In Nepal, it is quite common to find patients with large stone burden and thick gallbladder wall which often leads to incision extension. We have used this extended incision to our advantage. The present technique of two port laparoscopic cholecystectomy not only helps overcoming the specimen extraction difficulties but also contributes to better cosmesis.

A total of 25 patients underwent the surgery in 2008 to 2010.

The mean operating time was 50 minutes. None had significant procedural blood loss, iatrogenic injury, perforation of gallbladder, bile spillage, significant gas leak or subcutaneous emphysema at either port site. All patients were comfortable in the postoperative period and were routinely discharged on 2nd postoperative day except for two patients who has surgical site infection and fever respectively. Although three cases were converted to standard 4 port technique, none required conversion to open cholecystectomy. Out of 25 patients, 7 cases have completed 3 months follow-up and did not show any complication like port site hernia.

The described method of performing two port laparoscopic cholecystectomy is safe, simple and inexpensive yet cosmetically rewarding.

Misro AK, Sapkota P. Two Port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique. World J Lap Surg 2014;7(3):103-106.

Most of laparoscopic instruments are disposable and not reusable. Therefore, laparoscopic surgery is more ineffective according to environment conservation and recycling of resources than open surgery.

Trans-trocar appendix removal method was shown instead of using disposable specimen vinyl bag. Advantages of transtrocar removal are cost-effective and decrement of disposable instrument. But, there has not been cited in the literature about clinical experiences and outcomes. Therefore, this study was conducted to analyze the clinical outcomes.

Uncomplicated appendicitis patients were reviewed retrospectively in 2013. The enrolled patients were divided as trans-trocar appendix removal group (TTAR) and disposable specimen vinyl bag group (DSVB). Clinical data and outcomes were analyzed and compared.

A total of 119 patients undergoing laparoscopic appendectomy were enrolled. Fifty-nine patients belonged to TTAR and 60 patients were DSVB. In the both groups, there were no significant differences in postoperative outcomes. Success rate of trans-trocar removal was 89.3%. According to body mass index (BMI), success rate is 100% below 20 kg/m², 87.8% in patients between 20 kg/m² and 25 kg/m² and 61% above 25 kg/m².

Although, it is difficult to generalize the results, it is thought that trans-trocar appendix removal is alternative and feasible on basis of our study. But in BMI > 25 kg/m², it is thought to be technically careful to perform trans-trocar appen- dix removal. It is also necessary to make comparison the efficacy of appendix removal methods through prospective randomized clinical study to establish the better method for laparoscopic appendectomy.

Bae JM. Clinical Experiences of Trans- Trocar Appendix Removal in Laparoscopic Appendectomy. World J Lap Surg 2014;7(3):107-110.

Federal Medical Centre, Gombe is one of the tertiary hospitals located in the north east of Nigeria. It serves as a referral center to neighboring state and also giving secondary care to the immediate environment. The institution has evolved in giving minimal access surgery services in appendicectomies, cholecystectomies, diagnostic laparoscopy, endourology, etc. We are presenting our experience in laparoscopic appendectomies.

To share our experience in laparoscopic appendectomy.

One year review (May, 2013 to February, 2014) of patients that underwent laparoscopic appendectomy were made. Recruitment for the procedure is done via presentations at the emergency department (ED) or at the surgical outpatient department (SOPD). All cases that had complications and previous abdominal surgeries or had cardiopulmonary disease are excluded. Patients were counseled and taken written consent for conversion to open.

Twenty patients were reviewed that had laparoscopic appendectomy. All had successful surgery; there was no conversion to open. Mean operative time is 34.2 minutes; mean recovery period is 181 minutes (3 hours), mean pain perception was 2.55 (mild pains), mean hospital stay was 22 hours. They were followed up at the SOPD and none of them had ports sites wound infection or clinical evidence of other complications.

Laparoscopic appendectomy is a favorable option in the treatment of uncomplicated appendicitis. Early recovery, reduced pain and hospital stay are the outcome observed.

MOT: Mean operative time; PP: pain perception; RT: Recovery time; HS: Hospital stay.

Mshelia NM, Obiano SK, Guduf MI, Gital YS, Khalifa S. Our Experience in Laparoscopic Appendectomy in Federal Teaching Hospital, Gombe. World J Lap Surg 2014;7(3):111-115.

Evaluation of laparoscopic approach for management of patients with confirmed or suspected acute appendicitis.

Although appendicitis is the most common condition requiring surgery in patients with right lower abdominal pain, this pain can be indicative of a vast list of differential diagnoses and is thus a challenge for clinicians. A definite diagnosis is obtained in 96% of patients undergoing laparoscopic appendectomy (LA) compared with 72% of those undergoing open procedures so patients can avoid the disadvantages of misdiagnosis beside other benefits of La.

A prospective outcome analysis was done for 573 patients over the last 6 years, from 2008 to 2013. All patients were planned to go for la. Modified Alvarado scoring system was used as a guide in diagnosing all patients. The following were recorded: operative time, conversion to open procedure, intraoperative findings, infection complications and length of hospital stay.

The mean operative time in this study was 42 ± 17.54 minutes. Nonappendiceal pathology was found in 31 patients (5.4%). Conversion to open procedure was done in 11 patients (1.9%). The accurate pathology was detected in 535 (93.3%) patients. The infection complications had occurred in 16 patients (2.6% of all patients). The mean hospital stay in this study was 1 ± 0.21 days.

Laparoscopic appendectomy is safe and can provide less postoperative morbidity, accurate method in diagnosing abdominal pathology other than acute appendicitis, and drawbacks of undiagnosed or misdiagnosed pathology that mimic acute appendicitis can be avoided.

OA: Open appendectomy; LA: Laparoscopic appendectomy; CT: Computed tomography; ECG: Electrocardiography; SPSS: Statistical package for the social sciences; DM: Diabetic mellitus; HCV: Hepatitis C virus; IAA: Intra-abdominal abscess.

Bahram MA. Laparoscopic Appendectomy: Is it the Gold Standard Approach for Management of Acute Appendicitis? World J Lap Surg 2014;7(3):116-120.

Type 2 diabetes mellitus (T2DM) comprises 90% of diabetics and is largely the result of excess body weight. There is rising evidence in the literature to suggest that laparoscopic sleeve gastrectomy (LSG) produces effective weight loss and improves obesity-related comorbidities, such as T2DM. The purpose of the study is to observe the effectiveness of LSG in the remission of T2DM.

A retrospective study of 107 diabetic obese patients who underwent LSG at Alamiri Hospital, from October 2008 to 2012 was conducted. The pre- and postoperative diabetic status, body mass index, and percent excess weight loss (%EWL) of the patients were retrieved and analyzed.

The mean age of the patients was 42 years ± 10.4 and 68% were females. Median preoperative BMI was 46 kg/m² (30-87) and median postoperative follow-up period was 18 (2-48) months. Pre- and postoperative fasting blood glucose and HbA1C were measured. Resolution and improvement of T2DM was 53.3% (n = 57) and 38.3% (n = 41), respectively. The %EWL was 72% at 1 year and 73% at 4 years and median postoperative BMI was 33 kg/m² (20-61). Duration based analysis showed that most of the resolved patients had diabetes for less than 5 years.

LSG resulted in total remission of T2DM in more than half of the patients and is more effective for the treatment of patients with short-term duration of the disease.

Al-Sabah S, Almazeedi S, Alosaimi S, Al-Mulla A, Ali DA, Al-Elewah A, Algooneh A. Remission of Type 2 Diabetes Mellitus after Laparoscopic Sleeve Gastrectomy. World J Lap Surg 2014;7(3):121-124.

Karatparambil AA, Sidhic C. A Review of Comparing Laparoscopic Roux-en-Y vs Minigastric bypass for the Morbid Obesity. World J Lap Surg 2014;7(3):125-128.

Hysteroscopy offers a valuable extension of the gynecologist armamentarium, as uterine cavity can be explored in detail for making exact diagnosis. Hysteroscopy can be used for diagnosis as well as management of various gynecological problems. A study was conducted to evaluate the role of hysteroscopy in gynecological conditions.

A prospective clinical study was conducted in the Department of Gynecology, Hindu Rao Hospital. Total 69 patients with abnormal uterine bleeding attending gynecology outpatient department were selected and subjected to hysteroscopic examination after detail history, examination and consent. Subjects were divided into six groups as per their history and examination.

In group I (DUB) 40.5%, in group II (infertility) 21.7%, in group III (postmenopausal bleeding) 11.6%, in group IV (suspected leiomyoma) 11.6%, in group V (lost IUCD) 7.3% and in group VI (secondary amenorrhea) 7.3% patients were there. Abnormal hysteroscopic findings were observed as follows, in group I: 85.71%, group II: 80%, group III: 80%, group IV: 62.5%, group V: 60%, group VI: 60% had. Out of 69 patients, in 73.91% patient's intrauterine pathology was seen on hysteroscopic examination. In our study commonest cause of abnormal blee- ding was endometrial hyperplasia (28.5%), endometrial polyp (18%), proliferative endometrium (28.59%), endocervical polyp (3.6%), submucous myoma (3.6%) and atrophic endometrium (3.6%) patients. In patients with lost IUCD, removal of IUCD was done and adhesionolysis was performed in patient with secondary amenorrhea.

Hysteroscopy is simple, safe, quick, and economical technique which allows exploration of uterine cavity in precise manner with speed and safety. Diagnostic and operative procedures can be performed in the same time.

Arora P, Mendiratta SL, Mittal M, Kumari P. Role of Hysteroscopy in Gynecological Conditions. World J Lap Surg 2014;7(3):129-132.

Colonoscopy has been accepted as the best method for the screening, diagnosis, treatment and follow-up of colorectal pathologies. It is an invasive procedure with many recognized complications such as iatrogenic colonic perforation (CP). Knowledge of the factors influencing (CP) is of decisive importance, especially with regard to the avoidance or minimization of the perforations. This is the second case in the literature with such unreported and rare risk factor for iatrogenic colonoscopic perforation.

We reported a 66-year-old female, not known to have any medical problems, underwent colonoscopy screening. No abnormalities detected up to the rectosigmoid junction when the gastroenterologist noted sudden and massive abdominal distension, the patient started com- plaining of severe generalized abdominal pain, however, she was hemodynamically stable. The procedure abandoned. Abdominal X-ray showed severe scoliotic deformity of the lumber spine with massive pneumoperitoneum. Diagnostic laparoscopy showed a small perforation at the anterior wall of sigmoid colon which was repaired, no fecal soiling of the peritoneal cavity was found as she was prepared for colonoscopy. Her course was unremarkable, and she was discharged 7 days later. A 2-week follow-up showed her to be asymptomatic with healed laparoscopic surgery scars and normal bowel motion.

Patients with skeletal deformity such as scoliosis undergoing colonoscopy have a higher risk of iatrogenic colonoscopic perforation. Symptoms of abdominal pain and distension during colonoscopy in this group of patients should alert the treating doctor for the possibility of colon injury which should be managed accordingly.

AlOsaimi S, Ekrouf S, AlMulla A. Scoliosis as a Rare Risk Factor for Colon Perforation during Colonoscopy: The Second Reported Case and Literature Review. World J Lap Surg 2014;7(3):133-135.

Haribhakti SP, Mistry JH. Training in Advanced Laparoscopic Surgery in India. World J Lap Surg 2014;7(3):136-137.