Journal of Minimal Access Surgery最新文献

{"title":"Indigenously modified endoluminal vacuum-assisted closure therapy for post-operative gastrointestinal transmural defects: Case series and review of literature.","authors":"Vishakha Kalikar, Kiran Basavraju, Meghraj Ingle, Roy Patankar","doi":"10.4103/jmas.jmas_133_24","DOIUrl":"10.4103/jmas.jmas_133_24","url":null,"abstract":"<p><strong>Abstract: </strong>A gastrointestinal (GI) transmural defect is defined as a total rupture of the GI wall and these defects can be divided into three main categories, including perforation, leaks and fistulae. Recognition of the specific classification of the defect is important for choosing the best therapeutic modality. We present a case series of patients with gastrointestinal transmural defects which were managed with indigenously modified endoluminal vacuum-assisted closure.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the analgesic efficacy of a low dose of intrathecal morphine in laparoscopic abdominal surgery: A randomised control trial.","authors":"Lakshmi Kumar, Ramya Anantharaman, Dimple Elina Thomas, Anjaly S Nair, Anandajith P Kartha, Karthik Kumar","doi":"10.4103/jmas.jmas_141_24","DOIUrl":"10.4103/jmas.jmas_141_24","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal opioid is an analgesic option in laparoscopic surgery. We assessed primarily the intraoperative opioid requirement amongst patients receiving intrathecal morphine (ITM) (Group M) versus standard care (Group C) for abdominal surgery. The secondary outcomes were intraoperative haemodynamic changes, extubation on table and pain scores in the intensive care unit (ICU) at 6 th hourly intervals for 24 h postoperatively.</p><p><strong>Patients and methods: </strong>Patients undergoing laparoscopic abdominal surgery were randomised into Group M ( n = 30) that received ITM at 2 μg/kg while Group C ( n = 30) was control. A rise in mean arterial pressure > 20% from baseline was treated sequentially with 0.3 mg /kg propofol and 0.5 μg/kg fentanyl intravenously (IV). Pain management in the ICU included paracetamol 1G IV 8 th hourly for all patients, while nefopam 20 mg and fentanyl 0.5 μg/kg IV were the second and third tiers of pain management.</p><p><strong>Results: </strong>Intraoperatively, 10 patients in Group M versus 26 in Group C needed additional fentanyl ( P < 0.001) and 15 versus 26 patients needed additional propofol ( P = 0.0024). Pain scores were superior in Group M at all time points in the ICU and at ambulation and during incentive spirometry. Thirteen patients in Group C versus 3 in Group M needed nefopam at the time of shifting to the ICU ( P = 0.004) and 10 patients versus 1 at 8 h in the ICU ( P = 0.003) while pain management at 16 h and 24 h was comparable.</p><p><strong>Conclusion: </strong>Pre-operative ITM at 2 μg/kg reduces intraoperative opioid requirement and improves analgesia 24 h postoperatively amongst patients undergoing major laparoscopic abdominal surgery without delay in extubation or changes in haemodynamics.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of variant ductal and vascular anatomy in children with choledochal cysts.","authors":"Ankur Mandelia, Rohit Kapoor, Anju Verma, Pujana Kanneganti, Rajanikant R Yadav, Moinak Sen Sarma, Nishant Agarwal, Tarun Kumar, Biju Nair, Amit Buan","doi":"10.4103/jmas.jmas_255_24","DOIUrl":"10.4103/jmas.jmas_255_24","url":null,"abstract":"<p><strong>Introduction: </strong>Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed.</p><p><strong>Results: </strong>Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities.</p><p><strong>Conclusion: </strong>Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of transverse testicular ectopia associated with polyorchidism addressed by minimally invasive surgery: A case report.","authors":"Mario Alberto Riquelme, Ana Cantu-Zendejas, Carlos Rodriguez","doi":"10.4103/jmas.jmas_30_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_30_24","url":null,"abstract":"<p><strong>Abstract: </strong>This report describes the rare case of transverse testicular ectopia (TTE) associated with polyorchidism in a 16-month-old male, successfully managed through laparoscopic surgery. The patient presented with bilateral cryptorchidism, a palpable mass in the right inguinal canal and an absent left-side gonad. Ultrasound revealed three gonad-like structures. Laparoscopy identified duplicated and fused testes at the right deep inguinal ring, and a third testis in the right inguinal canal. Minimally invasive techniques positioned the duplicated testes in the right hemiscrotum and the single testis in the left hemiscrotum. Post-operative follow-up confirmed optimal scrotal positioning, with normal growth. This rare case underscores the efficacy of laparoscopy in diagnosing and managing rare paediatric conditions, providing valuable insights for surgeons facing cryptorchidism or scrotal masses.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-peritoneal migration of abdominal drain after cholecystectomy-laparoscopic retrieval: A case report.","authors":"Mahendra Lodha, Naveen Sharma, Satya Prakash Meena","doi":"10.4103/jmas.jmas_137_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_137_24","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal wall failure.","authors":"Ekta Sharma, Shirish Goyal, Sanjay Gupta, Robin Kaushik, Ashok K Attri","doi":"10.4103/jmas.jmas_150_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_150_24","url":null,"abstract":"<p><strong>Abstract: </strong>Generalised weakness of the abdominal wall can lead to its failure to contain the abdominal viscera within the confines of the abdominal cavity, resulting in simultaneous hernias at different sites. We propose that this entity should be termed 'abdominal wall failure', and the laparoscopic approach is ideal for the management of such a condition. This report presents the case of a patient with concurrent hiatal hernia, bilateral direct inguinal hernias, bilateral femoral hernias and recurrent paraumbilical hernia, managed laparoscopically.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoclose-assisted intracorporeal intestinal anastomosis.","authors":"Christian Mouawad, Abdessalem Ghedira, Nehad Dager","doi":"10.4103/jmas.jmas_186_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_186_24","url":null,"abstract":"<p><strong>Abstract: </strong>While performing an intracorporeal intestinal anastomosis in minimally invasive procedures, surgeons may be encountered with many limitations which made many of them go back to doing extracorporeal anastomosis. In this article, we describe a simple but efficient technique using the Endoclose which improves the surgeon's ability to enhance the anastomosis' exposure while suturing, without having to add extra trocars.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual case of small-bowel obstruction: Broad ligament hernia.","authors":"Anmol Ahuja, Shyam Sundar Rengan, Ashish Dey, Vinod K Malik, Tarun Mittal","doi":"10.4103/jmas.jmas_280_23","DOIUrl":"https://doi.org/10.4103/jmas.jmas_280_23","url":null,"abstract":"<p><strong>Abstract: </strong>Broad ligament hernias (BLHs) are rare internal hernias that can lead to serious complications if left untreated. In this case report, we present the case of a BLH in a female patient and discuss its clinical presentation, diagnosis and management. A 40-year-old woman presented with subacute intestinal obstruction symptoms, including the inability to pass flatus and faeces and recurrent bilious vomiting. A computed tomography (CT) scan confirmed small-bowel obstruction adjacent to the uterus within the left broad ligament. Diagnostic laparoscopy revealed a loop of obstructed small intestine within the broad ligament, which was released and found to be healthy. The defect between the broad and infundibulopelvic ligaments was closed with sutures. The patient had an uneventful recovery and was asymptomatic at a 6-month follow-up. BLHs can be congenital or acquired, with acquired defects often resulting from previous surgeries or pregnancy-related causes. The clinical presentation typically involves the symptoms of bowel obstruction, and a CT scan is the diagnostic modality of choice, showing characteristic findings such as closed-loop obstruction and bowel dilation. Laparoscopic management offers the advantages of faster recovery and less morbidity. Closure of the defect using nonabsorbable sutures is the standard surgical approach, although a wide opening of the defect has also been described. Recurrence is a possibility, particularly if absorbable sutures are used for closure. This case report highlights the importance of early diagnosis and intervention in BLHs to prevent the complications and emphasises the role of laparoscopy in their management.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A small-sized tube versus traditional closed thoracic drainage in uniportal thoracoscopic surgery.","authors":"Zhoujunyi Tian, Guangliang Qiang, Fei Xiao, Hongxiang Feng, Zhenrong Zhang, Huanshun Wen, Chaoyang Liang","doi":"10.4103/jmas.jmas_39_23","DOIUrl":"10.4103/jmas.jmas_39_23","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the feasibility and safety of placing a small-sized tube as drainage in patients after uniportal thoracoscopic lung resection.</p><p><strong>Patients and methods: </strong>Patients who received uniportal video-assisted thoracoscopic surgery (U-VATS) lung resection were identified in our database. Patients placed small-sized tube drainage were compared with those placed conventional chest tube in terms of characteristics, operation modality, post-operative pulmonary complications, post-operative pain, chest tube duration and post-operative hospital stay. Propensity score matching was performed.</p><p><strong>Results: </strong>Of the 217 enrolled patients, 173 were assigned to the conventional tube group and 44 were assigned to the small-sized tube group. Rates of post-operative pulmonary complications were relatively low and similar between the two groups. After propensity score matching, operation duration was shorter (1 h vs. 1.21 h, P = 0.01) was shorter, and the maximum value of the Visual Analogue Scale (VAS) score after operation (1 vs. 1.5, P = 0.02) and the overall average value of VAS score after operation (0.33 vs. 0.88, P = 0.006) was lower in small-sized tube group. No significant difference was observed in chest tube duration (2 vs. 2, P = 0.34) and post-operative hospital stay (3 vs. 3, P = 0.34).</p><p><strong>Conclusions: </strong>Compared to conventional chest tubes, small-sized tubes for post-operative drainage after U-VATS lung resection may be a safe and promising approach for reducing post-operative pain.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"380-386"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10580857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for closing the posterior rectus sheath during enhanced view totally extraperitoneal Rives-Stoppa repair.","authors":"Sarfaraz Jalil Baig, Jignesh A Gandhi, Aarsh P Gajjar, Pallawi Priya, Devashree Sane","doi":"10.4103/jmas.jmas_177_23","DOIUrl":"10.4103/jmas.jmas_177_23","url":null,"abstract":"<p><strong>Introduction: </strong>The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities. However, the procedure requires overcoming a learning curve, and with increased adoption, new complications have emerged. One significant complication is the rupture of the posterior rectus sheath (PRS). In this article, we present our modifications of the technique to reduce tension during PRS closure.</p><p><strong>Patients and methods: </strong>The study included 105 patients who underwent endolaparoscopic extraperitoneal repairs for ventral hernias using two different techniques. Group A ( n = 68) underwent the original technique, whereas Group B ( n = 37) underwent the modified technique. The modifications in Group B included preserving the peritoneal bridge between the two PRS and the hernia sac, conducting a complete dissection of the space of Bogros and adopting a transverse or oblique closure of PRS along the lines of least tension. To assess the efficacy of these modifications in preventing PRS rupture, we compared the results of both groups.</p><p><strong>Results: </strong>Our findings indicate that following all the technical steps of the modified technique resulted in a reduced need for transversus abdominis release for PRS closure and a lower incidence of PRS rupture in the postoperative period. However, to further validate the effectiveness of these modifications, a larger follow-up period and a bigger sample size are required.</p><p><strong>Conclusions: </strong>The adoption of the modified technique can help achieve a tension-free PRS closure.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"387-392"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}