'Critical circle of fundoplication' – A key concept towards creating identical, replicable and consistent fundoplication wraps

Background: There is a significant learning curve associated with laparoscopic Nissen's fundoplication, during which, complications due to surgical errors are more likely to occur. Moreover, length of the wrap, its situation on the lower esophagus and the points of the fundus brought together to create the wrap are arbitrary and as per the surgeon's judgement and estimation. This leads to a lot of variation in the wraps created, not only from surgeon to surgeon, but also from case to case for each individual surgeon. We propose a new concept of 'Critical Circle of Fundoplication' and the new approach to construct the fundoplication based on this concept, by application of which, a mathematically precise fundoplication can be created which is consistent, accurate and optimum. Patients and Methods: A total of 132 patients were operated based on the concept of 'Critical Circle of Fundoplication' between 2015 and 2020, of which 116 patients completed one year of follow-up and are included in the paper. Results: The demographic characteristics, intraoperative findings and postoperative are described in detail. An additional average time of 10.5 minutes (range: 8-26 minutes) was required in the precise measurements and markings that were required by this approach. Conclusion: By application of the concept of 'Critical Circle of Fundoplication', precise, consistent and optimum wraps can be created. By eliminating the errors of structural construction and placement of the wrap, overall results can be improved

Spillage-free laparoscopic management of hepatic hydatid disease using the hydatid trocar canula

Introduction: This study was undertaken to demonstrate the efficacy of the Hydatid Trocar Canula system for safe and effective treatment of hepatic hydatid cysts. Materials And Methods: All cases presenting to our centre for treatment of hydatid cyst of the liver with certain exceptions were considered for laparoscopic management using the specifi cally designed Hydatid Trocar Canula system. The technique of surgery and the step wise sequence of deployment of the device are described. Results: Since January 2007, 16 patients compromising six males and 10 females underwent this procedure at our centre. The average age of the patients was 37.6 years and all of them had a single cyst. The average duration of surgery was 86 minutes. None of the cases suffered intraoperative mishap like spillage or anaphylaxis. Till date, follow-up has been maintained in 81.3% of the patients and no recurrence has been detected. Conclusion: The correct use of the Hydatid Trocar Canula system allows for spillage-free and complete evacuation of hepatic hydatid cysts

Laparoscopic intra-peritoneal onlay mesh plus repair for ventral abdominal wall hernias - is there substance to the hype?

Aim: To summarize our experience in laparoscopic intra-peritoneal onlay mesh (IPOM) plus repair for ventral abdominal wall hernias over a 10-year period.Methods: All patients posted for laparoscopic repair of midline lower abdominal ventral hernia on an intention to treat basis were included in the study. Patients unfit for general anesthesia, patients posted for open repair or a hybrid approach (open reduction and closure of defect followed by laparoscopic IPOM repair) were excluded. Pre-operative patient demographics were noted. Intra-operative and post-operative data was recorded and analyzed.Results: A total of 278 patients were posted for elective laparoscopic repair of lower midline ventral hernias between January 2007 and January 2017, of which, 56.1% were para-umbilical hernias and 43.9% were incisional hernias. These included 155 female patients. The average body mass index was 27 kg/m2. Thirty-five patients were being operated for a recurrent ventral hernia. The average defect width was 1.2 cm for paraumbilical hernias and 2.2 cm for incisional hernias. The mean operating time was 55 min for para-umbilical hernias and 71 min for incisional hernias. In 13.1%, the fascia could not be sutured. There were no conversions to open surgery. Average length of hospital stay was 2.04 days with average follow-up period of 4.6 years. Overall morbidity was 7.9% with 2 recurrences. There was no mortality or mesh infection.Conclusion: Thus, IPOM plus repair is a safe, feasible and effective technique for the treatment of ventral abdominal wall hernias

Laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

Aim: The aim was to study the feasibility of the laparoscopic approach in the management of ulcerative colitis, to assess the functional results at 1-year and to review of literature on the topic. Materials and Methods: All patients presenting for surgical management of histopathologically proven ulcerative colitis during the study period were included in the study. All patients presenting in a non-emergency setting were offered a two-stage procedure (Group A). The first-stage consisted of laparoscopic total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) with a diverting split end ileostomy. Ileostomy was closed in the second stage. For patients presenting in acute setting (Group B), the first-stage consisted of laparoscopic TPC with end ileostomy followed by IPAA with diverting split end ileostomy in the second-stage and finally ileostomy closure in the third-stage. The technique is described. Results: A total of 31 cases underwent laparoscopic TPC-IPAA, of which 28 belonged to Group A and 3 were included in Group B. All surgeries were successfully completed laparoscopically without need for conversion. The average operating time was 375 min in Group A (range: 270-500 min) and 390 min in Group B (range: 250-480 min). Oral diet was resumed at a mean of 3.4 days (range: 1.5-6 days) and the mean hospital stay was 8.2 days (range: 4-26 days). Overall morbidity rate was 16.2%; re-operation rate was 9.7% while mortality was nil. Conclusions: Laparoscopic TPC-IPAA is feasible in acute as well as non-acute setting in patients needing surgical management of ulcerative colitis

Prevalence and Patterns of Sexual Dysfunction in Male Patients Suffering from Major Depressive Disorder Attending Psychiatry Outpatient Department

Background: Major depressive disorder (MDD) can cause sexual dysfunction (SD), and it is more frequent with antidepressant treatment. Different antidepressant agents have different effects on SD according to their group and dose, which is studied in the present research. Aims: (a) To study the prevalence and patterns of SD in male patients with MDD, both drug naïve and on antidepressant treatment. (b) To correlate the severity of depression and SD. Settings and Design: Cross-sectional study carried out among 200 patients who attended to the psychiatry outpatient department of a tertiary care hospital. Materials and Methods: Every fifth patient with MDD attending to an investigator had been enrolled for the study. Sociodemographic details and clinical variables were obtained. The diagnosis of MDD established by the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, criteria and the Hamilton Depression Rating Scale was used to assess the severity of depression. The Arizona Sexual Experience Scale and Change in Sexual Functioning Questionnaire-14 was applied to measure SD. Statistical Analysis: Statistical analysis was done using the χ 2 test, unpaired t test, Pearson correlation coefficient, and analysis of variance test. Results: Total 82 (41%) patients had SD. Amongst them, 37 (45.12%) patients had the onset of SD before and 45 (54.88%) patients had the onset of SD after treatment. There was a statistically significant correlation between the severity of depression and SD ( P = .001), SD responses of patients on the selective serotonin reuptake inhibitor and tricyclic antidepressant ( P = .005). Sexual pleasure shows statistical significance with severity ( P = .004) and duration of depressive illness ( P = .03). The age factor was statistically significant with SD. Conclusions: Sexual dysfunction had significance with the severity of depression. Sexual pleasure had significance with severity and duration of depression, and some SD domains had significance with age groups