Current Issue Volume 10, Number 3 , September-December 2017

EDITORIAL
RK Mishra

Editorial

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:v]



Robotic surgery is now mushrooming very fast in developed country including India. The introduction of the da Vinci robotic surgical system has led to a continuous discussion about the cost-effectiveness of its use. More needs to be done to reduce the cost of Robotic surgery in developing country. The robot’s “ EndoWrist Instruments” have a high degree of dexterity, allowing surgeons the ability to operate in very tight spaces in the body that would otherwise only be accessible through open surgery which requires large incisions.


ORIGINAL ARTICLE
Tanweer Karim, Vivek K Katiyar, Rabishankar Singh, Subhajeet Dey

Short-term Results of Laparoscopic Transabdominal Preperitoneal Inguinal Hernioplasty in a Developing Country

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:83-86]



Introduction: Inguinal hernias have plagued mankind for its upright gait since evolution. Around 16% of the patients presenting to surgery outpatient department have inguinal hernias. Various procedures like the use of patients’ own tissues or prosthetic meshes have been used in the past to repair inguinal hernia with varying degrees of success. Laparoscopic hernioplasty is the latest technique with several advantages over open procedures like reduced postoperative pain and shorter recovery period. However, steeper learning curve and cost of the procedure have been cited as limiting factor.

Aim: To study the outcome of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in terms of operating time, postoperative pain, wound complications, and recurrence.

Materials and methods: This is an analysis of patients that underwent TAPP inguinal hernia repair, from January 2013 to May 2015. Case records of 90 patients between 18 and 60 years that underwent TAPP by a single surgical team were followed prospectively. Data regarding operative time, complications, immediate postoperative pain, chronic groin pain, recurrence, and sensory disturbance were recorded and evaluated.

Results: All the patients were males aged from 18 to 60 years. Mean operative time was 60 minutes (40-120 minutes). Postoperative pain as assessed by visual analog scale (VAS) 6 hours after has been low (mean: 2). Chronic pain occurred in 2 patients (2.22%), but that has not affected routine work or mobility.

Conclusion: Short-term results of TAPP hernia repair using mesh demonstrated to be an effective and safe procedure with low prevalence of chronic pain that was generally of a mild, infrequent nature. Intraoperative bleeding and use of postoperative analgesia were considerably less. There was no incidence of early recurrence. Learning curve is not so steep as claimed, and considering advantages, the cost of the procedure should not be a limiting factor even in a developing country.

Keywords: Laparoscopic hernia repair, Lichtenstein hernioplasty, Stoppa repair, Total extraperitoneal hernioplasty, Transabdominal preperitoneal hernioplasty.

How to cite this article: Karim T, Katiyar VK, Singh R, Dey S. Short-term Results of Laparoscopic Transabdominal Preperitoneal Inguinal Hernioplasty in a Developing Country. World J Lap Surg 2017;10(3):83-86.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Vinaya K Ambore, Jalbaji P More, Ajay H Bhandarwar, Saurabh S Gandhi, Chintan B Patel, Ravi Taori

Comparative Study of Tacker vs Glue Fixation of Mesh in Laparoscopic Intraperitoneal Onlay Mesh Repair of Ventral Hernias

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:87-90]



Aim: To compare results of tacker and glue fixation of mesh in laparoscopic intraperitoneal onlay mesh repair of ventral hernias.

Materials and methods: Patients admitted to the General Surgery Department of Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India, from January 2015 to June 2016 for ventral hernia repair were included for the study. A total of 60 patients were enrolled, and each group consisted of 30 cases.

Results: In our study, the mean age of ventral hernia patients subjected for glue fixation was found to be 38 years and for tacker fixation it was found to be 38.77 years. There is no statistically significant difference among the age of cases in the two groups in terms of mean age (p = 0.75). Out of 60 cases, 28 (46.66%) were females, whereas 32 (53.33%) cases were males. Maximum size of hernia defect was restricted to 6 cm. The mean size of hernia defect was 2.84 ± 1.02 cm in the glue fixation group, while that in the tacker fixation group was 3.15 ± 0.731 cm. Mean duration of surgery was 83.67 minutes in the glue fixation group and 64.50 minutes in the tacker fixation group. There was no intraoperative and postoperative complications with glue fixation. In tacker fixation, seroma was seen in 4 cases (13.33%), hematoma in 1 (3%), bowel ileus in 1 (3%), whereas there were no intra-abdominal complications, bowel obstruction, bleeding from trocar site, and enterocutaneous fistula. The mean pain [visual analog scale (VAS) score] of glue fixation and tacker fixation at 24 hours was 1 and 2.23 respectively. Mean postoperative hospital stay for patients with tacker fixation is 3 days, and 2 days in glue fixation. Mean time to return to normal activities was 3 ± 0.6 days in tacker fixation group and 1 ± 0.58 days in glue fixation group. No recurrence was found in both groups of fixation methods.

Conclusion: Mesh fixation with glue is better as compared with tacker in terms of cost, postoperative pain, and length of hospital stay; however, the use of tacker or glue depends on surgeon preference, patient affordability, and availabilities of facilities.

Keywords: Glue fixation, Intraperitoneal onlay mesh, Laparoscopic, Tacker fixation, Ventral hernia.

How to cite this article: Ambore VK, More JP, Bhandarwar AH, Gandhi SS, Patel CB, Taori R. Comparative Study of Tacker vs Glue Fixation of Mesh in Laparoscopic Intraperitoneal Onlay Mesh Repair of Ventral Hernias. World J Lap Surg 2017;10(3):87-90.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
KM Rita

Laparoscopic Management of Hirschsprung’s Disease

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:91-94]



Laparoscopy has improved the outcome and management of Hirschsprung’s disease. The most commonly seen Hirschsprung’s disease with transition zone in the rectosigmoid is done in the neonatal period as one-stage transanal endorectal pull-through (ERPT) procedure. In all other children, it must be one-stage laparoscopy-assisted transanal pull-through procedure. Advantage of a laparoscopic procedure is that a biopsy report of the level of transition zone and the normal ganglionic segments is obtained before the dissection is begun. It allows peritoneal dissection and isolation of marginal artery under vision. Also adequate length of colon can be dissected free of the attachments under vision.

Keywords: Hirschsprungs disease, Laparoscopy, Transition zone.

How to cite this article: Rita KM. Laparoscopic Management of Hirschsprung’s Disease. World J Lap Surg 2017;10(3):91-94.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Mohammad O Tabrez, Rajneesh K Mishra, Jatinder S Chowhan

Two-port Mini vs Conventional Four-port vs Singleincision Laparoscopic Cholecystectomy: An Update with Review of Literature

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:95-97]



Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for the removal of gallbladder stones. In an attempt to reduce the invasiveness of the procedure, surgeons have done various modifications like reduction of port size and/or number, which is used in conventional LC. The main objective of this review is to compare the two-port mini LC with other techniques of LC like conventional four-port laparoscopic surgery or single-incision laparoscopic cholecystectomy (SILC) in elective laparoscopic cholecystectomy and determine the outcome of two-port mini LC.

Material and methods: Literature review was performed on newly minimal invasive approach for LC, two-port cholecystectomy, variations in size and port of cholecystectomy and their advantages over one another, and SILC. The search was performed using the search engines like Google, PubMed.

Results: Postoperative pain was significantly low in the twoport group. The overall analgesia requirements and return to daily activity were significantly lower in two-port group. The cosmesis score of the two-port group was better than fourport group or SILC. However, the length of hospital stay and complications was similar between the two-port and four-port LC, but it differs in SILC.

Conclusion: Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared with that in four-port LC or SILC. Hence, two-port mini LC can be tried firstly and can be converted to additional four-port LC when necessary.

Keywords: Cholecystectomy, Laparoscopic cholecystectomy, Lapchole, Mini-laparoscopy, Review, Single-incision laparoscopic cholecystectomy, Two-port laparoscopy.

How to cite this article: Tabrez MO, Mishra RK, Chowhan JS. Two-port Mini vs Conventional Four-port vs Single-incision Laparoscopic Cholecystectomy: An Update with Review of Literature. World J Lap Surg 2017;10(3):95-97.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Abhay Singhal, Swati Garg, Rajneesh K Mishra, Jatinder S Chouhan

Can Robotic Gastrectomy be considered as Gold Standard for Upcoming Surgeons? A Multi-institutional Comparative Review

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:98-101]



Surgical techniques have evolved tremendously over this past century. Minimally invasive surgery for gastric cancer is not a new research field, but still an important problem remains regarding the selection of the appropriate technique for a given gastric cancer case. Although evidence is limited, the use of the robotic surgery platform is far assessed as a feasible and safe procedure, which is also easier to learn as less than 10 cases of robotic surgery are needed to become proficient therein. This review will however cover in-depth review of retrospective reports, analyzing the pros and cons of robotic surgery and highlighting the remaining study questions.

Keywords: Gastrectomy, Gastric cancer surgery, Minimally invasive surgery, Robotic surgery.

How to cite this article: Singhal A, Garg S, Mishra RK, Chowhan JS. Can Robotic Gastrectomy be considered as Gold Standard for Upcoming Surgeons? A Multi-institutional Comparative Review. World J Lap Surg 2017;10(3):98-101.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
MSR Pradeep, V Sandeep Kumar

Port-site Metastasis after Minimally Invasive Surgery for Urological Malignancy: A Review of Literature

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:102-107]



Introduction: Port-site metastasis (PSM) has been a concern with the common use of minimally invasive surgery, especially laparoscopy in urologic oncology. We conducted this study to provide a review of PSMs reported after minimally invasive surgery in managing urologic malignancies, possible contributing factors and preventive measures.

Materials and methods: An electronic search of MEDLINE, PubMed, Google Scholar, and HighWire Press with the combined keywords “port-site metastasis” and “urology” was carried out.

Results: A total of 40 articles comprising almost 60 cases addressing PSM after minimally invasive surgery for urological malignancy were identified.

Conclusion: Port-site metastasis in urological laparoscopic surgery is rare and is preventable. Risk can be minimized by applying open surgery oncological procedural principles.

Keywords: Laparoscopy, Port-site metastasis, Robotic, Urological malignancy.

How to cite this article: Pradeep MSR, Kumar VS. Portsite Metastasis after Minimally Invasive Surgery for Urological Malignancy: A Review of Literature. World J Lap Surg 2017;10(3):102-107.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Pallikonda S Madhulika, Juan U González-Tova

Hypocalcemia and Vitamin D Deficiency in Patients Post-bariatric Surgery: A Systematic Review

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:108-111]



Introduction: Bariatric surgery is viewed as the best tool for the control and treatment of severe obesity; however, postsurgery, they have a greater risk of developing nutritional deficiencies as this procedure hinders the absorption of most of the nutrients.

Objective: To evaluate the effect of vitamin D insufficiency and that of calcium in bone in patients after Roux-en-Y gastric bypass (RYGB), and the mode of administration of calcium, its dosage, and efficacy.

Materials and methods: A precise survey was performed with articles identified that are associated with the subject of interest. Articles from 10 years back were looked up in PubMed, the US National Library of Medicine, the National Institutes of Health, Medline, Lilacs, Scielo, and Cochrane utilizing the headings “bariatric surgery,” “bone,” “obesity,” “vitamin D,” “calcium,” and “absorption.”

Results: Five articles were incorporated into this survey that have analyzed the facts that bariatric surgery can cause wholesome inadequacies of nutrition and poor assimilation of fats and fat-dissolvable vitamins and micronutrients, e.g., calcium.

Conclusion: Patients submitted to RYGB should make use of multivitamins and minerals, especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment, and control of risk factors are essential to prevent complications after this operation.

Keywords: Bariatric surgery, Calcium deficiency, Vitamin D deficiency.

How to cite this article: Madhulika PS, González-Tova JU. Hypocalcemia and Vitamin D Deficiency in Patients Postbariatric Surgery: A Systematic Review. World J Lap Surg 2017;10(3):108-111.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Balachandran Premkumar, Subhankar Paul

Achalasia Cardia: Revisited

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:112-116]



Introduction: Achalasia cardia is a very common esophageal motility disorder affecting a large population worldwide including the Indian subcontinent. The diagnosis of the condition is equally important as the treatment ranges from medicines to botulinum injection, to pneumatic dilatation and surgery. This study gives an overview of achalasia cardia and the modalities to diagnose and treat the condition.

Keywords: Achalasia cardiae, Cardiospasm, Esophageal achalasia, Esophageal peristalsis.

How to cite this article: Premkumar B, Paul S. Achalasia Cardia: Revisited. World J Lap Surg 2017;10(3):112-116.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Juan U González-Tova, Pallikonda S Madhulika

Systematic Review of Laparoscopic Surgery and Simulation-based Training

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:117-128]



Introduction: We performed a systematic review to analyze the effect and to describe all available simulation-based training as well as the securing of laparoscopic surgery aptitudes during residency programs.

Materials and methods: This systematic review aimed to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills using the published randomized controlled trials (RCTs) Searching in PubMed from 2014 till now. This review of the literature tends to the subject of whether laparoscopic recreation deciphers the gain of surgical abilities to the operation room (OR).

Results: According to this review, we found that specific learned skills could be reproduced in the OR. Reenactmentbased preparing and laparoscopic surgery found that particular abilities could be translatable to the OR. Twenty one investigations revealed learning results measured in five behavioral classifications: Economy of development (8 ponders); suturing (3 examines); execution time (13 considers); mistake rates (7 thinks about); and worldwide rating (7 contemplates).

Conclusion: Simulation-based training can help to obtain obvious advantages of surgical aptitudes in the OR. This review proposes that simulation-based training is a successful approach to instruct laparoscopic surgery abilities, increasing reproduction of laparoscopic surgery aptitudes to the OR, and increment safety for patients. Nevertheless, more research ought to be directed to decide whether and how this training can become a part of surgical curriculum.

Keywords: Laparoscopic training, Simulation, Surgical skills.

How to cite this article: González-Tova JU, Madhulika PS. Systematic Review of Laparoscopic Surgery and Simulationbased Training. World J Lap Surg 2017;10(3):117-128.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Shalmali Alva

Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese and Morbidly Obese Patients

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:129-132]



The review article deals with the comparison between the procedures of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in the morbidly obese/obese patient subset. Given that the bariatric surgery deals not only with the weight loss of the patient, but also the accompanying myriad systemic and metabolic manifestations, this comparison was made to look into any prominent differences in the outcome of patients including postoperative sequelae. The studies were taken from reputed institutes across the world that were sourced from Medline and Cochrane Central and PubMed, which compared these two procedures on their patient groups and also followed up to a maximum period of 5 years for improvement on overall health parameters. The two procedures have shown fairly comparable results with regard to improvement in metabolic and hormonal parameters and LRYGB as better than LSG in long-term excessive weight loss in the follow-up phase of up to 5 years.

Keywords: Excessive weight loss, Laparoscopic Roux-en-y gastric bypass, Laparoscopic sleeve gastrectomy, Morbid obesity.

How to cite this article: Alva S. Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-y Gastric Bypass Surgery in Obese and Morbidly Obese Patients. World J Lap Surg 2017;10(3):129-132.

Source of support: Nil

Conflict of interest: Nil


REVIEW ARTICLE
Priyanka Shekarappa

Management of Ovarian Dermoid Cyst and Highlight on Chemical Peritonitis

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:133-134]



Mature cystic teratomas or dermoid cysts, most common among germ cell tumors of ovary, contribute to 70% of benign neoplasms affecting women of age group less than 30 years. Mature cystic teratomas or dermoid cysts are most commonly mistaken for malignancy in ultrasound.

Keywords: Chemical peritonitis, Dermoid cysts, Laparoscopy, Tissue retrieval techniques.

How to cite this article: Shekarappa P. Management of Ovarian Dermoid Cyst and Highlight on Chemical Peritonitis. World J Lap Surg 2017;10(3):133-134.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
R Meenakshi Menon

Laparoscopy in Cesarean Scar Pregnancy

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:135-138]



Introduction: With the increase in rates of cesarean deliveries, complications in subsequent pregnancies like placenta accreta/ percreta, uterine rupture, and cesarean scar ectopic pregnancy are on the rise. Cesarean scar pregnancy (CSP) accounts for about 2 to 4% of all ectopic pregnancies. Improvement in diagnostic techniques and advancement in transvaginal ultrasound and advent of minimal access surgery has contributed to early detection and timely management of CSP.

Objective: This article aims to review different treatment modalities of CSP and hence to compare efficacy of laparoscopy with other management techniques.

Materials and methods: Case series, retrospective cohort studies, and articles were reviewed which included studies from PubMed, MEDLINE, Cochrane library, and EMBASE. The main outcome was successful first-line treatment. Complications during treatment were listed as bleeding more than 1 L, blood transfusion, hysterectomy, and laparotomy.

Results: Successful treatment and reduced complications were noted with laparoscopy as compared with medical management.

Conclusion: Interventional than medical approach is preferred in management of CSP. Laparoscopic surgery helps in removal of ectopic tissue in cesarean scar with simultaneous repair of the defect under adequate visualization.

Keywords: Cesarean scar pregnancy, Ectopic pregnancy, Laparoscopy.

How to cite this article: Menon RM. Laparoscopy in Cesarean Scar Pregnancy. World J Lap Surg 2017;10(3):135-138.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Rajendra Shitole, Sharankumar Kavalgi, Hemant Deshpande

Heterotopic Pregnancy: Successful Management by Laparoscopic Salpingectomy in First Trimester and Continuation of Intrauterine Pregnancy until Term.

[Year:2017] [Month:September-December] [Volumn:10 ] [Number:3] [Pages:58] [Pages No:139-141]



Introduction: We report a case of a heterotopic pregnancy (HP) with resultant normal intrauterine pregnancy after laparoscopic salpingectomy. A heterotrophic pregnancy is defined as the coexistence of intrauterine and extrauterine gestation. Incidence is more common in infertility patients conceived after treatment than natural conception. A 20-year-old primigravida presented with 7 weeks amenorrhea, pain in abdomen, and per vaginal spotting. The ultrasound (USG) report was suggestive of a rightsided adnexal mass indicative of either tubal ectopic along with an intrauterine live gestation of 7 weeks and hemoperitoneum. Emergency laparoscopy was done and right salpingectomy was done in view of right ruptured tubal ectopic pregnancy. The intrauterine pregnancy then continued subsequently to 35 weeks of gestation as on September 18, 2017. Early diagnosis and prompt intervention are essential to save the intrauterine pregnancy and avoid maternal morbidity and mortality related to hemoperitonium due to ruptured ectopic pregnancy.

Keywords: Hemoperitonium, Heterotopic pregnancy, Laparoscopy, Salpingectomy.

How to cite this article: Shitole R, Kavalgi S, Deshpande H. Heterotopic Pregnancy: Successful Management by Laparoscopic Salpingectomy in First Trimester and Continuation of Intrauterine Pregnancy until Term. World J Lap Surg 2017;10(3):139-141.

Source of support: Nil

Conflict of interest: None


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