Journal of Minimal Access Surgery最新文献

{"title":"Laparoscopic common bile duct exploration and retrieval of endoscopic lithotripsy basket after mechanical failure.","authors":"Lawrence Nip, Mark Lynch, Zinu Philipose, Serena Ceraldi","doi":"10.4103/jmas.jmas_177_24","DOIUrl":"10.4103/jmas.jmas_177_24","url":null,"abstract":"<p><strong>Abstract: </strong>Impaction of a mechanical lithotripsy basket during endoscopic retrograde cholangiopancreatography is a rare but serious complication resulting from technical failure. We describe a novel case of lithotripsy basket retrieval aided by laser fragmentation. This 87-year-old male underwent an emergency laparoscopic subtotal cholecystectomy, common bile duct (CBD) exploration and laser lithotripsy after attempts at endoscopic mechanical lithotripsy caused a stone-basket complex to become impacted within the CBD. In the absence of endoscopic salvage techniques, laparoscopic CBD exploration is a valid and safe option where surgical expertise permits.</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":"142752161","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":"Middle-grade led Expedited Gall bladder lists: Is it safe and feasible?","authors":"Raunaq Sundeep Chhabra, Hasan Ali, Faizan Ullah, Bruno Lorenzi, Amal George","doi":"10.4103/jmas.jmas_179_24","DOIUrl":"10.4103/jmas.jmas_179_24","url":null,"abstract":"<p><strong>Introduction: </strong>Gallstone-related acute admissions account for a significant percentage of acute general surgery admissions. Providing a dedicated expedited gall bladder list service to deal with these cases appears to be not only clinically effective but also cost-effective. There are various logistical reasons why hospitals are unable to provide such dedicated lists, inadequate surgical staff being one of them. We initiated a middle-grade-led expedited gall bladder list with indirect consultant oversight at our hospital as a consultant-led list was not feasible. This study evaluates the safety and efficacy of this service post-implementation.</p><p><strong>Patients and methods: </strong>A retrospective analysis was conducted on prospectively collected data from February 2022 to September 2023. Patients were triaged using a dedicated questionnaire and operated on within 2-8 weeks of admission. The outcomes measured included complications, readmissions and the need for consultant opinion and assistance.</p><p><strong>Results: </strong>Amongst 101 patients, the mean age was 50.59 ± 15.25 years, with a majority being female and having an American Society of Anaesthesiologists grade of 2. Consultant assistance was required in 14 cases, with 9 requiring active participation. Complications were comparable to national averages, with four cases of bile leaks and one small bowel injury. Six readmissions were recorded for various postoperative issues.</p><p><strong>Conclusion: </strong>The middle-grade led expedited gall bladder service demonstrated a safe and effective alternative to consultant-led lists, offering a pragmatic approach to addressing surgical demands within the constraints of staff and facility limitations.</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":"142752176","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 institutional approach to thick wall gall bladder and our experience of 5450 gallstone disease.","authors":"Bhanu Pratap Singh, Anshuman Pandey, Hitesh Sarda, S N Hareesh, Sudip Regmi","doi":"10.4103/jmas.jmas_209_24","DOIUrl":"10.4103/jmas.jmas_209_24","url":null,"abstract":"<p><strong>Introduction: </strong>Gallstone disease (GSD) has a high prevalence in India. GSD presentation varies from being asymptomatic to severe complications. Laparoscopic cholecystectomy (LC) is the procedure of choice. Histopathological varies from chronic cholecystitis to carcinoma gall bladder (CaGB). Thick wall gall bladder (TWGB) is grey zone. Various parameters of GSD especially TWGB were evaluated to develop an approach to reduce perioperative complications and histopathological surprises.</p><p><strong>Patients and methods: </strong>This study was conducted at the Department of Surgical Gastroenterology, Dr. RMLIMS, Lucknow. Data of all patients undergoing cholecystectomy between January 2015 and March 2023 were analysed retrospectively. Demographic profile, clinical presentation, blood investigations, radiological findings, operative findings and histopathology report were examined. Clinical and radiological features of difficult cholecystectomies, incidence and type of bile duct injury (BDI), presentation and outcomes of TWGB, incidence of incidental CaGB and its outcome, were evaluated and analysed.</p><p><strong>Results: </strong>A total of 5450 patients underwent cholecystectomy during the study period. GSD is common in females and 4 th decade. The laparoscopic to open conversion rate was 1.2%, the most common cause was unclear anatomy. The incidence of BDI in our series was 0.11% ( n = 6). The most common histopathological outcome was chronic cholecystitis followed by xanthogranulomatous cholecystitis. Incidence of incidental carcinoma gall in our series was 0.3% ( n = 16) with an overall survival of 68.75% at a mean follow-up of 19.4 months. TWGB workup includes contrast-enhanced computed tomography, intraoperative most have difficult cholecystectomy and had a higher rate of conversion, injury and incidental CaGB.</p><p><strong>Conclusion: </strong>Thorough pre-operative evaluation and using the suggested algorithm may decrease perioperative complications and histopathological surprises after LC.</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":"142752125","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":"Pyeloplasty for pelviureteric junction obstruction in anomalous kidneys: A long-term follow-up experience at a tertiary care centre.","authors":"Lalit Kumar, Rishi Nayyar, Brusabhanu Nayak, Prabhjot Singh, Rajeev Kumar, Amlesh Seth","doi":"10.4103/jmas.jmas_79_24","DOIUrl":"10.4103/jmas.jmas_79_24","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the feasibility, safety, and effectiveness of different pyeloplasty procedure approaches for pelvicureteric junction (PUJ) obstruction in kidney anomalies. The presence of difficult, unfamiliar and anomalous anatomy makes pyeloplasty challenging in these conditions.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of pyeloplasty in patients with congenital anomalous kidneys at our national tertiary referral centre. Seventeen patients who had pyeloplasty for PUJ obstruction from December 2013 to July 2019 were included.</p><p><strong>Results: </strong>Seventeen cases had anomalous kidneys consisting of horseshoe kidneys in nine patients, ectopic non-fused kidneys in four patients, ectopic fused kidneys in three patients and duplex kidneys in one patient. The mean follow-up duration was 34 months (4-70 months). The robotic approach was most commonly used in nine patients followed by a laparoscopic and open approach, each in four patients, respectively. Only one patient had an intraoperative complication. One patient required conversion to an open approach. The mean operative duration in open, laparoscopic and robotic approaches was 102 min, 105 min and 140 min, whereas the mean hospital stay was 6.50 days, 3.25 days and 4.22 days, respectively. Post-operative complications occurred in 29.41% of patients with Clavien grade ≥3 complications in one case only (5.88%). Success was 94.12% without any salvage intervention.</p><p><strong>Conclusion: </strong>Pyeloplasty is a feasible, effective and safe procedure even in complex cases of renal anatomic anomalies with PUJ obstruction. With increasing experience, minimally invasive techniques though technically demanding provide equivalent success rates with better cosmetic outcomes and faster convalescence.</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":"142752178","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":"Video-assisted thoracoscopic surgery in pancreaticopleural fistula: A case report.","authors":"Amit Anil Thombare, Girish Davinder Bakhshi, Sumit Boricha, Manish Sunil Hande, Ram Kishore","doi":"10.4103/jmas.jmas_175_24","DOIUrl":"10.4103/jmas.jmas_175_24","url":null,"abstract":"<p><strong>Abstract: </strong>Pancreatico-pleural fistula (PPF) is sequelae of pancreatitis. It is more commonly seen in alcoholic pancreatitis with abdominal symptoms and signs. PPF presenting with respiratory symptoms and signs in the absence of abdominal signs is rare. Moreover, trivial trauma which went unrecognised in a 14-year-old child for 3 months resulting in PPF has not been reported in the literature. This chronic PPF results in the formation of adhesions between the lung and pleura. These adhesions result in the incomplete expansion of the lungs even after thoracocentesis. The present case highlights the significance of video-assisted thoracoscopic surgery in such cases with a review of diagnostic and management guidelines.</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":"142752190","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":"Comparison of modified tumescent and conventional laparoscopic transabdominal pre-peritoneal repair in the patients of inguinal hernia: A randomised control trial.","authors":"Kanika Sharma, Avinash Koul, Gopal Puri, Yashvant Singh Rathore, Rajinder Kumar Chrungoo","doi":"10.4103/jmas.jmas_99_24","DOIUrl":"10.4103/jmas.jmas_99_24","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal hernia surgery, a common procedure worldwide, continues to develop to achieve minimal access and tension-free repairs. However, a universally accepted technique has yet to be developed. Our study introduces a new approach, a modified tumescent transabdominal pre-peritoneal (TAPP), to a low-cost setting. We then compare its safety and efficacy with the conventional TAPP, providing a new perspective on hernia repair methods.</p><p><strong>Patients and methods: </strong>The study was conducted between April 2016 and September 2017 at the department of surgery in a medical college in Jammu. Sixty patients were randomly assigned to either the conventional TAPP group or the tumescent TAPP group using computer-generated randomisation. In the tumescent group, we carefully administered a tumescent solution into the pre-peritoneal space after creating pneumoperitoneum and then compared the effectiveness and safety of the two procedures.</p><p><strong>Results: </strong>Our study revealed significant differences in various aspects between the two groups. In the conventional group, 16.7% of patients experienced challenging peritoneal flap dissection, while none in the tumescent group faced this issue. In addition, none of the patients in the tumescent group had an intraoperative haemorrhage. The conventional group had a mean operating time of 100.4 ± 11.21 min. On the other hand, the tumescent group had a significantly shorter mean operating time of 84 ± 13.47 min. The complication rates were 16.7% in the tumescent group and 30% in the conventional group. After the surgery, 13.3% of patients in the conventional group reported persistent pain, compared to only one patient in the tumescent group, which was statistically significant.</p><p><strong>Conclusion: </strong>Our study demonstrates that tumescent TAPP can overcome the challenges of conventional TAPP surgery, offering practical benefits such as reduced bleeding, easier dissection, decreased post-operative pain and shorter operating time. Administering tumescent solution before TAPP repair of inguinal hernia provides technical and clinical advantages, suggesting the potential for shorter surgeries and a quicker learning curve.</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":"142752134","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":"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}