Gastric plication of the greater curvature is spreading over all the bariatric centers as a new investigational procedure for the treatment of morbid obesity. Conventional bariatric surgeries ‘gastric band’,‘sleeve gastrectomy’,‘vertical banding gastroplasty’ and ‘gastric bypass’ are associated with severe complications and a high rate of failure or weight regain.

Authors present their experience on 482 laparoscopic greater curvature plication (LGCP) performed over a period of 26 months. A total of 449 patients responded to inclusion criteria:147 men and 302 women. Their mean age was 35.99 ± 10.85 years. Their mean body mass index (BMI) was equal to 39.93 ± 6.15 kg/m².

The average percentage of excess weight loss (%EWL) at 1, 3, 6, 12, 18 and 24 months was 30.19, 47.07, 63.05, 68.15, 68.62 and 69.29% respectively. Moreover, this study was divided into two subgroups and results were studied based on the type of suturing and patient's BMI over a period of 1 year. The first subgroup included 183 patients, where gastric plication was performed with continuous suturing at the first and second row. The second subgroup included 186 patients, where gastric plication was performed with separated stitches at the first row and continuous suturing at the second row. In the second subgroup, a higher degree of %EWL was found. The complication rate was greater in the first subgroup. The overall rate of immediate surgical complications was 1.33%. Mean hospital stay was 36 hours.

Gastric plication is safe and efficient on EWL based on short-term results. Separated suturing is associated with a higher %EWL and a lower rate of complications, with a short hospital stay. Long-term data are needed to consolidate these results.

Andraos YA, Ziade D, Achkouty R, Andraos TY. Gastric Plication as a New Stand-Alone Procedure for the Treatment of Morbid Obesity. World J Lap Surg 2014;7(2):49-59.

The baseball diamond principle (BDP) is the conventional principle used for ports placement in video-assisted thoracic surgery (VATS). The triangle target principle (TTP) was introduced as an alternative principle where BDP is associated with difficulties especially in lung resections. We compared the task performance and surgeon's discomfort during some nonpulmonary VATS procedures between using the BDP and TTP in swine models.

Thirty-six nonpulmonary VATS procedures were done on swine models at the World Laparoscopy Hospital, Gurgaon, NCR Delhi, India, from 19th February 2013 to 23rd march 2014. The procedures are 12 VATS pericardial window, 12 esophagocardiomyotomy and 12 thoracic sympathectomy (6 using BDP and 6 using TTP of each procedure). The outcome measures were the execution time, the errors rate and the surgeon's discomfort.

Video-assisted thoracic surgery pericardial window using TTP took longer time to be executed with a mean difference of 93 seconds when compared to using BDP but the errors rates and surgeon's discomfort was similar between BDP and TTP. VATS esophagocardiomyotomy using BDP took longer time with a mean difference of 326.67 seconds but using the TTP was associated with more errors and surgeon's discomfort. In VATS thoracic sympathectomy using the BDP took longer time with a mean difference of 194 seconds, but the execution time data using BDP was not reproducible when validated statistically. The errors rates and surgeon's discomfort was similar between BDP and TTP.

Using baseball diamond principle appears to lead to better task performance and less Surgeon's discomfort during some nonpulmonary VATS procedures in swine models but there is need for studies with larger sample size. TTP use may be more favored during nonpulmonary VATS when stapling will be required.

Ismail AJ, Mishra RK. Comparing Task Performance and Comfort during Nonpulmonary Video-assisted Thoracic Surgery Procedures between the Application of the ‘Baseball Diamond’ and the ‘Triangle Target’ Principles of Port Placement in Swine Models. World J Lap Surg 2014;7(2):60-65.

The standard four-port laparoscopic cholecystectomy (SLC) is presently the gold standard in gallbladder surgery in the United Kingdom. The introduction of single port laparoscopic cholecystectomy (SILC) is said to offer potential improvements in pain and cosmesis postoperatively. This study surveyed patient satisfaction at each of their port sites following uncomplicated four-port cholecystectomy.

Retrospective postal questionnaire poll of 100 patients aged between 18 and 82. A ten-point visual analog score was used to assess postoperative pain at each respective port site within the first 72 hours. A similar scale was used to assess cosmetic satisfaction relating to scar color, stiffness, thickness and irregularity. Patients were asked whether or not they would prefer a single incision operation based on their experience of the standard four-port technique.

Sixty-one patients returned their questionnaires (61% response rate). The median pain scores were highest at the umbilical port site the epigastric port site collectively had the worst cosmetic outcome in terms of satisfaction with scar color, stiffness, thickness and irregularity. 79.7% of patients were satisfied with the four-port procedure and only 20.3% would have preferred a single-port operation if given the option.

Patient satisfaction with standard four-port cholecystectomy is high. The umbilical port was consistently the most painful postoperatively, with cosmesis scores being worst for the epigastric port site. However, there is no firm data that would support SILC over SLC based on this evidence.

Patel M, Neal CP, Dennison AR, Metcalfe MS, Garcea G. Pain and Cosmesis following Four-Port Laparoscopic Cholecystectomy: The Patient View. World J Lap Surg 2014;7(2):66-68.

In patients with choledochocystolithiasis (CCL), early laparoscopic cholecystectomy (LC), within 72 hours, is recommended after endoscopic stone extraction. The objective of this study is to investigate LC for CCL within 24 hours of endoscopic retrograde cholangiopancreatography (ERCP) to determine its feasibility and safety.

Group I, those patients who had LC within 24 hours after ERCP was compared with group II, those who had LC after 24 hours, but within 72 hours. Primary outcome was the conversion rate from LC to open cholecystectomy. Secondary outcomes were duration of LC, postoperative morbidity and hospital stay.

Of 60 consecutive patients, 31 were in group I and 29 were in group II. There were no differences in groups I vs II in demographics, laboratory or ultrasonographic findings. The hospital stay in group I was significantly shorter than that of group II (2.5 ± 1.5 vs 4 ± 2 days respectively). There was no statistically significant difference in operative time, conversion to open cholecystectomy or postoperative morbidity between both groups.

LC for CCL within 24 hours after ERCP is feasible and safe with short hospital stay.

Ammar SA, Bar MA, El Shafy M. Laparoscopic Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography: The Optimal Timing for Operation. World J Lap Surg 2014;7(2):69-73.

Reports have suggested increased use of laparoscopy in the treatment of urological diseases and equally wrong port positions as the commonest cause of struggling during surgeries and increased in complications and operative time.

We aimed to find out the ideal positions for laparoscopic ports to be placed during urological procedures.

We performed different laparoscopic tasks in both the upper and lower urinary tract regions, at different ports position making different manipulation angles and operative time recorded. The procedures were performed on both dry and wet laboratory and on human during laparoscopic donor nephrectomies.

The average operative time of those ports whose position approximate to manipulation angle of 60° was shorter and more comfortable to the surgeons.

There is no ideal positions for port placement in urological procedures based on anatomical landmarks, but rather any position that approximate its manipulation angle to as close to 60° as possible.

Yunusa B, Mishra RK, Chowhan JS. Is There an Ideal Port Position for Laparoscopic Urological Procedures? World J Lap Surg 2014;7(2):74-87.

We analyzed 18 published articles to critically look at the effectiveness of adhesive barriers in operative gynecology. A literature research was performed using internet.

Oxidized regenerated cellulose (Interceed) was found to be an effective adhesion barrier with treated sidewalls showing significantly less area involved with adhesions (p < 0.05). With 4% icodextrin solution (Adept), no significant reduction of de novo adhesions was found in patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts (p = 0.909). With use of hyaluronic acid (Intergel), a significant difference was found in the mean adhesion severity scores (p < 0.05). The Sepracoat group had a significantly lower incidence of de novo adhesions in terms of proportion of sites involved, percentage of adhesion free patients as well as adhesion extent and severity. Oxiplex was found to prevent an increase in adhesion score when compared to placebo.

The decision whether to use an adhesion barrier or not, need to be a well thought out one after weighing the balance between the efficacy of the material against the cost implications involved. The quest for the best of the adhesive barriers still continues.

Puliyathinkal S, Vahab KPA, Umadevi N, Geetha KC, Mumtaz P, Govind A, Mahesh P, Hashim A. Adhesion Prevention in Operative Gynecology: How Realistic are our Expectations? World J Lap Surg 2014;7(2):88-91.

Fourteen cases of PRP were managed with LRP from February 2008 to August 2012.

Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (3-8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 to 7 cm in length. Twelve out of 14 children had recurrence even after sclera-therapy before referral to laparoscopic rectopexy. The mean duration of surgery was 30 minutes (20-60 minutes). No intraoperative complications were reported, only one case get constipation and managed conservatively and no recurrence.

LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclera-therapy injection.

Ibrahim MM, Razik MAE, Abdelkader AM. Laparoscopic Rectopexy: is it Useful for Persistent Rectal Prolapse in Children? World J Lap Surg 2014;7(2):92-96.

Misro A, Kadoglou N. Practice of Laparoscopy Principles from Pages of Ancient History and Mythology. World J Lap Surg 2014;7(2):97.

Nana BO, Bang GA, Ousmana O, Ekani YMB, Essomba A, Takongmo S, Sosso M. Laparoscopic Segmental Colectomy as Management of a Delayed Post Colonoscopic Polypectomy Bleeding: A Case Report in Yaoundé (Cameroon)— A Third World country. World J Lap Surg 2014;7(2):98-100.

Mistry JH, Gupta A, Soni H, Shah A, patel KS, Haribhakti S. Primary Pancreatic Leiomyosarcoma: Laparoscopic Distal Pancreatosplenectomy. World J Lap Surg 2014;7(2):101-102.