification of the biliary and vascular structures and minimizes iatrogenic biliary injuries. Identification of RS may not be easy in liver cirrhosis and need careful dissection of vascular and biliary structures.

378

Original Article

Maged Rihan

Extracorporeal Abdominal Transillumination in Laparoscopic Ventral Hernia Repair: A Tool to Achieve More Confidence and Safety

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:207 - 210]

Keywords: Laparoscopy, Parallel-design study, Transillumination, Two-port technique, Ventral hernia

   DOI: 10.5005/jp-journals-10033-1536  |  Open Access |  How to cite  | 

Abstract

Background: Two-port laparoscopic ventral hernia repair is currently practiced with preferable results. This study was conducted aiming to add to the general safety of trocar placement, and trying to solve the problems of the blind insertion of the primary trocar. This can be achieved by extracorporeal transillumination of the anterior abdominal wall before insertion of the primary trocar; thus, delineating whether the abdominal wall harbors any underlying tissues, and accordingly trying to visualize what is being performed rather than doing it blindly. Materials and methods: This is a single-center study. Patients’ enrollment was carried out between March 2018 and June 2019. They were randomized into two groups: Laparoscopic repair using transillumination before inserting the primary (camera) trocar (group I) and laparoscopic repair only (group II). The primary endpoint was the length of the direct distance between the primary port and the left midaxillary line. This distance is inversely proportional to the distance that will exist between the camera port and the hernial defect. Secondary outcomes involved the duration of the operation and adverse events. Results: The analysis included 46 patients, of whom 23 were randomized to group I and 23 to group II. No significant differences were present regarding patient characteristics or operation times. The direct distances between the primary trocar and the left midaxillary line were significantly less in group I, a median of 35 mm (15–65 mm) than in group II, a median of 75 mm (45–85 mm) (p = 0.013). Conclusion: Extracorporeal abdominal wall transillumination is a promising approach for achieving more safety and confidence in the two-port laparoscopic ventral hernia repair and represents an auxiliary tool for surgeons as a trial to visualize if there are structures adherent to the inner aspect of the anterior abdominal wall to improve abdominal entry safety.

347

Original Article

Sunil Kaval, Swati Tewari, Ekta Rani

Bacterial Infection and Sensitivity Pattern of Cholecystitis among Cholecystectomy Patients

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:211 - 214]

Keywords: Analysis, Antibiotic sensitivity, Bile, Cholecystectomy

   DOI: 10.5005/jp-journals-10033-1540  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: This retrospective type of study was done to know the bacterial cause of cholecystitis and to isolate different bacteria present in bile of cholecystectomy patients. Antibiotic sensitivity was also done to know the antibiotic-resistance pattern among the organism isolated. Materials and methods: In this study, 126 patients’ bile was sent to the Microbiology Department for culture and antibiotic-sensitivity testing during the period of October 2017–November 2018. Cultures were placed in blood agar and MacConkey agar. Organisms were isolated on the basis of growth characteristics and biochemical findings. Antibiotic sensitivity was done using the Kirby–Bauer disk-diffusion method. Results: This study included 126 post-cholecystectomy patients, out of which the male-to-female ratio was 1:2.71. While the female was 92 (83%) and the male was 34 (17%). In this study, we have included all the age-groups of patients, but most of the patients were middle-aged, that is, between 41 and 60 years 78 (62%). In the microbiological analysis, only 68 (54%) samples were culture-positive. In our study, Escherichia coli 43 (63.2%) was isolated among maximum samples and the second most common was Klebsiella spp. 17 (25%). Conclusion: Therefore, it is important to know about common bacteria causing gallbladder infection and their antibiotic-resistance pattern. This study may be helpful in designing the antibiotic prophylaxis among these patients.

496

Original Article

Ayman M Essawy, Ahmed E Fares, Ashraf M Thabet, Khaled M Bauomie

Short-term Outcomes of Laparoscopic Ventral Approach of Rectopexy with Polypropylene Mesh for Rectal Prolapse

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:215 - 219]

Keywords: Laparoscopy, Polypropylene mesh, Rectal prolapse, Rectopexy

   DOI: 10.5005/jp-journals-10033-1538  |  Open Access |  How to cite  | 

Abstract

Background: Complete rectal prolapse (CRP) is a disease in which all layers of the rectum herniate through the anal sphincter. Patients with CRP may complain of constipation which precedes the prolapse. Aim of the study: To evaluate the efficacy of laparoscopic ventral mesh rectopexy (LVMR) in the management of CRP. Patients and methods: This trial was conducted on 20 patients with rectal prolapse (RP) who underwent LVMR admitted from the general surgery outpatient clinic in Fayoum University Hospital in the period from July 2015 to December 2017. Results: We included 15 male patients (75%) and 5 female patients (25%), the average age of participants was 34.4 years. There was a significant improvement in constipation and inflammation and ulceration postoperatively. Recurrence occurred in one patient (5%). Conclusion: The utilization of an anterior approach of laparoscopic technique is the approach of choice for patients with full-thickness RP. The LVMR has the advantage of avoiding unnecessary repeated operations with all its physical and psychological effects on patients, minimal recurrence, a high success rate, and a low complication rate for this procedure.

296

Original Article

Tapan Atulkumar Shah, Jatinkumar Bipinchandra Modi, Jaimin Dipakkumar Shah, Rajesh Shah, Divyata Vasa, Yagnik Katara

A Prospective Study of Outcomes of Patients with Hemorrhoids after Minimal Invasive Procedure for Hemorrhoids

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:220 - 223]

Keywords: Hemorrhoid, Minimal invasive procedure for hemorrhoids, Stapled hemorrhoidopexy

   DOI: 10.5005/jp-journals-10033-1541  |  Open Access |  How to cite  | 

Abstract

Introduction: Hemorrhoids are commonly reported anorectal diseases in which veins in the rectum and anal canal get swollen and inflamed, which causes discomfort and bleeding. Within the normal anal canal, there are specialized, highly vascularized cushion-forming discrete masses of thick submucosa containing blood vessels, smooth muscle, and elastic and connective tissue. They are located in the left-lateral, right-anterior, and right-posterior quadrants of the canal to aid in anal continence. The term hemorrhoids should be restricted to clinical situations in which these cushions are abnormal and cause symptoms. Hemorrhoids are a result of sliding downward of these cushions. Hemorrhoids result from disruption of the anchoring and flatting action of musculus submucosa and (Tretiz's muscle) its richly intermingled elastic fibers. Conventional hemorrhoidectomy is the open surgical procedure in which the hemorrhoid pedicle is ligated by transfixing suture. Stapled hemorrhoidopexy (SH) was introduced by Longo that requires no external incision, instead, hemorrhoidal tissue is lifted into ring of tissue with suture and a stapler removes the hemorrhoids, effectively cutting off blood flow to the tissue. Aims and objectives: The current study defines the efficacy of stapled hemorrhoidopexy and its consequences. Materials and methods: It is an institutional prospective study, including patients on which stapled hemorrhoidopexy was done from 4th January, 2019 to 6th December, 2020, who consented to be a part of the study. These patients were followed up through regular visits to the OPD every week for the first month, every 15 days for the next 2 months, and later via telephonic conversations up to a period of 6 months post surgery. Stapled hemorrhoidopexy was performed as per the procedure. Patients were discharged after successful completion of the operation. All clinical variables were collected from a standardized questionnaire evaluation obtained through office follow-up. Results: Total 166 patients: 142 males and 24 females underwent SH (male:female ratio was 5.92:1). The mean age being 44.75 ± 12.99 years. After operation, patients were discharged on postoperative days 1–4; the mean being 1.67 ± 0.66 days. None of the patients had bleeding in the immediate post or period up to 1 month. Nine patients (5.4%) complained of pain in the immediate postoperative period, 1 had grade III hemorrhoids, 2 had grade II hemorrhoids, 2 had bleeding per rectally with grade II internal hemorrhoids, 1 had interno-external piles, 1 had prolapsed piles, 2 had thrombosed piles. In total, 3 had edema in the early postoperative period, 1 had interno-external piles, 1 had prolapsed piles, and 1 had thrombosed piles. After 1 month, 4 (2.40%) had complained of bleeding per rectally, and none of the patients developed incontinence at the 6-month follow-up. Two patients had a recurrence of reports that had interno-external piles. Two patients who had developed peri-purse-string hematoma developed partial stricture in the long run. The mean blood loss during surgery was 44.39 ± 8.08 mL, the mean duration of surgery was 25.13 ± 3.24 min, and the mean duration of patients returning to work after surgery was 5.08 ± 1.17 days. The overall success rate was 98.2%. Conclusion: Stapled hemorrhoidopexy represents a relatively simple and fast operation with less blood loss during surgery, especially when compared with other traditional procedures. The cost of minimal invasive procedure for hemorrhoids (MIPH) gun was the only major limitation.

543

Original Article

Aniket Agrawal, Gursev Sandlas, Charu Tiwari, Sachit Anand, Anoli Agrawal, Vivek Viswanathan

Laparoscopic vs Robotic Approach for Rectal Cancer: A Meta-analysis

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:224 - 228]

Keywords: Minimal access surgery, Open and laparoscopic surgery, Rectal cancer, Robotic surgery

   DOI: 10.5005/jp-journals-10033-1537  |  Open Access |  How to cite  | 

Abstract

Technology is evolving constantly today, and among the plethora of innovations, the one with the most potential to look forward to, in surgery, is the introduction and evolution of Robotics. Demand, as well as a pursuit of minimally invasive surgery, has increased exponentially particularly in the last decade, with Robotics being at the leading edge of this evolution. It has shown a potential to provide outcomes that were comparable to those achieved with the laparoscopic approach, with some evidence suggesting even better outcomes than laparoscopy in high-risk groups such as patients with obesity, those treated by extended procedures, and male patients. Despite all its benefits, there is still no sturdy evidence established yet about the overall superiority of robotic surgery over the laparoscopic approach. This lack of concrete evidence warranted the need for a meta-analysis that would help reveal any significant differences between the two approaches (robotics vs laparoscopic). Our study aimed to understand and establish the differences between the two approaches of rectal cancer resections, as well as to ascertain the positive efficacy and benefits of robotic surgery, if any, over the conventional laparoscopic approach. The results of this study found that the rates of sphincter preservation, intersphincteric resection (ISR), and conversion were lower with the robotic total mesorectal excision (TME) compared to laparoscopic TMEs, while no significant difference was found in the rate of major (grade ≥III) complications between the two groups.

513

Original Article

Sathishkumar Arone, Raghunath KJ, R Venkatasubramanian, M Muralidharan, Dakshay Chordia

Role of Preoperative Ultrasonography Findings in Predicting Difficult Laparoscopic Cholecystectomy

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:229 - 234]

Keywords: Difficult laparoscopy, Gallbladder, Laparoscopic cholecystectomy, Prospective observational study, Ultrasonography

   DOI: 10.5005/jp-journals-10033-1539  |  Open Access |  How to cite  | 

Abstract

Aim: Most of the complications in a laparoscopic cholecystectomy are due to the difficulties faced during the surgery. In this research, the attempt was made to determine the factors that can predict a difficult laparoscopic cholecystectomy preoperatively based on ultrasound findings. Materials and methods: One hundred patients who are satisfied with our inclusion criteria were included in our study. Preoperative ultrasonography (USG) findings like thickness and size of the gallbladder (GB) wall, the diameter of the common bile duct (CBD), GB stone size and numbers, and the existence of fluid collection around the GB were given a grade of 1 or 0 based on findings being affirmative or dissent. The sums of the grade were taken and were interrelated with the difficult laparoscopic cholecystectomy. Intraoperative findings, namely, injury and damages made to the bile duct, CBD or artery, the existence of thick adhesions on the GB sides, region of the Calot's being frozen, ripped up GB and spillage of bile and stones, unusual and atypical anatomy, bleeding that hampers and obstructs the visual field, and time taken of 60–120 minutes were considered as difficult laparoscopic cholecystectomy. Results: Four preoperative findings, namely, the thickness of GB, GB stone impacted at the neck, GB stone size, and the existence of fluid collection around the GB had statistical significance in anticipating a difficult laparoscopic cholecystectomy. An elevated preoperative ultrasonography score had shown higher chances of a difficult laparoscopic cholecystectomy. Conclusion: Preoperative ultrasonography findings have a role in predicting a difficult laparoscopic cholecystectomy. Clinical significance: Laparoscopic cholecystectomy will be useful to have some authentic factors (USG findings) to prognosticate difficulty, conversion, or complications in laparoscopic cholecystectomy.

325

RESEARCH ARTICLE

Behnam Reza Makhsosi, Fatemeh Darabi, Tara Mazaheri, Mansour Rezaei, Zohair Mazaheri, Alireza Rohban

The Prevalence of Malignant Tumors of the Appendix in Patients with a History of Appendectomy and its Association with Demographic and Laboratory Variables

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:235 - 238]

Keywords: Appendicitis, Appendectomy, Iran, Tumors

   DOI: 10.5005/jp-journals-10033-1530  |  Open Access |  How to cite  | 

Abstract

Aim: Appendicitis is one of the major causes of acute abdominal pain and one of the most common reasons for emergency surgery. Studies have shown that those that have undergone appendectomy are more likely to develop malignant tumors of the appendix. The present study investigates the prevalence of the appendix's malignant tumors in patients with a history of appendectomy and its association with demographic and laboratory variables. Materials and methods: This study is descriptive, in which 4940 patients with a history of appendectomy between 2011 and 2018 in Imam Reza Hospital, Kermanshah, Iran, have been studied. Initially, the patients’ medical files were investigated, and the necessary demographic and laboratory information were extracted. Then, the data were analyzed by descriptive statistics, including mean and variance for quantitative variables and frequency/percentage plus two-dimensional contingency tables for qualitative variables by SPSS 21. Results: The mean age of the patients with appendectomy was 25.50 years, and the prevalence of malignant tumors of the appendix in patients was 0.5%. Overall, 41 cases (0.8%) showed positive pathology regarding the existence of a tumor in the appendix; among them, 26 cases (0.5%) had malignant types, while 15 cases (0.3%) showed benign types. Out of the 26 cases with the appendix's malignant tumors, 14 were male (53.8%), and 12 were female (46.2%). The majority of malignant tumors of the appendix were observed in those above 50 years of age. Among the malignant tumors, 9 (34.61%) were adenocarcinoma mucinous, 6 (23.07%) were carcinoid, 5 (19.23%) were adenocarcinoma, 5 (19.23%) were malignant mucocele, and 1 (3.84%) was cystadenoma. The relationship between the number of white blood cells (WBC) and the appendix's malignant tumors was significant; the WBC count was significantly lower in those with malignant tumors compared to others. In addition, the relationship between age and the existence of malignant tumors was significant (p = 0.025); older individuals were significantly more likely to develop malignant tumors of the appendix compared with younger individuals. The study results did not show any significant relationship between gender and the presence of malignant tumors of the appendix (p = 0.340). Conclusion: Concerning the local invasion and distant metastasis of some appendix tumors, follow-up of pathology reports by the patient (especially older ones) as well as the physician plus post-appendectomy checkup within short and regular time intervals and, if required, follow-up treatment is essential.

515

RESEARCH ARTICLE

Mostafa M Sayed, Hesham A Reyad, Mohamed Korany, Ibrahim M Abdelaal

Comparison between Laparoscopic Ventral and Posterior Mesh Rectopexy for Rectal Prolapse

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:7] [Pages No:239 - 245]

Keywords: Laparoscopic posterior mesh rectopexy, Laparoscopic ventral mesh rectopexy, Rectal prolapse

   DOI: 10.5005/jp-journals-10033-1534  |  Open Access |  How to cite  | 

Abstract

Aim: Recently, laparoscopic techniques are widely used for treatment of rectal prolapse. Therefore, the present work aims to compare the results between laparoscopic ventral mesh rectopexy (LVMR) and laparoscopic posterior mesh rectopexy (LPMR) for patients suffering from rectal prolapse. Materials and methods: This prospective study included forty-four patients with rectal prolapse admitted and managed at the Assiut University Hospitals (Assiut, Egypt) in the period between November 2016 and 31 December 2020. They were divided into two groups (22 patients in each group). Operative parameters, complications, length of hospital stay, postoperative improvement of constipation and fecal incontinence, as well as recurrence were investigated. Clinical symptoms were followed up after surgery with the mean period of 23.73 ± 14.817 months. Results: In the presented study, the mean patient age was 42.43 ± 14.05 years. There were 14 males (6 in the LPMR group vs 8 in the LVMR group) and 30 females (16 for LPMR vs 14 for LVMR) without a significant difference in-between. Operative time was shorter in LPMR (114.09 ± 12.690 minutes) compared with LVMR (181.82 ± 15.395 minutes). No postoperative complications were observed in 81.82% of patients who underwent LPMR and 90.91% of patients who underwent LVMR. Patients who underwent LVMR showed no impotence. Wexner's constipation score was postoperatively lower in LVMR than in LPMR (6.71 ± 3.29 vs 10.78 ± 2.80; respectively) indicating the significant improvement of constipation in LVMR compared with LPMR. A significant improvement of the symptoms of obstructed defecation syndrome was observed in both groups (p-value = 0.0001). Gastrointestinal quality-of-life score was highly increased from 66.09 ± 9.59 to 114.23 ± 8.64 after LVMR. Conclusion: Our study proves that LVMR is superior to LPMR in prevention of impotence, improvement of constipation as well enhancement of the quality of life. Thus, LVMR offers a safer and more effective approach for patients of all ages.

794

REVIEW ARTICLE

Aashna Mehta, Aniket Agrawal, Gursev Sandlas, Vivek Viswanathan

Evolution of Surgical Management for Ulcerative Colitis in the Last Decade: A Comprehensive Literature Review

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:246 - 248]

Keywords: Ileal pouch-anal anastomosis, Minimal access surgery, Open surgery, Surgical management of ulcerative colitis, Total proctocolectomy, Ulcerative colitis

   DOI: 10.5005/jp-journals-10033-1535  |  Open Access |  How to cite  | 

Abstract

Introduction: Inflammatory bowel disease (IBD) is a term that canopies disorders which involve conditions causing chronic inflammation of the gastrointestinal tract (GIT). It mainly includes two conditions, viz.: Crohn's disease (Crohn's) and ulcerative colitis (UC). Ulcerative colitis had a high mortality rate of >50% until the mid-1950s corticosteroids were first introduced for its treatment. Since then, there have been many advances in the management of UC, with the current approach being initial treatment with pharmacological therapy and switching over to surgical management in refractory cases. Our review aimed to look at how the surgical management of UC has advanced over the last decade in various aspects. Materials and methods: The authors searched the PubMed database in December 2021 using the search terms “IPAA for UC” and “Total Proctocolectomy for UC”. After applying the inclusion and exclusion criteria, we found 57 articles that were numbered from 1 to 57 and entered in a randomizer (https://www.randomizer.org/) that gave us seven random numbers, and articles corresponding to those numbers were considered for this review. Conclusion: Surgical management for UC has evolved toward a minimal access approach in the last decade; however, complications such as pouchitis and anastomotic leak are still some of the challenges faced in surgical management for UC. Further multicenter cohort studies comparing the rates of complications in different approaches can produce results that may further improve patient outcomes.

503

CASE SERIES

A Virupaksha, Soumya Rajshekar Patil, S Jayashree, N Madhuri

Laparoscopic Management of Cesarean Scar Pregnancy: A Case Series

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:249 - 254]

Keywords: Cesarean scar pregnancy, Laparoscopic excision of cesarean scar ectopic, Scar ectopic

   DOI: 10.5005/jp-journals-10033-1528  |  Open Access |  How to cite  | 

Abstract

Cesarean scar pregnancy (CSP) stands as a unique variety of ectopic gestation. The incidence is on rise ever since the steady rise with the number of cesarean (C-section) deliveries and improved technology. By means of sonography in the past few decades, there has been a rise in detection rates of CSP. Life-threatening complications, such as uterine rupture, hemorrhage, hypovolemia, and even death, are associated with CSP. Literature on scar ectopic is sparse, it is essential to report all cases of C-section scar ectopic so as to get a better understanding of its management as well as to create awareness on the possibility of this entity. In this regard, we are reporting three cases of C-section scar ectopic which were successfully managed by laparoscopy.

269

CASE REPORT

Ambuj Agarwal, Divij Jayant, Kailash Chand Kurdia, Arunanshu Behera

Type VI Choledochal Cyst: A Rare Case Presenting with Acute Pancreatitis

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:255 - 257]

Keywords: Acute pancreatitis, Intraoperative diagnosis, Type VI choledochal cyst

   DOI: 10.5005/jp-journals-10033-1512  |  Open Access |  How to cite  | 

Abstract

Choledochal cyst (CDC) of cystic duct, i.e., choledochal cyst type VI is an extremely rare clinical entity, with few case reports only. Even the Todani classification of choledochal cyst does not include as a separate entity. Most of choledochal cyst VI is asymptomatic. For an accurate diagnosis, magnetic resonance cholangiopancreatography (MRCP) is required. There is no consensus regarding the management of the cystic duct cyst due to the rarity of the disease, but treatment alternatives extend from laparoscopic cholecystectomy to complete excision of the biliary duct with bilio-enteric reconstruction. We present a case of middle-aged woman who presented with biliary pancreatitis and managed with interval laparoscopic cholecystectomy. Choledochal cyst type VI had been identified intraoperatively.

345

CASE REPORT

Murugappan Nachiappan, Ravi Kiran Thota, Srikanth Gadiyaram

Left-sided Gallbladder: An Intraoperative Surprise during Laparoscopic Cholecystectomy

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:2] [Pages No:258 - 259]

Keywords: Aberrant gallbladder, Cholecystectomy, Laparoscopy, Left-sided gallbladder.

   DOI: 10.5005/jp-journals-10033-1513  |  Open Access |  How to cite  | 

Abstract

Aim: This article reports a case of the left-sided gallbladder (GB) which is more often than not an intraoperative surprise. The knowledge about the entity and associated anatomical variations is crucial to prevent complications. Background: Cholecystectomy is a commonly performed surgical procedure. Left-sided GB is an intraoperative surprise. The reported incidence of left-sided GB is 0.04–1.1% of cases. There is an increased incidence of variant anatomy and a 7% incidence of bile duct injury in these patients. Case description: A 29-year-old lady underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. During laparoscopy, the falciform ligament was unusually stretched toward the right lobe of the liver, going to the region where one would normally see the fundus of GB. Hence, an additional 5-mm port was placed mid-way between the xiphoid process and umbilicus to the left of midline, apart from the standard ports. The fundus and the body of the GB were seen to the left of the falciform ligament. While the infundibulum of the GB was anterior and to the left of the hepatoduodenal ligament, distorting the Calot's triangle. We proceeded with the “fundus first” approach and could complete the procedure. Retraction of the fundus toward the right shoulder with a downward and a lateral traction at the infundibulum helped in Calot's dissection. The patient had an uneventful postoperative course. Conclusion: Left-sided GB is a rare anomaly, most often detected intraoperatively. Use of an additional port and the fundus-first approach helped in successful laparoscopic completion of the procedure. Clinical significance: This case report highlights an intraoperative surprise, a left-sided GB, encountered in laparoscopic cholecystectomy, one of the most commonly performed operations. The knowledge about the entity and the associated variations in critical structure anatomy would be crucial for the surgeons to safely complete the procedure by laparoscopic means.

357

CASE REPORT

Siddartha Gowthaman Subramaniyan, HB Akshaya

Melena Post-laparoscopic Appendicectomy—One of a Kind: A Rare Case Report

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:2] [Pages No:260 - 261]

Keywords: Appendicectomy, Laparoscopy, Melena

   DOI: 10.5005/jp-journals-10033-1514  |  Open Access |  How to cite  | 

Abstract

Melena usually occurs as a result of an upper gastrointestinal bleed, rarely it can be due to bleeding in the small intestine and ascending colon. Appendicectomy is one of the safest procedures done with overall minimal complication rate of about 5%. In this article, we have discussed about melena post-laparoscopic appendicectomy, which is one of the rarest complications of the procedure.

769

CASE REPORT

Murugappan Nachiappan, Ravikiran Thota, Srikanth Gadiyaram

Laparoscopic Spleen-preserving Distal Pancreatectomy for Grade III Pancreatic Injury: A Case Report

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:262 - 265]

Keywords: Duct disruption, Laparoscopy, Pancreas, Trauma

   DOI: 10.5005/jp-journals-10033-1542  |  Open Access |  How to cite  | 

Abstract

Aim: This article reports a case of grade III pancreatic injury managed by laparoscopic spleen-preserving distal pancreatectomy (SPDP). It also discusses the management options available, the timing of surgery, and the surgical options with the review of available literature. Background: Pancreatic surgery represents one of the most challenging areas in gastrointestinal surgery. Isolated pancreatic injury is uncommon following abdominal trauma. Pancreatic transection with duct disruption following blunt abdominal trauma could be managed by both conservative and surgical approaches. Complete pancreatic transection with duct disruption carries high morbidity and mortality. Distal pancreatic resection along with splenectomy is the preferred surgical procedure. Laparoscopic distal pancreatectomy has gained worldwide acceptance in recent years for non-traumatic cases. We report a case of grade III pancreatic injury in a 15-year-old girl managed with laparoscopic SPDP. Case description: A 15-year-old girl presented to us with around 24 hours of blunt trauma to the upper abdomen. She was hemodynamically stable. On examination abdomen was tender and there was voluntary guarding. Evaluation with contrast-enhanced computed tomography (CECT) showed grade III pancreatic injury. There was no pneumoperitoneum. The rest of the solid organs were normal. After resuscitation in line with advanced trauma life support (ATLS) protocols, she underwent a laparoscopic SPDP after written informed consent. She made an uneventful recovery and was discharged on the sixth postoperative day. At the last follow-up, eight years after the surgery, she had no symptoms of endocrine or exocrine insufficiency. Conclusion: Laparoscopic SPDP for pancreatic trauma, though technically demanding and time-consuming, is a feasible undertaking in hemodynamically stable patients. Clinical significance: This case highlights that SPDP for grade III pancreatic injury could be accomplished laparoscopically. A minimally invasive approach is feasible in patients with no associated injuries and hemodynamic stability. Early diagnosis and surgical management are crucial for optimal outcomes.

379

CLINICAL TECHNIQUE

Ehab M Oraby, Ola A Harb, Mokhtar A Bahbah

Concomitant Obesity and GERD: Is Laparoscopic Sleeve Gastrectomy Still Considered the Best Option? A Clinical and Endoscopic Evaluation

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:266 - 271]

Keywords: Body mass index, Gastroesophageal reflux disease, Obesity, Sleeve gastrectomy

   DOI: 10.5005/jp-journals-10033-1517  |  Open Access |  How to cite  | 

Abstract

Background: Obesity is a real worldwide problem. About one billion people are suffering from obesity all over the world. Two-thirds of the communities are adults, then the remaining one-third are children and adolescents. Obese patients especially those with central obesity are showing an incidence of 20–50% for preexisting gastroesophageal reflux disease (GERD). Objectives: This article is trying to define the relationship between these items in obese patients in our community through clinical and endoscopic evaluation. Patients and methods: This prospective study involved 61 patients who were scheduled for bariatric procedures. All patients were invited to answer a GERD questionnaire and to do upper GI endoscopy twice: once preoperative and second time 1 year postoperatively. Patients were divided into three groups regarding preexisting GERD and operative procedure. Results: Group A patients showed significant worsening of GERD scores, endoscopic esophagitis grade, and proton pump inhibitor dependency (PPI). Group B patients showed significant improvement in GERD scores without improvement in esophagitis grade. Group C patients showed multifactorial significant improvement. Conclusion: Laparoscopic sleeve gastrectomy (LSG) operation seems to be truly a refluxogenic procedure, while Roux-En-Y gastric bypass (RYGB) should be considered as better alternatives to avoid postoperative worsening of GERD and degree of esophagitis. These results need confirmation by studies with a bigger number of patients.

313

CLINICAL TECHNIQUE

Rezkalla Akkary, Jinane G Doumat, Loic H Jochault, Sandy F Jochault-Ritz

Scarless Appendectomy in Children. Is it Safe? Our Initial Single-center Experience

[Year:2022] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:272 - 275]

Keywords: Appendectomy, Laparoscopy, Single trocar surgery

   DOI: 10.5005/jp-journals-10033-1518  |  Open Access |  How to cite  | 

Abstract

Purpose: Since the description of laparoscopic appendectomy, the surgeons are trying to develop techniques using less incisions. We describe our initial experience with the transumbilical laparoscopic-assisted appendectomy (TULAA) in children. Materials and methods: A prospective, single surgeon, single-center study was conducted. The technique was described (Video). The rates of conversion of intraoperative complications and of postoperative complications were noted. Risk factors for conversion were analyzed. Results: Forty patients were included. Conversion to a classical 3-port technique was done in 13 cases. The only intraoperative complication was an epiploic bleeding encountered in 1 patient. The only postoperative complication was an umbilical abscess in 2 patients. A scarless abdomen was noted 1 month postoperatively. Conclusion: Transumbilical laparoscopic-assisted appendectomy had combined the exposure advantages of laparoscopy and the low cost of open surgery. Despite the small population number, it seems to be safe, reproducible, and effective, and it had superior esthetic advantages. Clinical significance: Trans-umbilical laparoscopic-assisted appendectomy reduces the incisions needed to do an appendectomy with no increased risk in complications when compared to the traditional techniques.

337

© Jaypee Brothers Medical Publishers (P) LTD.