A study on evaluation of biliary leaks following hydatid liver surgeries

Background: A high incidence of post-operative bile leaks is reported to be a significant disadvantage of conservative surgical procedures. Materials and Methods: One hundred patients with 180 cysts were operated upon using conservative surgical techniques from May 2007 to November 2009. Results: Post-operative biliary leakage occurred in 26 (26%) patients. Independent clinical predictors for post-operative bile leak were raised alkaline phosphatase and gamma-glutamyl transpeptidase levels (P 0.05). Post-operative complications were seen in 21 patients (21%). Complications were seen in 12 of 26 patients with bile leak (46.16%) and in 9 patients among 74 patients (12.16%) without a bile leak (P 300 ml/day), 3 patients were managed conservatively, and in one patient there were no signs of a reduction in bile leakage even after 4 weeks; in this case, endoscopic retrograde cholangiopancreatography with a sphincterotomy was performed, which led to the healing of the fistula 1 week after the endoscopic sphincterotomy. Conclusion: Biliary leakage is common following conservative surgery and is the main cause of post-operative morbidity. Most of the bile leaks can be prevented by thorough inspection of the cavity peroperatively for cyst-biliary communication. Identifying risk factors preoperatively may help to optimize perioperative management. Most bile leaks heal by conservative management. [Arch Clin Exp Surg 2015; 4(2.000): 89-94

Laparoscopic Evaluation of Nonspecific Abdominal Pain in Females

The aim was to determine the role of laparoscopy in the management of nonspecific abdominal pain (NSAP) in sexually active females. Fifty (50) patients with NSAP were included in the study which then underwent laparoscopy to make a definitive diagnosis. Peroperative laparoscopic findings were; Acute appendicitis in 17 patients (34%); Pelvic Inflammatory diseases (PID)/salpingitis in 9 patients (18%); Adhesions in pelvis and RIF in 5 patients (10%); Ovarian Cyst in10 patients (20%); Endometriosis in 2 patients (4%); Peritoneal Tuberculosis in 3 patients (6%); No diagnosis in 4 patients (8%). The age wise incidence of various Laparoscopic findings in patients with NSAP were: Acute appendicitis was common in 13 to 20 year age group ( 10/17 patients) followed by 21 to 28 year age group (5/17 patients); PID was common in 21 to 28 year age group (6/9 patients); Endometriosis was found common in 29 to 36 year age group (2/2 patients); while as ovarian cysts were observed with increased frequency in 21 to 28 year age group (8/10 patients). The study revealed appendicitis to be more common in females in their early reproductive years of life. PID, was more frequently noticed in sexually active females. Endometriosis was observed only in two patients and both of them where in the middle of their reproductive age while as symptomatic ovarian cysts was a more common finding in unmarried females in 21-28 years of age group. This study concluded that laparoscopy has a diagnostic as well as a therapeutic implication in management of NSAP. [Med-Science 2015; 4(4.000): 2700-8

Laparoscopic management of a giant trichobezoar causing Rapunzel syndrome: A case report

Trichobezoars are retained clusters of swallowed hairs seen most commonly in adolescent girls. Many of these patients have some underlying psychiatric problem and as this condition is often associated with few or no symptoms, the onset of this condition leads to a delayed presentation. Trichobezoars are most commonly managed by open surgical techniques and there are only a few reports that have used the laparoscopic method for its removal. This report presents the suc- cessful laparoscopic management with port site incision extension for the extraction of giant trichobezoar in a 16-year-old female patient. [Arch Clin Exp Surg 2017; 6(1.000): 41-44

Use of Intraperitoneal and Port Site Infiltration of Bupivacaine for Controlling Pain after Laparoscopic Cholecystectomy: A Prospective Study

Purpose: Pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort especially with coughing, respiratory movements and mobilization during initial few hours after surgery or during night after surgery. Material and Methods: Study included 200 patients who underwent laparoscopic cholecystectomy. They were divided into two groups of 100 patients each. One group (experimental) received bupivacaine and other group (Control) received 30 ml of normal saline after completion pf laparoscopic cholecystectomy. Results: Mean time of requirement of rescue analgesia in experimental group was 8.5 hours, whereas mean time of requirement of rescue analgesia in controls was 7.29 hrs. Total consumption of diclofenac in cases was 95mg whereas in controls it was 108.75mg (p=0.246), while as total consumption of tramadol in cases was 50 mg, whereas in controls it was 130mg (p<0.05). Postoperative abdominal pain as well as shoulder tip pain were less at all-time intervals (4h, 12h, and 24h) in cases compared to controls. Only 2 patients developed bradycardia and 1 patient developed mild drowsiness in experimental group in post-operative period. All the 3 patients required only monitoring and settled in 3-4 hours. Mean hospital stay in experimental group was 1.71 days, whereas in controls it was 1.93 days. Conclusion: Intraperitoneal and port site bupivacaine significantly reduces both somatic and visceral components of pain in post-operative period in laparoscopic cholecystectomy. It decreases the requirement of rescue analgesia and expedites discharge of patient from hospital. [Cukurova Med J 2015; 40(4.000): 692-697

A prospective observational study of laparoscopic varicocelectomy and open inguinal varicocelectomy in tertiary care hospital in Kashmir

Background: Varicocele is the most common cause of male infertility characterised by pathological dilatation of veins draining the testicles leads to increased temperature of seminiferous tubules which progressively affects the testicular growth, histology and function resulting in progressive decline in fertility. 40% of males evaluated for infertility have varicocele. Surgery relieves the symptoms associated with the disease and improves the semen quality. Surgery is done by open and laparoscopic methods. The aim of this study is to compare the open and laparoscopic varicocelectomy in terms of , Operating time, Hospital stay, Improvement in semen analysis and Post operative complications (Hydrocele, Hematoma formation, Recurrence)

Comparative Study of Fibrin Sealent versus Use of Tackers in Inguinal Hernia Repair

Purpose: To determine role and benefit of fibrin glue over tackers for mesh fixation in laparoscopic inguinal hernia repair. Backgroud: Mesh fixation by tackers may lead to many complications peroperatively like bleeding, increased hospital stay and overall more cost and later on chronic groin pain. Material and Methods: 60 inguinal hernia with age more than 18 years were taken and were divided in two groups; 30 patient group who underwent TAPP and 30 patient group who underwent TEPP. In 15 patients in both groups tackers were used and in other half fibrin glue was used for fixation of mesh using a 3mm catheter (Duplotip: Baxter Healthcare), which fits the Tisseel syringe. Results: The use of fibrin sealent has a distinct advantage in laparoscopic treatment of inguinal hernias compared with use of tackers as a method of mesh fixation. The use of fibrin sealant reduces the risk of post- and intraoperative complications, such as bleeding, seroma, chronic pain, has a lower incidence of postoperative neuralgia and provides an early faster return to social life. The recurrence rates do not vary much, but the operative time is slightly longer if the preparation time of the fibrin sealant is taken into consideration. In our study, we found a marginal difference in the cost of the two groups, fibrin sealant and stapled tackers. [Cukurova Med J 2015; 40(3.000): 457-465