A two year retrospective review of Laparoscopic versus open Appendicectomy in perforated appendix in Hospital Ipoh (June 2006-May 2008)

Appendicectomy is one of the most common general surgical procedures performed all over the world in the surgical department. Since its description by McBurney in 1894 the open approach has become the standard surgical intervention for appendicitis, remaining virtually unchanged for 100 years owing to its proven efficacy and safety. Laparoscopic appendicectomy on the other hand was first performed by Semm in 1983 (Litynski, G.S. 1999).But its popularity increased steadily throughout the 1990s. However, unlike cholecystectomy, the benefits of the laparoscopic approach have not been as apparent for appendicectomy, even more so in perforated appendicitis. Many early randomized trials failed to show any overall benefit for laparoscopy and others at best parity between the 2 procedures. Current studies however indicate a shift in favour of laparoscopy, probably due to the increase in laparoscopic exposure at all levels of surgical training. The aim of this study is to compare certain parameters between Laparoscopic appendicectomy with open appendicectomy. xii RESULTS: Two hundred and five patients with perforated appendicitis were reviewed. Fifty-six patients had laparoscopic appendicectomy and one hundred and forty nine patients had open appendicectomy. The median age in the laparoscopic group was 28 and the open group was 30. The difference in the median age groups was not statistically significant .The p value is 0.310. The mean (s.d) operating time for laparoscopic appendicectomy was 69 minutes (29 minutes).The mean operating time for the open group was 63 minutes (28 minutes). This study showed that there was no significant difference in the mean length of operating time between the two methods. The p value is 0.669. The mean (s.d.) length of hospital stay for the patients in the laparoscopic group was 3.5days (1.6 days). In the open group the mean length of hospital stay was 3.1 days (1.9 days). This was statistically not significant (p=0.382).There was also no statistical significance in the duration the patients took to tolerate orally and for the temperature to settle in both the groups. There were a total of six patients with the surgical site infection and seven who had readmission. Although all 6 patients with surgical site infection were from the open group and none in the laparoscopic group this was not statiscally significant. p = 1.000. Five patients in the laparoscopic group and two in the open group were readmitted within a week of their respective surgeries for ileus. This difference was also not statistically significant with a p value of 1.000.The mean (s.d.) amount of analgesia used in laparoscopic appendicectomy was 387.5mg (259.4mg) . The mean (s.d.) for the use of analgesia in the open group was 274.5mg (204.3mg) for the open group. This was statistically significant where p = 0.006. CONCLUSION: There is no clinically significant difference between laparoscopic appendicectomy and open appendicectomy for perforated appendicitis

Bayesian hierarchical nonlinear modelling of intra-abdominal volume during pneumoperitoneum for laparoscopic surgery

Laparoscopy is an operation carried out in the abdomen or pelvis through small incisions with external visual control by a camera. This technique needs the abdomen to be insufflated with carbon dioxide to obtain a working space for surgical instruments' manipulation. Identifying the critical point at which insufflation should be limited is crucial to maximizing surgical working space and minimizing injurious effects. Bayesian nonlinear growth mixed-effects models are applied to data coming from a repeated measures design. This study allows to assess the relationship between the insufflation pressure and the intra--abdominal volume

Comparison of clinical and physiologic parameters, complications, and techniques, between laparoscopic ovariectomy and ovariohysterectomy in dogs

Dissertação de Mestrado Integrado em Medicina VeterináriaGonadectomy is one of the most frequently performed surgical procedures in veterinary medicine, this can be achieved by several techniques, for example ovariohysterectomy (OVH) or laparoscopic ovariectomy (LapOVE). Given that these procedures are performed routinely, the objective of this work is to compare the parameters temperature and glucose, complications (intraoperative and post-operative), the time it takes to execute the surgical techniques and pain to evaluate if one is superior to the other. This study was done throughout the six months of traineeship at Kingston Veterinary Group at Park Street Hospital. To accomplish it, two groups were used, - the LapOVE with 14 animals and the OVH with 10 animals, in which the parameters above mention, were recorded and compared. We can conclude from the results obtained, that the time to prepare the patient, perform the surgical procedure and the total procedure is longer for the LapOVE group as opposed to the OVH group. To evaluate if there was a significant effect of the procedure over temperature and glucose a linear mixed model analysis was performed. There was a significant effect of the procedures over time on temperature levels (P <0.0003) with OVH having a less impact on the patient, given that the temperature before and after the surgery varied less. The procedure chosen had a significant effect on glucose P (<0.016). Which can mean less operative pain in the LapOVE procedure. Regarding post-operative pain, although a very slight difference existed in the first three hours after the patients were extubated, there were no major differences between the two procedures, even when the pain score in the OVH group was higher than the LapOVE. In the LapOVE group there were more intraoperative and postoperative complications. Even though the laparoscopic technique presented several advantages, for this specific procedure, gonadectomy, they were not substantial or important enough to choose performing a LapOVE over a conventional OVH.RESUMO - Comparação de parâmetros clínicos e fisiológicos, complicações e técnicas entre ovariectomia por laparoscopia e ovariohisterectomia em cães - A gonadectomia é um dos procedimentos cirúrgicos realizados com maior frequência na medicina veterinária, podendo ser realizado por várias técnicas como por exemplo, a ovariohisterectomia (OVH) ou ovariectomia por laparoscopia (LapOVE). Uma vez que estes procedimentos são realizados por rotina na prática clínica, este trabalho tem por objetivo comparar os parâmetros temperatura e glucose, as complicações (intraoperatórias e pósoperatórias), os tempos de execução das técnicas cirúrgicas e dor para avaliar se alguma delas poderá ser superior à outra.. Este estudo decorreu ao longo de seis meses do estágio intracurricular no “Kingston Veterinary Group”, no Hospital de Park Street. Para o realizar utilizaram-se dois grupos, - o da LapOVE com 14 animais e o da OVH com 10 animais, nos quais se registaram e de seguida compararam os parâmetros já mencionados. Os resultados obtidos permitem verificar que o tempo necessário para preparar o paciente e para realizar a cirurgia, bem como o tempo total do procedimento foram superiores no grupo LapOVE do que no grupo OVH. Para se avaliar se houve um efeito significativo do procedimento sobre a temperatura e a glucose realizou-se uma análise com modelos lineares mistos, tendo-se verificado um efeito significativo do procedimento ao longo do tempo na temperatura (P <0.0003) tendo a OVH um menor impacto sobre o paciente pois a temperatura antes e depois da cirurgia variou menos. O procedimento escolhido teve um efeito significativo na glucose (P<0.016), o que poderá ser indicativo de menor dor cirúrgica no procedimento da LapOVE. Em relação à dor pós-cirúrgica, apesar de existir uma pequena diferença nas primeiras três horas após os pacientes serem extubados, não houve diferença pronunciada entre os dois procedimentos, mesmo quando a pontuação da dor no grupo OVH foi superior ao grupo LapOVE. No grupo LapOVE houve mais complicações intraoperatórias e pós-operatórias. Assim e apesar da técnica laparoscópica, apresentar algumas vantagens para este procedimento específico, a gonadectomia, as mesmas não são suficientemente fortes ou importantes para que se prefira a realização da LapOVE em vez de OVH convencional.N/

Optimizing Working Space in Laparoscopy: Studies in a porcine model

__Abstract__ Adequate working space is essential for safe and effective laparoscopic surgery. However, the factors that determine working space have not been sufficiently studied. Working space can be very limited, especially in children. A literature review was undertaken to search for factors that can be influenced to increase working space in laparoscopy

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents

Hernia Surgery

A hernia occurs when an internal organ pushes through a weak spot in the body’s muscle or tissue. There are several types of hernia, including inguinal hernias, femoral hernias, umbilical hernias, and hiatal hernias. Hernias usually do not get better on their own and surgery may be the only way to repair them. This book discusses different types of hernias and hernia surgeries, including open surgery, laparoscopic surgery, and robotic repair

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p &lt; 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p &lt; 0.001). Males were significantly more likely to be admitted than females (p &lt; 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Updated Topics in Minimally Invasive Abdominal Surgery

Updated topics in minimally invasive abdominal surgery provides surgeons interested in minimally invasive abdominal surgery with the most recent techniques and discussions in laparoscopic surgery. This book includes different topics covering a big variety of medical conditions with up-to-date information. It discusses many controversies in a clear and user-friendly manner. This book is made for young junior surgeons in training and also senior surgeons who need to know the most recent work in the field of laparoscopy. To make the material easily digestive, we provided the book with many figures and illustrations for different procedures and technical pearls

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents