Retrospective evaluation of patients of gastroesophageal reflux disease treated with laparoscopic Nissen's fundoplication

Aims: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). Materials and Methods: Forty-two patients with typical symptoms of GERD, who were operated for laparoscopic Nissen's fundoplication from March 2001 to August 2008, were studied. The study was limited to patients with positive findings on upper gastrointestinal (GI) endoscopy done by us and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only one patient who had negative endoscopic findings underwent a 24-h pH monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome, and quality of life after surgery. Results: Relief of the primary symptom responsible for surgery was achieved in 95.24% of patients at a mean follow-up of 28 months. Thirty-five patients were asymptomatic, two had minor gastrointestinal symptoms not requiring medical therapy, three patients had gastrointestinal symptoms requiring medical therapy/Proton Pump Inhibitors (PPI) and in two patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in six patients. Median hospital stay was 3 days, decreasing from 6 days in the first 10 patients to 3 days in the last 10 patients. Conclusions: Laparoscopic Nissen's fundoplication is the choice of operation for clinically symptomatic GERD patients

Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia

Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures

Hybrid Single-incision Laparoscopic Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We report one of the initial clinical experiences from India for Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis (RPC IPAA) with this new technique. A SILSTM port was used through the curved intra-umbilical 25-mm incision. A 12-mm port was placed in the right iliac fossa at the ileostomy site. Another 5 mm port was placed in the left iliac fossa at the drain site. 10 mm 0 degree lens was used through the SILS port. Two 5 mm port were placed from the SILS port. Right iliac fossa port was the surgeon’s right hand port and left hand port was 5 mm SILS port. Left iliac fossa port and 5 mm SILS port were used by the assistant surgeon for retraction. The specimen was delivered through the umbilical incision by extending the incision for 1.5 cm on either side. Ileal J Pouch was created extracorporeally and then anastomosed to the anal canal with the circular stapler laparoscopically. The diverting loop ileostomy was brought out through the right iliac fossa 12 mm port. The pelvic drain was brought out through the left iliac fossa port. The procedure was completed without any perioperative complications. Operative time was 256 minutes. Postoperative follow-up did not reveal any umbilical wound complication. Till date we have performed 26 Laparoscopic RPC with IPAA and this was the first Single Incision Laparoscopic RPC with IPAA. For experienced laparoscopic colorectal surgeons, single incision laparoscopic colectomy (SILC) is feasible. Single-incision laparoscopic colectomy is a promising alternative method as minimally invasive abdominal surgery for the treatment of patients requiring colectomy