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   2020| January-March  | Volume 16 | Issue 1  
    Online since December 20, 2019

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Safety and feasibility of single-port laparoscopic appendectomy as a training procedure for surgical residents
Kwang Yeol Paik, Seung Hoon Yoon, Sung Geun Kim
January-March 2020, 16(1):13-17
DOI:10.4103/jmas.JMAS_136_18  PMID:30178766
Background: Single-port laparoscopic appendectomy (SPLA) is one of the most commonly performed single-port surgeries worldwide. This study aimed to determine whether the performance of SPLA by residents without sufficient experience as operators of conventional LA (CLA) is safe and feasible. Patients and Methods: Records of patients who underwent LA between March 2017 and February 2018 at a hospital in Korea were retrospectively analysed. Patients aged <18 years or >80 years were excluded from the study. SPLA and CLA were performed by two 2nd-year residents (junior group) and three 3rd-year residents (senior group). Demographic data, perioperative variables and surgical outcomes were compared. Results: During the study period, 154 patients underwent LA (104 SPLA and 50 CLA) performed by surgical residents. No differences were found between the SPLA and CLA groups in demographic data or perioperative variables, except for the drain insertion rate. The SPLA group had significantly shorter mean operation times than did the CLA group. No significant difference was observed between the junior and senior groups in the mean operation time for LA. Perioperative outcomes were not significantly different between groups. Fewer women underwent SPLA performed by 2nd-year residents compared with SPLA performed by 3rd-year residents. However, there were no differences in other general characteristics or perioperative outcomes. Conclusions: SPLA was safe and feasible when performed by junior residents. Surgical residents with sufficient experience as assistants during laparoscopic appendectomies could perform SPLA safely. Furthermore, SPLA could serve as a teaching procedure for surgical residents.
  2,866 200 -
Outcomes of laparoscopic incarcerated inguinal hernia repair in children
Brigitta Balogh, Dániel Hajnal, Tamás Kovács, Amulya K Saxena
January-March 2020, 16(1):1-4
DOI:10.4103/jmas.JMAS_84_19  PMID:31898599
Aim: Laparoscopic inguinal hernia repair (LIHR) is gaining widespread acceptance, but its role in the management of incarcerated cases is not well outlined. This review analyses the outcomes of laparoscopic repair of incarcerated inguinal hernia in children. Patients and Methods: Literature was searched on PubMed® using terms 'laparoscopic', 'incarcerated', 'inguinal', 'hernia' and 'children'. Age, sex, side, sac content, operative technique, follow-up period, complication and recurrence rate were analysed. Results: Fifteen articles with 689 paediatric incarcerated inguinal hernias were identified between 1998 and 2018. Median age of patients was 22.4 months (2 weeks–16 years; M:F = 2.2:1). Side was mentioned in n = 576: n = 398 (69.1%) right and n = 178 (30.9%) left. In n = 355 (51.5%) manual reduction and delayed surgery (MRDS), in n = 34 (4.9%) manual reduction in general anaesthesia (MRGA) followed by emergency LHR and in n = 300 (43.5%) intraoperative reduction (IOR) was necessary. Incarcerated contents were documented in n = 68: intestine n = 36 (52.9%), ovary n = 14 (20.6%), omentum n = 11 (16.2%), appendix n = 5 (7.4%) and Meckel's diverticulum n = 2 (2.9%). Among the n = 18 girls in IOR group, n = 14 (77.8%) had ovaries incarcerated. For LHR, the hook method was used in 376 (54.6%) and purse-string suture in 313 (45.4%), with two conversions in IOR group. Mean followup was 15 months (3–80 months), with one (0.15%) testicular atrophy, and 4 (0.58%) recurrences in MRDS and 1 (0.15%) in IOR. All five cases were closed with pursestring technique. Total recurrence rate was 0.73%; significantly higher (P = 0.014) with pursestring (n = 5, 1.6%) than with the hook (none). Conclusion: Hook and purse-string methods are equally popular in LHR for paediatric incarcerated hernias, with 50% hernia reductions possible at the time of surgery. Recurrence rate is low and comparable with non-incarcerated hernias; however, it is significantly higher in purse-string method than hook technique.
  2,861 160 2
Robotic-assisted versus open left pancreatectomy for cystic tumours: A single-centre experience
Luca Morelli, Gregorio Di Franco, Simone Guadagni, Matteo Palmeri, Niccolò Furbetta, Niccola Funel, Desirée Gianardi, Andrea De Palma, Luca Pollina, Andrea Moglia, Andrea Pietrabissa, Giulio Candio, Franco Mosca, Alfred Cuschieri
January-March 2020, 16(1):66-70
DOI:10.4103/jmas.JMAS_158_18  PMID:30178768
Background: Cystic pancreatic lesions (CPLs) are being identified increasingly, and some benefit from surgical treatment. With the increasing use of robotic-assisted surgery (RAS) for neoplasms of the pancreas, the aim of the present comparative study is to establish whether the RAS offered any advantages over conventional open surgery (OS) in the management of CPLs. Patients and Methods: Twenty-seven out of 37 robot-assisted left-sided pancreatectomy (LSP) performed between January 2010 and April 2017 were carried out for CPLs. The surgical outcome and histopathology were compared retrospectively with a control group of 27 patients who had undergone open LSP for CPLs, selected using a one-to-one case-matched methodology (OS-Group) from the prospectively collected institutional database. Results: The spleen was preserved in a significantly higher percentage of patients in the RAS-group (63% vs. 33.3%,P < 0.05). There was no difference in the post-operative course (pancreatic fistula and morbidity) between the two groups. The median post-operative hospital stay was significantly shorter in the RAS-group: 8 days (range 3–25) versus 12 days (range 7–26) in the OS-group (P < 0.01). No conversion to open approach was reported in the RAS-group. Conclusions: Robotically assisted LSP is a safe and effective procedure. It is accompanied by a significantly higher spleen preservation rate compared to the open approach. In addition, because of the reduced trauma, RAS incurred a shorter post-operative hospital stay and faster return to full recovery, particularly important in patients undergoing surgery for relative indications. However, these benefits of RAS for LSP require confirmation by prospective randomised controlled studies.
  2,768 85 2
Early outcome of bariatric surgery for the treatment of type 2 diabetes mellitus in super-obese Malaysian population
Reynu Rajan, Mohammed Sam-Aan, Nik Ritza Kosai, Mohamad Aznan Shuhaili, Tee Sze Chee, Ajay Venkateswaran, Kamal Mahawar
January-March 2020, 16(1):47-53
DOI:10.4103/jmas.JMAS_219_18  PMID:30618425
Introduction: Despite many challenges, the benefit of bariatric surgery in super-obese population remains irrefutable with significant improvement in metabolic syndrome and quality of life. There are currently no published data from Malaysia on this topic. Objective and Methodology: A single-centre retrospective study aimed at analysing the outcome of laparoscopic bariatric surgery on super-obese Malaysians with type 2 diabetes mellitus (T2DM) at 12 months following surgery. Demographic details, glycaemic control and weight-loss parameters were analysed.P < 0.01 was considered statistically significant. Results: Of the 33 patients, 55% were women and 45% were men with a mean age of 40 ± 11 years and body mass index (BMI) of 59.3 ± 9.0 kg/m2. Majority of patients were of Malay ethnicity (82%). Malaysian-Indians and Malaysian-Chinese each accounted for 9% of total case volume. The three types of laparoscopic bariatric surgery recorded in this study were sleeve gastrectomy (82%), Roux-en-Y gastric bypass (9%) and mini-gastric bypass (9%) with operative time of 103.5 ± 31.1, 135.8 ± 32.6 and 116.2 ± 32.3 min, respectively. Percentage total body weight loss was 33.11% ± 9.44% at 12 months following surgery (P < 0.01). BMI change and percentage excess BMI loss showed similar improvement. Glycosylated haemoglobin and fasting blood sugar decreased from pre-operative values of 7.0% ± 1.0% and 7.0 ± 0.9 mmol/L to 5.6% ± 0.4% and 5.0 ± 0.6 mmol/L at 12 months (P < 0.01). Remission of T2DM was noted in 93% of patients. There was no correlation between weight loss and improvement in glycaemic status. Conclusion: There are significant weight loss and improvement of glycaemic control at 12 months post-laparoscopic bariatric surgery among super-obese Malaysians.
  2,751 99 2
Comparative study of laparoscopic radical gastrectomy and open radical gastrectomy
Jie Jiao, Shaozhuang Liu, Cheng Chen, A. Maimaiti, Qingsi He, Sanyuan Hu, Wenbin Yu
January-March 2020, 16(1):41-46
DOI:10.4103/jmas.JMAS_155_18  PMID:30106026
Introduction: At present, the main treatment of gastric cancer is surgical resection combined with radiotherapy and chemotherapy, the most important part of which is radical gastrectomy. Laparoscopic radical gastrectomy for advanced gastric cancer is difficult to operate, and whether it can achieve the same curative effect with the laparotomy is still controversial. Materials and Methods: This study retrospectively analysed the clinical data of 269 gastric cancer patients surgically treated by our medical team from May 2011 to December 2015 for comparative analysis of the clinical efficacy of laparoscopic-assisted radical gastrectomy and traditional open radical gastrectomy. Results: The laparoscopic surgery group had longer duration of surgery, less intra-operative blood loss, shorter post-operative exhaust time, shorter post-operative hospital stay and shorter timing of drain removal. The average number of harvested lymph nodes in the laparoscopic surgery group was 22.9 ± 9.5 per case. And in the laparotomy group the average number was 23.3 ± 9.9 per case. The difference had no statistical significance. With the increase of the number of laparoscopic surgical procedures, the amount of intra-operative blood loss gradually decreases, and the duration of surgery is gradually reduced. Conclusion: Laparoscopic radical gastrectomy is superior to open surgery in the aspects of intra-operative blood loss, post-operative exhaust time, post-operative hospital stay and timing of drain removal. With the number of laparoscopic radical gastrectomy cases increased, the duration of surgery is shortened and the amount of intra-operative blood loss will decrease.
  2,676 113 1
Laparoscopic repeat liver resection after open liver resection: A comparative study from a single-centre
Taiga Wakabayashi, Yuta Abe, Osamu Itano, Masahiro Shinoda, Minoru Kitago, Hiroshi Yagi, Taizo Hibi, Go Oshima, Takuya Minagawa, Yuko Kitagawa
January-March 2020, 16(1):59-65
DOI:10.4103/jmas.JMAS_175_18  PMID:30178770
Background: Technological innovations have made it possible to use laparoscopic liver resection in cases with pre-existing adhesions or cicatricial changes. However, laparoscopic repeat liver resection (LRLR) still represents a challenge for surgeons, especially in case of previous open liver surgery. This study evaluated the outcomes of LRLR after open liver resection (OLR) in cases of recurrent liver cancer. Materials and Methods: A total of 62 patients who underwent laparoscopic minor liver resection at our institution between September 2012 and September 2016 were retrospectively divided into an LRLR group (n = 13) and a laparoscopic primary liver resection group (LPLR; n = 49). The two groups were compared in terms of patient demographics, surgical procedures and short-term outcomes. Recurrence-free survival (RFS) and overall survival (OS) were compared for patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLMs). Results: There was a significant intergroup difference in the hepatitis virus background, although the two groups' primary histology and pre-operative liver function were comparable. The two groups had statistically similar values for extent of resection, operative time, estimated blood loss, transfusion requirement, conversion to laparotomy, post-operative complications, surgical margins, time to oral intake and hospital stay. No significant differences were detected when we stratified the cases according to low and intermediate difficulty. Furthermore, there were no intergroup differences in RFS or OS in the two groups for patients with HCC and CRLM. Conclusions: The findings suggest that minor LRLR after OLR is safe and comparable with minor LPLR in the present study.
  2,623 112 2
Laparoscopic surgery for non-obstetric acute abdomen in pregnancy: A retrospective case series review
Sameer Ashok Rege, Chiranjeev Roshan, Vairagar Siddhant, Surpam Shrinivas, Rewatkar Ajinkya
January-March 2020, 16(1):54-58
DOI:10.4103/jmas.JMAS_145_18  PMID:30416136
Background: Laparoscopic techniques have been used during pregnancy by obstetricians since the 1970's, primarily to diagnose and treat ectopic and heterotopic pregnancies. Pregnancy was considered as an absolute contraindication to laparoscopy by surgeons as recently as 1991, and a few still doubt the safety of minimal access in gravid patients. When an emergent operation is indicated, the surgery should not be withheld on the sole basis of patient's gravid state. On the contrary, the alleviation of maternal disease is thought to take priority because the health of the foetus is dependant on the mother. Materials and Methods: This is a retrospective study of a case series of 18 obstetric patients who presented with non-obstetric causes of acute abdomen requiring surgical intervention. Ultrasonography and magnetic resonance imaging (MRI) along with other laboratory investigations were carried out to reach the diagnosis. Laparoscopic surgery was considered as the modality of treatment. All the patients were given the necessary care post-surgery and were followed up till parturition to look for any complications. Results: The data were analysed considering the presentation, diagnostic variations and the surgical modifications statistically. Conclusion: The decision of surgery should be prompt and should be weighed against complications of conserving the patient. Due to the diagnostic limitations of ultrasonography, MRI should be coupled to confirm the diagnosis. Laparoscopy offers less analgesic requirements and shorter hospital stay. The operative time is highly subjective to the experience and training of the surgeon and the laparoscopic set-up itself.
  2,589 114 -
Practicality and short-term outcomes of intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single-centre retrospective study
Mingjie Xia, Xinyuan Guo, Quan Wang
January-March 2020, 16(1):18-23
DOI:10.4103/jmas.JMAS_187_18  PMID:30416138
Objective: Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis is feasible because of improved approaches to laparoscopic surgery and the availability of a variety of surgical instruments. This study was designed to evaluate the practicality, safety and short-term operative outcomes of intracorporeal gastroduodenostomy in TLDG for gastric cancer. Materials and Methods: Medical records of patients with primary distal gastric cancer undergoing Billroth I (B-I) (n = 37) or B-II anastomosis (n = 41) in TLDG from February 2010 to November 2015 were retrospectively analysed. Perioperative data including the extent of lymph node dissection, number of stapler cartridges used, time required to create the anastomosis, operative time, estimated blood loss, proximal and distal margin length, and number of lymph nodes harvested were collected. Short-term post-operative outcomes evaluated during the initial 30 days after surgery included time to first flatus and earliest liquid consumption, length of post-operative hospital stay and incidence of post-operative complications. Results: B-I anastomosis was mainly applied to patients with carcinoma in the lower third of the gastric body (B-I, 81.08% vs. B-II, 31.71%;P < 0.001). Mean operating (B-I, 153.57 ± 18.25 min vs. B-II, 120.17 ± 11.74 min;P = 0.004) and anastomosis (B-I, 31.92 ± 6.10 min vs. B-II, 25.29 ± 3.84 min;P = 0.01) times were significantly longer for B-I anastomosis compared to B-II anastomosis. There were no significant differences in the number of stapler cartridges used, estimated blood loss, time to first flatus and liquid consumption, length of hospital stay or incidence of complications between these groups. Conclusions: TLDG with B-I or B-II anastomosis is safe and feasible for gastric cancer. B-II anastomosis may require less time than B-I anastomosis.
  2,499 88 -
Laparoscopic management of intra-hepatic gallbladder perforation
Tejas Nikumbh, Ajay Bhandarwar, Shubhangi Sanap, Gajanan Wagholikar
January-March 2020, 16(1):77-79
DOI:10.4103/jmas.JMAS_267_18  PMID:30618436
Intra-hepatic perforation of the gallbladder (GB) leading to hepatic abscess is a serious and rare complication of cholecystitis, with very few sporadically reported cases in the literature. Hence, there is no standard approach to treat it. A thorough radiological evaluation with computed tomography and endoscopic retrograde cholangiopancreatography is necessary before proceeding with surgery in such cases. An early laparoscopic intervention to perform a sub-total cholecystectomy with drain placement is enough to treat both cholecystitis and liver abscess in a definitive manner. While previous reports have advocated an open surgery, our series demonstrates that early laparoscopic management is a safe and suitable approach in such cases.
  2,352 130 1
Laparoscopic redo surgery in recurrent ileocolic Crohn's disease: A standardised technique
Valerio Celentano
January-March 2020, 16(1):90-93
DOI:10.4103/jmas.JMAS_144_18  PMID:30178767
Background: Despite many advances in the medical management of Crohn's disease (CD), there is still a significant risk of surgical resection for lack of response to medical management or complications during the lifetime of a patient. Laparoscopic surgery offers short-term benefits such as decreased pain, lower wound complication rates, earlier resumption of diet and bowel function, better cosmesis and shorter hospital stays, while reduced post-operative adhesions and lower incisional hernia rate may represent long-term benefits. Methods: A modular, standardised laparoscopic approach can be applied to safely perform laparoscopic redo surgery in the hostile setting of the recurrent CD and to facilitate teaching and training of these advanced procedures. Results: Laparoscopic surgery in CD can be particularly challenging due to multifocal disease with extensive inflammation and a thickened mesentery, the potential for abscesses, fistulas and phlegmons and high conversion rates have been reported in reoperative surgery for recurrent CD with abscesses and adhesions representing the main reasons for conversion. Conclusions: A standardised laparoscopic approach for redo surgery in recurrent CD has been described. Multidisciplinary management of CD is essential and bowel preservation must be the priority.
  2,366 108 3
Laparoscopic resection of duodenal carcinoid: A feasible method: Single institute case series
Vimalkumar R. Dhaduk, Vishwas Johri, S. R. Harshavardan Majesty, Nadeem Mushtaque, Nikunj Jain, Prasanna Kumar Reddy
January-March 2020, 16(1):24-29
DOI:10.4103/jmas.JMAS_131_18  PMID:30106022
Background: Duodenal carcinoids (neuroendocrine tumour) are rare tumour, but recently, increase in incidence has been noted. Various techniques for excision of tumour have been described in literature, but very few case reports and case series have mentioned about laparoscopic management of carcinoid tumour. We describe a case series of seven cases of duodenal non-periampullary carcinoids which was managed by laparoscopic method. Aims: The aim of the study was to check feasibility of laparoscopic management of duodenal carcinoid and technique of surgery. Settings and Design: This study design was a case series and prospective data were retrospectively collected. Materials and Methods: A total of 7 patients were operated for carcinoid tumour of duodenum mainly involving first part by laparoscopic method from February 2016 to January 2017. All patients were followed up for minimum 1-year period and various pre-operative, intra-operative findings and post-operative outcome were noted. Results: Out of seven patients, 6 patient were managed by laparoscopic duodenotomy and transduodenal excision whereas one patient required duodenectomy of first part. Mean operative time was 99 min, mean intraoperative blood loss was 55.7, mean hospital stay was 99.7 and no recurrence in a 1-year follow-up. Conclusions: Laparoscopic excision of carcinoid tumour is safe, technically reproducible and feasible method.
  2,263 130 -
Dulucq's technique for laparoscopic totally extraperitoneal hernioplasty
Mohit Agrawal, Sonali Bhagwat, Prashanth Rao
January-March 2020, 16(1):94-96
DOI:10.4103/jmas.JMAS_66_18  PMID:30416144
Background: Inguinal hernia repair has been a controversial area in surgical practice. Its complexity is reflected by the fact that numerous different procedures including both open and laparoscopic techniques are in use today. Laparoscopic totally extraperitoneal (TEP) repair is preferred over transabdominal pre-peritoneal repair as the peritoneum is not breached and also due to fewer intra-abdominal complications. This is the most elegant technique but rather difficult to perform. Aim: The purpose of this study was to describe Dulucq's technique for inguinal hernia repair and the use of three-dimensional mesh without fixation in laparoscopic TEP inguinal hernioplasty. Methods: Surgical technique of laparoscopic TEP inguinal hernia repair is detailed in the text. Results: A total of 945 hernia repairs were included in the study. The hernias were repaired by Dulucq's technique. Mean operative time was 45 min in unilateral hernia and 65 min in bilateral hernia. There were no serious complications. Conclusion: The laparoscopic TEP hernioplasty by Dulucq's technique is feasible with fewer intra-abdominal complications. The dissection must always be done with the same stages with minimal monopolar diathermy and patient in a slight Trendelenburg position.
  2,204 150 -
Ileocolic invagination in adults: A totally minimally invasive endoscopic and laparoscopic staged approach
Elio Treppiedi, Lorenzo Cocchi, Giuseppe Zimmitti, Alberto Manzoni, Valeria Seletti, Alessandra Bizzotto, Cristiano Spada, Marco Garatti, Edoardo Rosso
January-March 2020, 16(1):87-89
DOI:10.4103/jmas.JMAS_279_18  PMID:30777993
Adult intussusception of the bowel is a rare clinical entity, and its management remains debated. The timing of treatment is not yet standardised, and no guidelines exist. We report a case of an 83-year-old woman presenting to the emergency department of our hospital with a history of increasing abdominal pain in the right iliac fossa. A contrast-enhanced computed tomography scan showed the presence of a large ileocolic intussusception with evidence of the terminal ileus invaginated within the right colon and the ileocolic vessels dragged and trapped into the intussusception. A colonoscopy confirmed the ileocolic invagination with a large right colonic lesion as leading point, and a partial pneumatic (carbon dioxide) and hydrostatic reduction was achieved. Subsequent laparoscopic right colectomy was performed according to oncological principles. A totally minimally invasive approach of this rare condition has been achieved but the literature lacks about the correct management of this entity.
  2,233 85 1
Laparoscopic hand-assisted liver resection for tumours in the left lateral section
Eran Sadot, Natalia Goldberg, Emil Damoni, David Aranovich, Hanoch Kashtan, Arie Bitterman, Riad Haddad
January-March 2020, 16(1):35-40
DOI:10.4103/jmas.JMAS_148_18  PMID:30106024
Context: The role of the laparoscopic left lateral sectionectomy (LLLS) is debatable, and Level-1 data are lacking. Aims: The aim of the study is to evaluate the feasibility and safety of this approach. Settings and Design: This was a retrospective study. Subjects and Methods: From 2007 to 2014, patients undergoing LLLS were identified from two institutions. Statistical Analysis Used: Continuous variables were compared between groups with Student's t-test or Mann–Whitney test, as appropriate by type of distribution. Categorical variables were compared with Chi-square or Fisher's exact test, depending on the number of observations. Results: Thirty-eight patients were included in the study. The mean age was 63.5 + 13 years (range, 31–89), and the mean number of tumours was 1.7 + 1.5. Eleven (29%) patients underwent LLS combined with an additional liver resection (combined resections group). The mean duration of the operation and the mean estimated blood loss were significantly decreased in the LLS group compared to the combined resection group (101 + 71 min vs. 208 + 98 min and 216 + 217 ml vs. 450 + 223 ml;P < 0.05 for both, respectively). The major complications rate was 8% and no mortality occurred. Conclusions: In a subset of carefully selected cases, LLLS may provide the benefits of laparoscopy. This does not appear to compromise perioperative morbidity rates. We believe that this approach may serve as a training platform for surgical trainees.
  2,001 116 2
Video-assisted mediastinoscopy is safe in patients taking antiplatelet or anticoagulant therapy
Charlotte Cohen, Daniel Pop, Olivier Aze, Nicolas Venissac, Jérôme Mouroux
January-March 2020, 16(1):30-34
DOI:10.4103/jmas.JMAS_173_18  PMID:30178769
Background: The aim of this study was to report our experience with video-assisted mediastinoscopy (VAM) in patients taking antiplatelet (AP) or anticoagulant therapies focusing on perioperative complications (especially haemorrhagic). Patients and Methods: We have done a retrospective study from a prospectively maintained database with diagnostic VAM (01/2008–06/2012). We included 54 patients with AP (41 patients – Group A) and anticoagulant (13 patients – Group B) therapies. The control group was formed by 263 patients (Group C). Data regarding the clinical records of the patients, operative time, per- and post-operative complications, total numbers of biopsies and the results of the pathologic examination were collected. We compared the groups A+B versus C, and then A versus C. Statistical differences were calculated by Chi-square test. Results: In Group A, we had two minor complications: cardiac arrhythmia and peroperative minor haemorrhage. The mean operative time was 29 min and the mean post-operative stay was 1.08 days. In Group B, we had one minor complication: Peroperative minor haemorrhage. The mean operative time was 35 min and the mean post-operative stay was 1.07 days. In Group C, the mean operative time was 28 min. One death occurred (mortality rate of 0.38%) because of cardiac arrest at the induction of anaesthesia. One major complication occurred (severe respiratory insufficiency needing re-intubation) and eight minor complications. Morbidity rate was 2.28%. Mean post-operative stay was 1.14 days. No statistical difference was noted between groups. Conclusion: VAM can be safely performed in patients receiving AP or anticoagulant treatments. There is no increase in peroperative bleeding or post-operative compressive cervico-mediastinal haematoma.
  1,941 108 -
Caecal duplication cyst: A rare disease with variable presentation and its management in the era of laparoscopy
Rahul Saxena, Manish Pathak, Arvind Sinha
January-March 2020, 16(1):71-73
DOI:10.4103/jmas.JMAS_220_18  PMID:30618426
Duplication cysts of the intestine are a rare congenital anomaly that can occur anywhere throughout the length of intestine and can be either cystic or tubular. Around two dozen cases of caecal duplication cyst (CDC) are reported in the literature with variable presentation. We describe three cases of CDC who presented at variable age and with variable presentation. None of the imaging study could confirm the site of the duplication, preoperatively. All patients underwent laparoscopy-assisted resection and anastomosis. All patients are free of any complications at median follow-up of 24 months.
  1,883 96 -
Laparoscopic repair of a combined transmesocolic, transomental hernia
Gaurav .V. Kulkarni, Dhiraj Premchandani, Akshay Chitnis, Avinash Katara, Deepraj .S. Bhandarkar
January-March 2020, 16(1):83-86
DOI:10.4103/jmas.JMAS_244_18  PMID:30777991
Transmesocolic and transomental hernias (TOHs) are rare types of internal hernia. Both these hernias occurring concurrently in a patient are even rarer. We report a patient with signs of recurrent small-bowel obstruction who was found to have a dual transmesocolic, TOH. Computed tomography imaging and subsequent laparoscopic exploration identified small-bowel loops passing through a defect in the transverse mesocolon behind the stomach to emerge through the gastrohepatic omentum. This was treated successfully by laparoscopy. To the best of our knowledge, this is the first reported case of a combined transmesocolic, TOH undergoing successful laparoscopic repair.
  1,810 68 1
Magnetic resonance imaging-guided three-dimensional real-time bile duct reconstruction and end-to-end anastomosis under laparoscopy: A case report
Zhu Jie, Zheng Siming, Zhang Xuechang, Wang Xiancheng
January-March 2020, 16(1):74-76
DOI:10.4103/jmas.JMAS_242_18  PMID:30618432
In laparoscopic cholecystectomy (LC), the anatomical variation of gallbladder canal should be noted. Bile duct injury is one of the most serious complications of LC, which might lead to serious complications. This case because of an intraoperative accidental cut to right anterior inferior lobe bile duct which joins to the cystic duct, after confirming by intraoperative magnetic resonance imaging-guided real-time three-dimensional bile duct reconstruction and performing end-to-end anastomosis of the right anterior inferior lobe bile duct and the gallbladder tube under laparoscopy, the patient was discharged 5 days after surgery, was followed up for 4 months and was disease-free.
  1,704 64 2
Single-incision laparoscopic cholecystectomy with the right accessory hepatic duct diagnosed preoperatively: A case report
Hiroyuki Matsubara, Seiji Satoh, Atsushi Fukugaki, Yousuke Kinjo
January-March 2020, 16(1):80-82
DOI:10.4103/jmas.JMAS_285_18  PMID:31571670
Accessory hepatic duct or gallbladder duplication is considered to be a risk factor for bile duct injuries and open conversion during laparoscopic cholecystectomy (LC). A 32-year-old woman with epigastric pain was referred to our department. Gallstone disease in the gallbladder was diagnosed by ultrasonography and magnetic resonance cholangiopancreatography. The involvement of an accessory hepatic duct was suspected during endoscopic retrograde cholangiography. Drip infusion cholangiography with computed tomography showed that the cystic duct merged with the accessory right hepatic duct. Single-incision LC (SILC) was successfully performed without bile duct injury. The operative time and intraoperative blood loss were 145 min and 1 mL, respectively. The patient was discharged 3 days' postoperatively, without complications. The involvement of the accessory right hepatic duct is a rare anomaly and is considered to be a risk factor for bile duct injuries. However, obtaining pre-operative images enabled us to perform SILC successfully.
  1,524 59 -
Academic league of videolaparoscopy: A new strategy to awaken the interest of medical students in minimally invasive surgery
Diego Laurentino Lima, Raquel Nogueira Cordeiro, Gustavo Lopes Carvalho
January-March 2020, 16(1):97-98
DOI:10.4103/jmas.JMAS_41_19  PMID:31571671
  1,228 68 -
Spondylodiscitis after minimally invasive recto- and colpo-sacropexy: Report of a case and systematic review of the literature
Philip C. Müller, Caroline Berchtold, Christoph Kuemmerli, Claudio Ruzza, Kaspar Z'Graggen, Daniel C. Steinemann
January-March 2020, 16(1):5-12
DOI:10.4103/jmas.JMAS_235_18  PMID:30416143
Background: Rectopexy and colpopexy are established surgical techniques to treat pelvic organ prolapse. Spondylodiscitis (SD) after rectopexy and colpopexy represents a rare infectious complication with severe consequences. We presented a case of SD after rectopexy and performed a systematic review. Methods: A systematic literature search was performed to identify case reports or case series reporting on SD after rectopexy or colpopexy. The main outcomes measures were time from initial surgery to SD, presenting symptoms, occurrence of mesh erosion or fistula formation and type of treatment. Results:xs Forty-one females with a median age of 59 (54–66) years were diagnosed with SD after a median of 76 (30–165) days after initial surgery. Most common presenting symptoms were back pain (n = 35), fever (n = 20), pain radiation in the legs (n = 9) and vaginal discharge (n = 6). A mesh erosion (n = 8) or fistula formation (n = 7) was detected in a minority of cases. The treatment of SD consisted of conservative treatment with antibiotics alone in 29%, whereas 66% of the patients had to undergo additional surgical treatment. If a revision surgery was necessary, more than one intervention was performed in 40%. Mesh and tack excision was performed in most cases (n = 21), whereas a neurosurgical intervention was necessary in 10 patients. Conclusion: Although a rare complication, surgeons performing rectopexy and colpopexy must be aware of the potential risk of SD Careful suture or tack placement into the anterior longitudinal ligament at the level of the promontory while avoiding the disc space is of paramount importance. Prompt diagnosis and multidisciplinary management are the cornerstones of a successful treatment.
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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04