This study was done to compare postoperative pain after cholecystectomy done by single
incision laparoscopic surgery (SILS) versus conventional four port laparoscopy.
This document reviews 10 randomized controlled trials comparing single port laparoscopic cholecystectomy to conventional laparoscopic cholecystectomy. It finds that single port laparoscopic cholecystectomy has a longer operating time but provides an equivocal benefit in terms of postoperative pain. It offers an improved cosmetic outcome but is associated with a low risk of bile duct injuries or the need for conversion to conventional laparoscopic cholecystectomy. The review concludes that single port laparoscopic cholecystectomy is as safe as conventional laparoscopic cholecystectomy in carefully selected patients.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
Litotrissia percutanea laparoscopica nel rene pelvico casi cliniciMerqurio
This document describes a novel technique of laparoscopically assisted percutaneous pyelolithotomy for treating kidney stones in pelvic kidneys. The technique was used in 3 patients with large pelvic kidney stones who were not suitable candidates for standard percutaneous or laparoscopic approaches. The procedure involves using laparoscopy to expose the renal pelvis, then inserting a needle percutaneously into the pelvis under direct visualization. The tract is dilated and a nephroscope is used to remove stones without needing to incise or suture the pelvis. This approach provides direct access to the pelvis without risks of standard percutaneous or laparoscopic techniques. All 3 patients were successfully treated with no complications and no
Nuovo metodo ad ultrasuoni per il trattamento dei calcoli renaliMerqurio
This document describes a novel method using focused ultrasound to reposition kidney stones. Researchers created a kidney phantom with an artificial collecting system and lower pole. Both artificial and human kidney stones were placed in the lower pole. An ultrasound imaging probe was used to locate the stones, while a separate focused ultrasound probe could deliver bursts of ultrasound to move the stones. In experiments, stones were successfully repositioned from the lower pole to the collecting system in seconds, moving at about 1 cm/s. This noninvasive method shows promise for aiding stone clearance after surgery or during medical expulsive therapy.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
This document discusses staple line reinforcement (SLR) options and whether they are useful in gastrointestinal surgery. It outlines the rationale for using SLR to prevent staple line leaks and bleeding. Several SLR products are described, including synthetic, biologic, and fibrin sealants. Studies comparing SLR products found some reduced bleeding and leaks compared to controls. However, SLR may increase risks of adhesions and strictures. More research is still needed to determine the cost-effectiveness of routine SLR use.
This document reviews 10 randomized controlled trials comparing single port laparoscopic cholecystectomy to conventional laparoscopic cholecystectomy. It finds that single port laparoscopic cholecystectomy has a longer operating time but provides an equivocal benefit in terms of postoperative pain. It offers an improved cosmetic outcome but is associated with a low risk of bile duct injuries or the need for conversion to conventional laparoscopic cholecystectomy. The review concludes that single port laparoscopic cholecystectomy is as safe as conventional laparoscopic cholecystectomy in carefully selected patients.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
Litotrissia percutanea laparoscopica nel rene pelvico casi cliniciMerqurio
This document describes a novel technique of laparoscopically assisted percutaneous pyelolithotomy for treating kidney stones in pelvic kidneys. The technique was used in 3 patients with large pelvic kidney stones who were not suitable candidates for standard percutaneous or laparoscopic approaches. The procedure involves using laparoscopy to expose the renal pelvis, then inserting a needle percutaneously into the pelvis under direct visualization. The tract is dilated and a nephroscope is used to remove stones without needing to incise or suture the pelvis. This approach provides direct access to the pelvis without risks of standard percutaneous or laparoscopic techniques. All 3 patients were successfully treated with no complications and no
Nuovo metodo ad ultrasuoni per il trattamento dei calcoli renaliMerqurio
This document describes a novel method using focused ultrasound to reposition kidney stones. Researchers created a kidney phantom with an artificial collecting system and lower pole. Both artificial and human kidney stones were placed in the lower pole. An ultrasound imaging probe was used to locate the stones, while a separate focused ultrasound probe could deliver bursts of ultrasound to move the stones. In experiments, stones were successfully repositioned from the lower pole to the collecting system in seconds, moving at about 1 cm/s. This noninvasive method shows promise for aiding stone clearance after surgery or during medical expulsive therapy.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
This document discusses staple line reinforcement (SLR) options and whether they are useful in gastrointestinal surgery. It outlines the rationale for using SLR to prevent staple line leaks and bleeding. Several SLR products are described, including synthetic, biologic, and fibrin sealants. Studies comparing SLR products found some reduced bleeding and leaks compared to controls. However, SLR may increase risks of adhesions and strictures. More research is still needed to determine the cost-effectiveness of routine SLR use.
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
This document discusses the challenges facing endourologists performing percutaneous nephrolithotomy (PCNL). It outlines several challenges including difficult patient populations, complex kidney stones, congenital kidney anomalies, and technical difficulties. It also describes advances in imaging technologies like multimodal imaging and stone morphometry analyses that help surgical planning. Advances in patient positioning like prone, supine, and flank positions and new instruments for lithotripsy, retrieval, and hemostasis are discussed. The document emphasizes the importance of training and experience to successfully perform the complicated PCNL procedure.
This research article evaluated the efficacy and safety of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for treating rectal cancer. 211 patients underwent either laparoscopic (131 patients) or open (80 patients) surgery. Results showed that both surgeries were successfully completed with no differences in lymph nodes removed or post-op complications. The laparoscopic group had shorter time to pass gas, get out of bed, and hospital stay. No differences were found in recurrence, mortality, or urinary/sexual dysfunction between groups. The study concludes that laparoscopic D3 lymphadenectomy combined with nerve preservation is a feasible and safe treatment for rectal cancer.
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
ECIRS versus PCNL for renal stone management. A meta-analysis of 3 studies with over 300 patients found that ECIRS had a shorter mean operative time and higher stone-free rate compared to PCNL, but similar length of hospital stay. A randomized controlled trial assessed 67 patients and found ECIRS had a shorter operative time and higher stone-free rate. Risk of bias was low. The analysis concluded ECIRS is more efficacious than PCNL for renal stones.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
DR deepak chahar polpiteal cyst arthroscopyDeepak Chahar
This document summarizes a study on the arthroscopic management of popliteal cysts. The study retrospectively analyzed 12 patients who underwent arthroscopic decompression of popliteal cysts along with treatment of associated intra-articular knee pathologies. At 24 months post-surgery, 6 patients had complete resolution of symptoms while 5 had minor limitations; 1 patient did not improve. The study concludes that an arthroscopic approach allows for effective decompression of popliteal cysts while simultaneously addressing underlying knee issues like meniscal tears or cartilage damage. This leads to good clinical outcomes with minimal complications.
A prospective randomized controlled trial assessing the efficacy of omentopex...Ricky Costa
This study aimed to assess whether attaching the omentum (fatty tissue) to the stomach during laparoscopic sleeve gastrectomy (LSG) surgery could help reduce post-operative gastrointestinal (GI) symptoms like nausea and vomiting. The study involved 60 patients undergoing LSG who were randomly assigned to either have LSG alone or LSG with omentopexy. Patients completed surveys assessing GI symptoms at several time points after surgery. The study found that attaching the omentum did not significantly reduce post-operative GI symptoms or food intolerance compared to LSG alone. Patients with omentopexy did require more anti-nausea medication initially but had no difference in other outcomes. The study concludes that
Standard versus tubeless mini percutaneous nephrolithotomyYouttam Laudari
This study compared outcomes of standard mini-percutaneous nephrolithotomy (SmPCNL) versus tubeless mini-percutaneous nephrolithotomy (TmPCNL) in patients with renal stones. There were no significant differences in operative time, drop in hemoglobin, postoperative leakage, or stone-free rates between the two groups. However, the TmPCNL group had significantly less postoperative analgesic requirements and shorter hospital stays compared to the SmPCNL group. The results suggest TmPCNL is as effective as SmPCNL at clearing stones but with less pain and shorter recovery time by avoiding nephrostomy tube placement.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Colonic stenting is an endoscopic procedure used to relieve large bowel obstruction caused by malignant tumors. It allows for patient evaluation and staging, avoids emergency surgery and stomas, and can provide long-term palliation. While technically challenging, stenting has high rates of technical and clinical success for both bridge to surgery and palliative cases when performed by an experienced multidisciplinary team. However, there are risks of perforation and re-obstruction that require careful patient selection, especially for those receiving bevacizumab therapies.
This study evaluated outcomes of the ReMeEx adjustable sling system for treating female stress urinary incontinence (SUI) over 15 years in 55 patients. The ReMeEx system allows postoperative readjustment of sling tension to improve continence without reoperation. At long-term follow-up, 50 patients were cured with 10 requiring readjustment. Complications like temporary retention were minor. The ReMeEx system achieved high cure rates and improved quality of life for SUI patients, including those with prior incontinence surgery or worse prognosis, by enabling durable sling tension adjustment without reoperation.
Post-operative pain management involves a multimodal approach to minimize pain and reduce opioid use and side effects. This includes pre-operative planning, various regional anesthesia techniques during surgery, and post-operative pain control using opioids, non-opioid analgesics, and patient-controlled analgesia. Proper pain management improves patient outcomes and satisfaction while reducing complications after surgery.
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
This document discusses the challenges facing endourologists performing percutaneous nephrolithotomy (PCNL). It outlines several challenges including difficult patient populations, complex kidney stones, congenital kidney anomalies, and technical difficulties. It also describes advances in imaging technologies like multimodal imaging and stone morphometry analyses that help surgical planning. Advances in patient positioning like prone, supine, and flank positions and new instruments for lithotripsy, retrieval, and hemostasis are discussed. The document emphasizes the importance of training and experience to successfully perform the complicated PCNL procedure.
This research article evaluated the efficacy and safety of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for treating rectal cancer. 211 patients underwent either laparoscopic (131 patients) or open (80 patients) surgery. Results showed that both surgeries were successfully completed with no differences in lymph nodes removed or post-op complications. The laparoscopic group had shorter time to pass gas, get out of bed, and hospital stay. No differences were found in recurrence, mortality, or urinary/sexual dysfunction between groups. The study concludes that laparoscopic D3 lymphadenectomy combined with nerve preservation is a feasible and safe treatment for rectal cancer.
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
ECIRS versus PCNL for renal stone management. A meta-analysis of 3 studies with over 300 patients found that ECIRS had a shorter mean operative time and higher stone-free rate compared to PCNL, but similar length of hospital stay. A randomized controlled trial assessed 67 patients and found ECIRS had a shorter operative time and higher stone-free rate. Risk of bias was low. The analysis concluded ECIRS is more efficacious than PCNL for renal stones.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
DR deepak chahar polpiteal cyst arthroscopyDeepak Chahar
This document summarizes a study on the arthroscopic management of popliteal cysts. The study retrospectively analyzed 12 patients who underwent arthroscopic decompression of popliteal cysts along with treatment of associated intra-articular knee pathologies. At 24 months post-surgery, 6 patients had complete resolution of symptoms while 5 had minor limitations; 1 patient did not improve. The study concludes that an arthroscopic approach allows for effective decompression of popliteal cysts while simultaneously addressing underlying knee issues like meniscal tears or cartilage damage. This leads to good clinical outcomes with minimal complications.
A prospective randomized controlled trial assessing the efficacy of omentopex...Ricky Costa
This study aimed to assess whether attaching the omentum (fatty tissue) to the stomach during laparoscopic sleeve gastrectomy (LSG) surgery could help reduce post-operative gastrointestinal (GI) symptoms like nausea and vomiting. The study involved 60 patients undergoing LSG who were randomly assigned to either have LSG alone or LSG with omentopexy. Patients completed surveys assessing GI symptoms at several time points after surgery. The study found that attaching the omentum did not significantly reduce post-operative GI symptoms or food intolerance compared to LSG alone. Patients with omentopexy did require more anti-nausea medication initially but had no difference in other outcomes. The study concludes that
Standard versus tubeless mini percutaneous nephrolithotomyYouttam Laudari
This study compared outcomes of standard mini-percutaneous nephrolithotomy (SmPCNL) versus tubeless mini-percutaneous nephrolithotomy (TmPCNL) in patients with renal stones. There were no significant differences in operative time, drop in hemoglobin, postoperative leakage, or stone-free rates between the two groups. However, the TmPCNL group had significantly less postoperative analgesic requirements and shorter hospital stays compared to the SmPCNL group. The results suggest TmPCNL is as effective as SmPCNL at clearing stones but with less pain and shorter recovery time by avoiding nephrostomy tube placement.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Colonic stenting is an endoscopic procedure used to relieve large bowel obstruction caused by malignant tumors. It allows for patient evaluation and staging, avoids emergency surgery and stomas, and can provide long-term palliation. While technically challenging, stenting has high rates of technical and clinical success for both bridge to surgery and palliative cases when performed by an experienced multidisciplinary team. However, there are risks of perforation and re-obstruction that require careful patient selection, especially for those receiving bevacizumab therapies.
This study evaluated outcomes of the ReMeEx adjustable sling system for treating female stress urinary incontinence (SUI) over 15 years in 55 patients. The ReMeEx system allows postoperative readjustment of sling tension to improve continence without reoperation. At long-term follow-up, 50 patients were cured with 10 requiring readjustment. Complications like temporary retention were minor. The ReMeEx system achieved high cure rates and improved quality of life for SUI patients, including those with prior incontinence surgery or worse prognosis, by enabling durable sling tension adjustment without reoperation.
Post-operative pain management involves a multimodal approach to minimize pain and reduce opioid use and side effects. This includes pre-operative planning, various regional anesthesia techniques during surgery, and post-operative pain control using opioids, non-opioid analgesics, and patient-controlled analgesia. Proper pain management improves patient outcomes and satisfaction while reducing complications after surgery.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
This document discusses post-operative complications from surgery. It identifies that the type of surgery, patient factors like preexisting conditions, and procedure-related issues can influence complications. Immediate complications include bleeding, airway problems, low oxygen, heart issues, and reduced urine output. Early complications are fever, pain, and nausea/vomiting. Delayed complications include infection. The document then examines specific complications like hemorrhage, damage to nearby structures, pain, low urine output, fever, infections, blood clots, heart problems, reduced bowel function, delirium, and pressure sores.
There are two types of pain experienced after surgery: cutaneous and visceral pain. Cutaneous pain is fast, sharp pain caused by chemicals released after incision that activate nerve endings in the skin. This pain travels along A-delta fibers to the spinal cord. Visceral pain is slow, aching pain detected by nerves in internal organs that activates C fibers, carrying referred pain signals. Both types of pain signals travel up the spinal cord and midbrain to be processed and perceived as the pain sensation. The type of post-operative pain determines the appropriate analgesic treatment.
Post-cholecystectomy complications can be early or late, biliary or non-biliary. Early complications include bile leak, hematoma, abscess, and dropped stones. Late complications include port site hernia, postoperative pain, stricture, and retained stones. The risk of these complications is higher with laparoscopic cholecystectomy during acute cholecystitis and for inexperienced surgeons. Important prevention strategies include surgical experience, proper technique such as obtaining the critical view of safety, and conversion to open when needed.
This document discusses post-cholecystectomy syndrome, beginning with case studies of patients who developed symptoms after gallbladder removal surgery. It then defines post-cholecystectomy syndrome as the persistence or development of new symptoms after cholecystectomy. The document outlines that 15% of patients develop symptoms, which can be due to functional disorders, prior surgery complications, or other underlying causes affecting the biliary tract, pancreas, or other organs. Investigation and management depends on identifying the specific cause, which can be found in 95% of cases, through imaging, endoscopy, or surgery to address conditions like sphincter of Oddi dysfunction.
A laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder through several small incisions in the abdomen. During the procedure, carbon dioxide is used to inflate the abdomen so instruments can be inserted to tie off the cystic duct and artery before removing the gallbladder. It is usually performed to treat gallstones, gallbladder polyps, or cholecystitis. Compared to open surgery, laparoscopic cholecystectomy results in less pain, shorter hospital stays, and better cosmetic outcomes, though there are risks such as injury to other organs or postoperative bleeding.
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
A cholecystectomy involves the surgical removal of the gallbladder. The gallbladder stores and concentrates bile produced by the liver to aid in fat digestion. Cholecystectomy is commonly performed to treat gallstones and related complications like gallbladder inflammation. The surgery can be performed through traditional open surgery or through laparoscopic methods involving small incisions. Conditions that may require open rather than laparoscopic cholecystectomy include severe inflammation, abdominal lining inflammation, liver cirrhosis, late-stage pregnancy, or bleeding disorders.
1. Surgical drains are used to collapse surgical dead space, drain abscesses, provide early warning of leaks, and control established fistula leaks.
2. Post-operative care objectives include re-establishing physiological equilibrium, preventing pain and complications, and promoting functions like respiration, circulation, nutrition, and wound healing.
3. Common post-operative complications involve respiratory, cardiovascular, gastrointestinal, urinary, wound, and integumentary systems. Close monitoring is needed to detect and manage complications early.
This document discusses various post-operative complications organized into categories. It describes wound complications including seroma, hematoma, wound dehiscence, and surgical site infections. It also covers thermal regulation issues like hypothermia and malignant hyperthermia. Gastrointestinal complications involving ileus, bleeding, and leaks are outlined. Other complications discussed include DVT, pulmonary embolism, infections and fever, pulmonary issues, renal failure, cardiovascular events, neurological problems like stroke and delirium, and diabetic ketoacidosis. Prevention and management strategies are provided for each complication.
Early complications of intraocular lens (IOL) surgery include corneal edema, wound leak, shallow anterior chamber, hyphaema, retained lens matter, and uveitis. Late complications include posterior capsular opacification, cystoid macular edema, endophthalmitis, and retinal detachment. Post-operative endophthalmitis is a vision-threatening complication that is treated with topical, systemic, and intravitreal antibiotics along with steroids. Posterior capsular opacification occurs in 10-50% of cases due to proliferation of lens epithelial cells.
Post-operative care involves monitoring the patient's ABCDEs and vital signs. Oxygen therapy is usually provided until the anaesthetic dissipates. Specific considerations depend on the surgery and may involve drain monitoring, stoma care, or extensive physiotherapy. Pain assessment and management is fundamental, using tools like scales and working with a multi-disciplinary team using medication, positioning, and early mobilization. Mobility should begin within 24 hours to prevent complications while monitoring the patient's condition and risks.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
This study reviewed 196 patients who underwent single-incision laparoscopic cholecystectomy (SILC) with routine intraoperative cholangiography (IOC) at a single institution. IOC was successful in 178 patients (90.8%) and detected abnormalities in 21 patients (10.7%), including common bile duct stones in 16 patients. IOC helped accurately identify biliary anatomy and avoided potential bile duct injury in one case. The authors conclude that routine IOC during SILC is feasible and useful for detecting bile duct stones and gaining an accurate picture of biliary anatomy.
Over the last two decades, laparoscopic cholecystectomy
has replaced open cholecystectomy as the standard surgical procedure for majority of patients of gall stone disease. Till 1999, laparoscopic Cholecystectomy was being performed using multiple ports usually 3 or 4 ports.
Intensive desire of surgeon to reduce the number of ports led invention of two port cholecystectomy and then finally
single incision laparoscopic cholecystectomy (SILC) .
n (%)
Results
Patient demographics and indications
Table 1 Patient demographics and indications
Surgeon 2
75 min (35–120 min)
85 min (45–180 min)
Junior resident
30 (50)
Fellow
30 (50)
due to severe inflammation (n = 2), inability to retract the
gallbladder (n = 2), and bleeding from the cystic artery
(n = 1). No patient required conversion to open cholecystectomy.
Intraoperative cholangiography and bile duct
exploration
Age (years): mean (range)
47 (18–80)
Gender: n
This document discusses surgical and interventional approaches for gallbladder disease. It describes laparoscopic cholecystectomy as the standard treatment for cholelithiasis and mild-to-moderate acute cholecystitis. Variations like single-incision laparoscopic cholecystectomy aim to reduce scarring but have technical challenges. Natural orifice transluminal endoscopic surgery (NOTES) offers improved cosmesis through transgastric or transvaginal access but requires special equipment. Percutaneous cholecystostomy effectively treats acute cholecystitis in patients who cannot undergo surgery but has frequent complications and diminishes quality of life. The optimal approach considers the patient's condition and disease consequences.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)KETAN VAGHOLKAR
Background: Appendicectomy is one of the common procedures performed by a general surgeon. However,
the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore
there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The
study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and
postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised
into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised
25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative
findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced
need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed
in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure
for appendicectomy.
Laparoscopic cholecystectomy has been the standard procedure for gallbladder removal since the 1990s. Recently, single incision laparoscopic cholecystectomy (SILC) has been developed to further reduce invasiveness. While technically challenging, SILC offers benefits like less pain, faster recovery, and better cosmetic outcomes compared to standard laparoscopic cholecystectomy. The document presents a study protocol to evaluate the benefits of SILC with intraoperative cholangiography, including safety, reduced invasiveness, and ability to manage unexpected bile duct issues. The prospective randomized study will compare outcomes of SILC with cholangiography to standard techniques in 100 patients. Results will help determine if S
This journal club discusses a study that compared surgical site infection rates between open and laparoscopic appendectomy. The study reviewed medical records of 749 patients who underwent appendectomy over an 18-month period. It found that the laparoscopic approach resulted in a significantly lower rate of superficial surgical site infections, likely because the surgical wounds avoid direct contact with infected tissues. However, the laparoscopic procedure took longer and had a higher risk of organ/space infections, though the difference was not statistically significant. Overall, the journal club concludes that laparoscopic appendectomy demonstrates reduced risk of superficial infections and has advantages of being minimally invasive.
This study compared outcomes of total knee arthroplasty (TKA) procedures with and without the use of surgical drains. The study included 121 patients undergoing primary TKA, with 59 knees not receiving a drain and 62 knees receiving a drain. Patients without drains required significantly less opioids for pain and had lower blood loss on the first postoperative day. While both groups showed improvements in function over time, patients without drains also had fewer wound-related complications and less frequent dressing changes during recovery. The study concludes that the routine use of surgical drains does not provide benefits and may increase postoperative pain and blood loss for patients undergoing primary TKA.
RCT on Base tie in laparoscopic appendecomy (Journal Club).pptxadnanhabib31
This is ppt made on a study based on Randomised controlled trial on the tie of appendix base in laparoscopic appendectomy by hem-o-lok,endoloop or stapler.This study showed that hem-o-lok clips are better and cheaper as compared to others.
Saif Presentation (2)_102514.pptx low pressure pneumoperitoneumLoloGhost
This thesis investigates the clinical outcomes of using low-pressure pneumoperitoneum compared to normal pressures during laparoscopic cholecystectomy. A randomized controlled trial was conducted with 100 patients, 50 in each group. The low-pressure group had pressures of 8-10 mmHg while the control group had the standard 12-15 mmHg. Results showed the low-pressure group had longer operating times but significantly less post-operative pain, nausea, and shoulder tip pain. While visualization and bleeding risks may be slightly impacted at lower pressures, overall patient recovery appeared improved with no significant safety issues observed.
The document discusses the history and evolution of surgical trials for colon cancer. It summarizes several key randomized controlled trials comparing laparoscopic versus open colectomy. The trials demonstrated that laparoscopic colectomy is associated with shorter hospital stays and faster recovery, without increased morbidity or affecting long-term oncologic outcomes. More recent studies also support the complete mesocolic excision technique with central vascular ligation over traditional Japanese D3 surgery for improved lymph node yield and potentially better survival. New technologies like robotic assistance and magnetic endoscopic probes aim to advance minimally invasive colon surgery and cancer screening.
STUDY OF eTEP FOR VENTRAL HERNIA REPAIR.pptxAnandaHegde1
This study aims to describe the technique of endoscopic eTEP Rives-Stoppa repair for ventral hernia repair. 41 patients undergoing eTEP ventral hernia repair were evaluated. The mean age was 57.1 years. Umbilical hernias were the most common based on EHS classification. The mean operative time was 3.7 hours. The mean hospital stay was 3.7 days. Post-operative complications included 1 recurrence and 1 seroma. The study concludes that eTEP is a cost-effective ventral hernia repair technique with low recurrence and morbidity rates.
State of the Art Consensus Conference on Prevention of Bile Duct Injury Durin...JosephDAguanno2
Strategies for Minimizing Bile Duct Injuries during cholecystectomy are founded in a Patient Safety Mindset, ensuring proper clearing of the surgical field, careful identification of cystic structures, and confidence in surgical technique.
Transgastric and transvaginal endoscopic cholecystectomy procedures were performed in 27 patients between 2007-2008. The procedures were performed using hybrid NOTES techniques, with laparoscopic assistance. Both transgastric and transvaginal routes were utilized to access the peritoneal cavity. The authors present their initial experience with these novel natural orifice techniques for cholecystectomy in humans.
This document summarizes the history and types of surgical drainage. It discusses active drains that use suction versus passive drains that rely on gravity. The evidence for and against drain use in different surgical procedures is examined through a review of literature including randomized controlled trials and meta-analyses. For many GI surgeries like cholecystectomy and appendectomy, evidence shows drains do not provide benefits and may increase complications, so drainage is not recommended. Further research is still needed for some procedures.
RCT on base tie in lap appendecomy.pptxadnanhabib31
This study aimed to compare outcomes of different techniques for closing the appendix stump during laparoscopic appendectomy (L-APPE). In a randomized clinical trial, 180 patients undergoing L-APPE for uncomplicated acute appendicitis were assigned to have their appendix stump closed using an endoloop, Hem-o-lok clips, or stapler. The stapler group had a significantly longer operative time and higher rate of intraoperative complications compared to the other groups. Postoperative complication rates were low across groups but costs were highest for the stapler technique. Hem-o-lok clips resulted in the shortest operative time and lowest costs, making them a reasonable option for appendix stump closure during L-
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Similar to Post Operative Pain after Cholecystectomy Conventional Laparoscopy versus Single Incision Laparoscopic Surgery (SILS) (20)
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document describes two cases of unusual manifestations of dengue fever. Case 1 is a 40-year-old man who presented with fever, headache, body aches, and a rash who developed hepatitis, thrombocytopenia, and respiratory distress from dengue hemorrhagic fever. Case 2 is a 24-year-old man who presented with fever and was found to have an intraocular hemorrhage, retinal detachment, ARDS, myocarditis, and hepatitis, also from dengue hemorrhagic fever. The document then reviews atypical neurological and gastrointestinal manifestations that have been reported with dengue infection.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
This document discusses pediatric liver transplantation. It begins by stating that pediatric liver transplantation is now an established treatment for end-stage liver failure from various causes, with excellent results due to improved immunosuppressive regimens, surgical techniques, and intensive care. It then discusses the historical development of liver transplantation, including the first attempts in the 1960s and key innovations like cyclosporine in the 1980s. The most common indications for pediatric liver transplantation are discussed as extrahepatic biliary atresia and acute liver failure. The document provides an overview of the pre-transplant evaluation process and post-transplant medical management and immunosuppression. It notes that living-related transplantation has helped address the shortage of donor l
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Post Operative Pain after Cholecystectomy Conventional Laparoscopy versus Single Incision Laparoscopic Surgery (SILS)
1. Post Operative Pain after Cholecystectomy: Conventional
Laparoscopy Versus Single Incision Laparoscopic Surgery (SILS)
2. Original Article
POST OPERATIVE PAIN AFTER CHOLECYSTECTOMY: CONVENTIONAL LAPAROSCOPY
VERSUS SINGLE INCISION LAPAROSCOPIC SURGERY (SILS)
A Prasad, KA Mukherjee, S Kaul and M Kaur
Department of Minimal Access Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110 076, India.
Correspondence to: Dr Arun Prasad, Department of Minimal Access Surgery, Indraprastha Apollo Hospitals,
Sarita Vihar, New Delhi 110 076, India.
e-mail: surgerytimes@gmail.com
Background: This study was done to compare postoperative pain after cholecystectomy done by single
incision laparoscopic surgery (SILS) versus conventional four port laparoscopy. Methods: 100 patients
undergoing cholecystectomy for symptomatic gall stones who were willing to be part of this comparison were
included in the study. Patients were randomized into two groups of 50 each. Only conventional instruments
were used in both groups to keep the cost of surgery same. No special ports, roticulating instruments or flexible
telescopes were used. Pain score was checked after 6 hours of surgery using a visual analogue score.
Results: We observed that there was no statistically significant difference in overall post operative pain. But on
further analysis, we found significant difference in post operative pain score in latter half of our series of SILS
when compared to conventional laparoscopic cholecystectomy and also the first half of the SILS group. There
was also significant difference between operative times in earlier and latter half of SILS. Conclusion: Single
incision laparoscopic surgery is a feasible and a promising method for cholecystectomy. It is possible to do this
procedure with out using special equipment. Although there was no significant difference in overall
postoperative pain, there is a possibility that after the initial learning curve, when the operative time reduces,
the postoperative pain may also decrease. More studies are needed.
Keywords: Laparoscopy, Cholecystectomy, Single Incision Laparoscopic Surgery (SILS).
INTRODUCTION
Laparoscopic cholecystectomy has replaced open
cholecystectomy as the gold standard surgical procedure
for majority of patients of gall stone disease [1].
Conventional laparoscopic Cholecystectomy is being
performed using 4 ports. There was a continuous effort to
minimize the number of ports, and finally single incision
laparoscopic surgery (SILS) came into practice [2].
Single incision laparoscopic surgery is a rapidly
evolving method that is complementing traditional
laparoscopy in selected fields and patients [3,4]. It has also
been suggested as a bridge between traditional
laparoscopy and natural orifice transluminal endoscopic
surgery [5].
Single incision laparoscopic surgery utilizes three ports
through the single skin incision at umbilicus [6]. It is being
considered as no scar surgery, because the incision is
placed within the umbilical scar that is not visible [7,8].
SILS has also decreased post operative pain in some
studies [9]. Many special instruments [6] and ports [10,11]
are available now for SILS. Technical modifications like
Apollo Medicine, Vol. 7, No. 2, June 2010
124
puppeteering of the gall bladder with a suture have been
done [12]. We however performed SILS cholecystectomy
using only conventional laparoscopic instruments. The
study compared SILS and conventional laparoscopic
cholecystectomy for post operative pain.
METHODS
Study was done at Indraprastha Apollo Hospital, New
Delhi, India from 1st October 2009 to 31st March 2010.
100 patients undergoing cholecystectomy for
symptomatic gall stones who were willing to be part of
this comparison were included in the study. Patients were
randomized into two groups of 50 each.
Inclusion criteria
Patient with symptomatic cholelithiasis and fit for
general anesthesia
Exclusion criteria
Patient unwilling to participate in the study
Acute cholecystitis
Abnormal liver function tests
3. Original Article
Contracted gall bladder on ultrasound
Thickened gall bladder wall on ultrasound
Suspicion of gall bladder carcinoma
While the above exclusion criteria are not always
contraindications for laparoscopic cholecystectomy, they
were excluded from the study as the focus was on post
operative pain and not feasibility in difficult operative
situations which could be the topic of a future study once
the benefits are established.
The name of the procedure was kept in a sealed
envelope that was opened after the patient was
anaesthetized. Only conventional instruments were used
in both groups to keep the cost of surgery same. No special
ports, roticulating instruments or flexible telescopes were
used.
A standard 4 port cholecystectomy was done for the
conventional group.
For the SILS group, a 2 cm transverse incision was
made at the level of umbilicus. Upper skin flap was raised
for a distance of 1 cm. After initial insufflation with Veress
needle, a 10 mm cannula was inserted at the incision line
and the two 5 mm cannulas half cm inferiorly and laterally
on both sides through the same incision (Fig.1). A grasper
introduced through the right lateral cannula did fundus
traction. The left lateral cannula was used for introduction
of the dissector to define Calot’s triangle (Fig.2). The
instrument cannulas and telescope cannula were crossed
by a chop stick method (Fig.3) to avoid sword fighting and
clashing of instruments in the abdomen. We started the
procedure with 10 mm laparoscope and later shifted to a 5
mm scope from the left lateral cannula to insert the 10 mm
clip applicator from the central cannula for clipping of the
cystic duct and artery. After dissection from the liver bed
and hemostasis, the gall bladder was delivered from the
central port site. Fascial defects were closed meticulously
and skin apposed.
Pain score was checked 6 hours after surgery using a
visual analogue score. Post operative analgesia was the
same for all patients in the form of injection Diclofenac
Sodium 75 mg given every12 hours.
Statistical analysis
A member of the team who did not know about
procedure performed on the patient did the statistical
analysis.
RESULTS
100 consecutive patients undergoing cholecystectomy
were taken for study and they were divided into two
groups having 50 patients in each group.
Group A – Conventional laparoscopy
Group B – Single incision laparoscopic surgery (SILS)
Patients were in between 19 to 57 years old. We had 21
male and 29 female patients in group A (conventional) and
Fig.1
125
Apollo Medicine, Vol. 7, No. 2, June 2010
4. Original Article
SILS group. In the first 25 patients of SILS, the mean pain
score was 1.9 which was not only higher than the mean
pain score of SILS group but also higher than
conventional group. Post operative pain was less in the
latter 25 patients of SILS group with a mean score of
1.6 (p value <0.05) in comparison to both conventional as
well as first half of SILS group.
Another finding in our study is change in operative
time in SILS group. Mean operative time in conventional
laparoscopy group was 28.08±1.35 while in SILS group it
was 66.76±5.78 minutes. Operative time (OT) in SILS
group varied grossly between earlier cases and latter
cases. In first 25 cases mean OT was 79.2 but in later half
it come down to 54.32 which is a significant decrease
(p value <0.001) (Table 1).
There were no conversions from SILS to conventional
laparoscopic cholecystectomy or conversion to open
surgery.
DISCUSSION
Fig.2
SILS is not a new concept, and was described as early
group B (SILS) comprised of 26 male and 24 female
patients. The average BMI was 27.3 and 27.7 respectively.
The two groups were statistically matched (Table 1).
We tabulated the pain score in both groups (Table 2).
The mean pain score was more in the conventional
laparoscopy group (1.78) compared to the SILS group
(1.7) but that difference was not statistically significant.
We observed that pain score was not evenly distributed in
Fig.3
Apollo Medicine, Vol. 7, No. 2, June 2010
126
Table 1. Age, sex and BMI distribution
Age
Male
Female BMI
Group A (conventional
Laparoscopic
cholecystectomy)
37.5
21
29
27.3
Group B (SILC)
38.1
26
24
27.7
5. Original Article
Table 2. Mean post operative pain score in different groups of patient
Number of
patients
Mean
pain score
P value
( t test )
Statistically
significant
Group A (Conventional)
50
2.78
0.16
No
Group B (SILS)
50
2.64
First Half (SILS)
25
2.84
0.02
Yes
Second Half (SILS)
25
2.48
Group A (Conventional)
50
2.78
0.04
Yes
Second Half (SILS)
25
2.48
Table 3. Mean operative time in different groups of patient
Group A
(Conventional
Lap Chole)
Group B
SILS
(Total)
Early
Half
Later
Half
Number of patient
50
50
25
25
Mean operative time
28.08 ± 1.35
66.76 ± 5.78
79.2
54.32
as 1992 by Pelosi, et al [2] who performed a singlepuncture laparoscopic appendectomy. First experiences
with SILS cholecystectomy were reported by Navarra,
et al in 1997 [3] and with a different approach by Piskun
and Rajpal in 1999 [4].
In recent years, SILS has been focused upon as a
bridge between Natural orifice transluminal endoscopic
surgery (NOTES) and traditional laparoscopic surgery [5].
NOTES is a technically challenging procedure and current
instruments need to be further improved [13]. SILS, on the
other hand, enables the application of a wide range of
already existing instruments. The main point for reducing
the number of incisions has not only been the cosmetic
advantage but also lowered incision risks, morbidity of
bleeding, incisional hernia, and organ damage. But
benefits regarding post operative pain in SILS has not
been confirmed. There were some studies that indicate
reduction in post operative pain [9] but those are small and
not sufficient to come to a conclusion.
Most of the available special ports and flexible
instruments are costly and disposable thereby increasing
the cost of the procedure significantly. In our series we
used only traditional laparoscopic instrument and
traditional ports. We did not use any specialized port,
rather we adopted different indigenous methods to prevent
air leak such as applying adhesive dressings, gauze soaked
with ointment etc around the cannulas.
The real challenge of SILS is to avoid conflict between
the operative instruments and the camera, to maintain the
pneumoperitoneum and reduce operative stress. As a
result of the limited space with using only a single
incision, it is difficult for both the surgeon and the
assistant to work in the area [14]. We have developed a
chop stick method to minimize instrument and telescope
clash during the procedure.
In our study we had 100 patients who were randomly
divided into two groups of 50 patients. Mean post
operative pain was less in SILS group but this was not
statistically significant. Operative time was higher in SILS
group which is comparable to the recently published series
[8,15]. In our early half of SILS series, the operative time
was more than latter half. We found that there was
significant difference in post operative pain between
earlier half and latter half of our SILS series. Post
operative pain is also significantly low if we compare
latter half of SILS group with traditional laparoscopic
series. So from these available data it is evident that post
operative pain may have some relation with operative
time. But it is also true that post operative pain was more in
patients of conventional laparoscopy group in compare to
later half of SILS although operative time is more in
second group. So to establish a mathematical relation
between these two variable (operative time and post
operative pain) a larger study is required. It is likely that
with increasing experience operative time as well as post
operative pain may decrease.
127
Apollo Medicine, Vol. 7, No. 2, June 2010
6. Original Article
Single-incision laparoscopic surgery for gall bladder
removal is a feasible and promising method for the treatment of symptomatic cholelithiasis [16]. This surgery can
be performed with traditional re-usable laparoscopic
instruments [17]. With experience the operative time is
expected to become comparable with conventional
laparoscopic cholecystectomy. Our study did not show
any difference in post operative pain after SILS compared
to standard laparoscopy but we feel that expertise and
reduction of operative time may reduce post operative
pain. No special telescopes, ports or hand instruments are
needed for this procedure but may have a role in advanced
laparoscopic procedures.
8. Hong TH, You YK, Lee KH. Transumbilical single-port
laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 2009; 23: 1393-1397.
9. Kurpiewski W, Pesta W, Kowalczyk M, Glowacki L,
Juskiewicz W. SILS cholecystectomy – our first
experiences. Videosurgery and other miniinvasive
techniques 2009; 4 (3): 91-94.
10. Romanelli JR, Mark L, Omotosho PA. Single port
laparoscopic cholecystectomy with the TriPort system: a
case report. Surg Innov 2008; 15: 223-228.
11. Merchant AM, Cook MW, White BC, Davis SS, Sweeney
JF, Lin E. Transumbilical Gelport access technique for
performing single incision laparoscopic surgery (SILS). J
Gastrointest Surg 2009; 13: 159-162.
REFERENCES
1. Johnson, CD. ABC of the upper gastrointestinal tract
Upper abdominal pain: Gall bladder. Br Med Journal
2001; 323:1170-1173.
2. Pelosi MA, Pelosi MA. Laparoscopic appendectomy
using a single umbilical puncture (minilaparoscopy). J
Reprod Med 1992; 37: 588-594.
3. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini
I. One-wound laparoscopic cholecystectomy. Br J Surg
1997; 84: 695.
4. Piskun G, Rajpal S. Transumbilical laparoscopic
cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech. 1999; 9: 361-364.
12. Chow A, Purkayastha S, Aziz O, Paraskeva P.
Single-incision
laparoscopic
surgery
for
cholecystectomy: an evolving technique. Surg Endosc.
2010; 24:709-714.
13. Marescaux J, Dallemagne B, Perretta S, Wattiez A,
Mutter D, Coumaros D. Surgery without scars: report of
transluminal cholecystectomy in a human being. Arch
Surg 2007; 142: 823-827.
14. Ishikawa N, Arano Y, Shimizu S, et al. Single incision
laparoscopic surgery (SILS) using cross hand technique.
Minim Invasive Ther Allied Technol. 2009;18:322-324.
5. Bresadola F, Pasqualucci A, Donini A, et al. Elective
transumbilical compared with standard laparoscopic
cholecystectomy. Eur J Surg. 1999; 165(1): 29-34.
15. Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK, Kim DG.
Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with
gallbladder disease. J Laparoendosc Adv Surg Tech A
2009; 19: 495-499.
6. Tacchino R, Greco F, Matera D. Single-incision
laparoscopic cholecystectomy: surgery without a visible
scar. Surg Endosc 2009; 23: 896-899.
16. Ersin S, Firat O, Sozbilen M. Single-incision laparoscopic
cholecystectomy: is it more than a challenge? Surg
Endosc 2010; 24: 68-71.
7. Cuesta MA, Berends F, Veenhof AA. The “invisible chole
cystectomy”: A transumbilical laparoscopic operation
without a scar. Surg Endosc 2008; 22: 1211-1213.
17. Cugura JF, Jankoviæ J, Kulis T, Kirac I, Beslin MB. Single
incision laparoscopic surgery (SILS) cholecystectomy:
where are we? Acta Clin Croat 2008; 47: 245-248.
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