Managing intra-operative complications during totally extraperitoneal repair of inguinal hernia

Laparoscopic inguinal hernia repairs are looked upon as technically demanding procedures having have a stiff ‘learning curve’ associated with its performance in terms of clinical outcome and patient's satisfaction. Complication rates have been shown to drop with increased surgical experience. The complication rate for laparoscopic repair of inguinal hernia ranges from less than 3% to as high as 20%. Complications of a totally extraperitoneal (TEP) repair include general complications that occur with any surgical procedure and anesthesia, mesh-related complications and those specific to the TEP procedure, like visceral injury, vascular injury, nerve injury and injury to the cord. Intraoperative complications can occur at every step of the operation, even though some of them are only occasionally reported. However, it is important to analyze all of them chronologically, so that we can define methods to prevent them or tackle them if they occur. Risk reduction strategies are required to improve the clinical outcome of TEP and this must be adopted for each individual surgical step

Single-incision laparoscopic cholecystectomy: How I do it?

Single-incision laparoscopic cholecystectomy (SILC) is a relatively new technique that is being increasingly used by surgeons around the world. Unlike the multi-port cholecystectomy, a standardised technique and detailed description of the operative steps of SILC is lacking in the literature. This article provides a stepwise account of the technique of SILC aimed at surgeons wishing to learn the procedure. A brief review of the current literature on SILC follows

Single-incision laparoscopic cholecystectomy: How I do it?

Single-incision laparoscopic cholecystectomy (SILC) is a relatively new technique that is being increasingly used by surgeons around the world. Unlike the multi-port cholecystectomy, a standardised technique and detailed description of the operative steps of SILC is lacking in the literature. This article provides a stepwise account of the technique of SILC aimed at surgeons wishing to learn the procedure. A brief review of the current literature on SILC follows

Single-incision bilateral laparoscopic oophorectomy

Although single-incision laparoscopic surgery made an appearance on the surgical scene only recently, it is being increasingly applied in the treatment of a variety of disorders. We report single-incision bilateral laparoscopic oophorectomy and salpingooophorectomy performed in two patients who had previously undergone breast conservation surgery for early breast cancer. Each procedure was undertaken using two 5-mm and one 3-mm ports inserted through a 2-cm transverse supraumbilical incision and standard laparoscopic instruments. The operative time was 50 and 65 min respectively and the blood loss negligible. The patients were discharged 36 and 24 h after surgery, required minimal postoperative analgesia and remain well at a follow up of 19 and 17 months, respectively. With the benefit of improved cosmesis, the single-incision approach holds the potential to replace the traditional bilateral laparoscopic oophorectomy

Laparoscopic splenectomy for tuberculous abscess of the spleen

Abscess of the spleen is an uncommon clinical entity and a tuberculous abscess is particularly rare. Although image-guided aspiration has been reported, splenectomy is the preferred modality of treatment. We report a 32-year-old female diagnosed to have a large, multilocular splenic abscess during investigation of a pyrexial illness. Her haemoglobin was 9.8 gm%, ESR 100 mm/1 st hour and she was HIV negative. She had been on anti-tubercular chemotherapy (started elsewhere) for 2 months but had shown poor response. A laparoscopic splenectomy undertaken using four-ports was challenging due to the presence of perisplenitis and adhesions in the splenic hilum. Also, fundus of stomach densely adherent to the upper pole of the spleen required stapled resection. Postoperatively, she developed a low-output pancreatic fistula that resolved with conservative treatment within a week. Histopathology of the spleen confirmed tuberculosis. She responded well to anti-tubercular chemotherapy and remains well 3 years later

Inflammatory pseudotumor of ascending colon presenting as PUO: a case report

Inflammatory pseudotumour (inflammatory myofibroblastoma, plasma cell granuloma) is a rare benign lesion in adults and children. It frequently simulates a true neoplasm both clinically and morphologically, presenting a diagnostic and therapeutic dilemma. We herein report a case of a 16 year old girl who presented with pyrexia of unknown origin for almost 4 months before developing a palpable lump in the right iliac fossa. The patient underwent a right hemicolectomy for a presumed ascending colonic neoplasm, and histology revealed that it was an inflammatory pseudotumour. Following resection of the mass there was resolution of constitutional symptoms and normalization of laboratory abnormalities. Since these tumors are self-limiting and have a favorable prognosis, our case review and review of literature suggests the importance of preoperative and intraoperative recognition of this entity, especially if laboratory parameters suggest an inflammatory process

Migration of intrauterine contraceptive device into the appendix

Intrauterine contraceptive devices (IUCD) have been used as an effective, safe and economic method of contraception for many years. Since its introduction, many complications have been reported, viz. dysmenorrhoea, hypermenorrhoea, pelvic infection, pregnancy, septic abortion, uterine perforation and migration into adjacent organs. Migration of IUCDs into the peritoneum, omentum, appendix, colon, wall of the iliac vein and bladder have been reported. We report a case of a 22-year-old lady with an IUCD migration into the tip of the appendix 14 months after its insertion

Prolene hernia system in the tension-free repair of primary inguinal hernias

Objective: The aim of this study was to determine the feasibility of using the Prolene® (polypropylene) Hernia System for open tension-free repair on inguinal hernias, and study the results in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. Material and Methods: From February 2002 through April 2003, we performed 50 open tension-free hernia repairs on 47 patients (46 men, 1 woman) with a mean age of 55.8 years. There were 26 right and 18 left hernias, and 3 were bilateral. Of these, 39 were direct, 10 were indirect and 1 was femoral type. All were primary hernias. Results: The duration of surgery averaged 35 minutes (range 20 to 90 min). There was no perioperative mortality. Four patients developed mild self-limiting neuralgias. There were no subcutaneous wound infections, no haematomas, no seromas and no testicular atrophy. The average duration of postoperative hospitalisation was 3.5 days. The length of follow-up ranged from 1 month to 15 months (mean= 6.24 months). We have had no recurrences so far. Conclusion: The Prolene Hernia System is a novel approach in the management of inguinal hernias, with encouraging initial results. Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up

Laparo-endoscopic single-site left adrenalectomy using conventional ports and instruments

Laparo-endoscopic single-site adrenalectomy (LESS-A) is commonly performed using specialized access devices and/or instruments. We report a LESS-A in a 47-year-old woman with a left aldosteranoma via a subcostal approach utilizing conventional laparoscopic ports and instruments. The feasibility and cost-effectiveness of this approach are highlighted and the literature on the subject is reviewed