Role of single-ring oval disposable wound protecting device in preventing surgical site infection in laparoscopic colorectal resections

Context: Surgical site infections (SSI) continue to be a major cause of morbidity, mortality, prolonged hospital stays and a major reason of financial burden to health-care providers and patients after major abdominal surgeries. Along with infection control practices and care bundles, additional use of devices which protect the wound from contamination is believed to decrease the burden of SSI. Aims: This study aims to assess the benefit of single-ring disposable wound protector in preventing SSI, overall complications, hospitals stay and morbidity data in laparoscopic colorectal resection. Settings and Design: The study design involves case–control study, retrospective. Subjects and Methods: A case–control study comparing single ring oval wound protector versus conventional wound protectors retrospectively between August 2019 and December 2021. The ease of use of the device, rate of SSI, overall complications, hospitals stay and morbidity data were analysed. Statistical Analysis Used: The statistical analysis was performed by IBM SPSS Statistics 20 version. All Categorical Variables will be described as frequency and percentage. Continuous variables will be described as mean ± standard deviation. Continuous variables were analysed using t-test and categorical parameters using Fisher's exact test. Results: Of the 110 patients studied, wound Protecting devices were used in 58 patients Wound Protector Group (WPG group) and 62 patients did not use such devices (no WPG). The groups were comparable in demographic features, risk features, systemic illness, type of surgeries undertaken and the specimen extraction wound used. There was a significant decrease in the incidence of SSI (1.7% vs. 16% P ≤ 0.008) and the hospital stay (P ≤ 0.03) when WPG was used compared to the group in which it was not used. Conclusions: Apart from the use of infection control practices and care bundles, the use of oval-shaped single-ring wound protector is likely to reduce SSI

Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: A prospective study

Aims: Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect. Materials and Methods: This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year. Results: Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months. Conclusion: After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months

Laparoscopic approach is safe and effective in the management of Mirizzi syndrome

Context: Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon. Aim: To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre. Materials and Methods: This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome. Results: A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group. Conclusion: MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well

Exploring minimally invasive options: Laparoscopic transabdominal levator transection for low rectal cancers

Extralevator abdominoperineal excision (ELAPE) of the rectum offers wider circumferential margin and decreased rate of intraoperative tumour perforation. However, the need to change the position of the patient in between abdominal and perineal stages of the procedure and extended perineal resection result in increased morbidity and operative time. Evolving technique of laparoscopic transabdominal controlled division of levator ani muscles under direct vision could address these issues while providing all benefits of ELAPE for patients with low rectal cancers

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital sta

Resection Prior to Liver Transplantation for Hepatocellular Carcinoma

OBJECTIVE: To evaluate the feasibility and postoperative course of liver transplantation (LT) in cirrhotic patients who underwent liver resection prior to LT for HCC. SUMMARY BACKGROUND DATA: Although LT provides longer survival than liver resection for treatment of small HCCs, donor shortage and long LT wait time may argue against LT. The feasibility and survival following LT after hepatic resection have not been previously examined. METHODS: Between 1991 and 2001, among 107 patients who underwent LT for HCC, 88 met Mazzafero’s criteria upon pathologic analysis of the explant. Of these, 70 underwent primary liver transplantation (PLT) and 18 liver resection prior to secondary liver transplantation (SLT) for recurrence (n = 11), deterioration of liver function (n = 4), or high risk for recurrence (n = 3). Perioperative and postoperative factors and long-term survival were compared. RESULTS: Comparison of PLT and SLT groups at the time of LT revealed similar median age (53 vs. 55 years), sex, and etiology of liver disease (alcohol/viral B/C/other). In the SLT group, the mean time between liver resection and listing for LT was 20 months (range 1–84 months). Overall time on LT waiting list of the two groups was similar (3 vs. 5 months). Pathologic analysis after LT revealed similar tumor size (2.2 vs. 2.3 cm) and number (1.6 vs. 1.7). Perioperative and postoperative courses were not different in terms of operative time (551 vs. 530 minutes), blood loss (1191 vs. 1282 mL), transfusion (3 vs. 2 units), ICU (9 vs. 10 days) or hospital stay (32 vs. 31 days), morbidity (51% vs. 56%) or 30-day mortality (5.7% vs. 5.6%). During a median follow-up of 32 months (3 to 158 months), 3 patients recurred after PLT and one after SLT. After transplantation, 3- and 5-year overall survivals were not different between groups (82 vs. 82% and 59 vs. 61%). CONCLUSIONS: In selected patients, liver resection prior to transplantation does not increase the morbidity or impair long-term survival following LT. Therefore, liver resection prior to transplantation can be integrated in the treatment strategy for HCC