ABSTRACT
In patients with history of previous abdominal surgery, creation of pneumoperitoneum during laparoscopicprocedure involves risk of complications as there is association of underlying adhesions at the umbilicus site.Palmer’s point is alternative site of primary port insertion. For creating pneumoperitoneum, visceral slidetechnique is used to detect the movement of viscera immediately deep to the abdominal wall. This techniqueis reliable in identifying adhesion-free areas of the abdominal wall. This study was undertaken to evaluate useof Palmer’s point in creation of pneumoperitoneum in patients of previous abdominal surgeries and to checkthe efficacy of the visceral slide technique for detection of umbilical adhesions in these patients. This one-yearstudy was conducted on 30 patients with previous history of abdominal surgery in the Government MedicalCollege, Jammu. Visceral slide test was conducted using a real time ultrasonography machine with a 7.5 MHzabdominal transducer placed in a sagittal plane at the umbilicus and the ultrasound scan focused on theinfraumbilical region between the anterior abdominal wall and the aortocaval complex. A normal visceral slide(positive test) is movement of the viscera more than 1 cm. An abnormal visceral slide (negative test) is definedas movement of the viscera less than 1 cm. At the end of the surgery, intra-operative, early and late complicationswere evaluated. Adhesions under the umbilicus were present and absent in 15 (50%) patients each. Thevisceral slide technique was negative in 9 (30%) and positive in 21 (70%) patients. Sensitivity, specificity,positive predictive value, negative predictive value and accuracy of visceral slide technique was 60%, 100%,100%, 72% and 70% respectively. Definitive evidence of the efficacy of Palmer’s point in creation ofpneumoperitoneum could not be established due to the small sample size and patients with limited spectrum ofabdominal surgeries. Further studies in the form of multicenter randomized control trials are needed to verifythe utility of Palmer’s point for creation of pneumoperitoneum and to evaluate the role of visceral slidetechnique in diagnosing intra-abdominal adhesions preoperatively.
ABSTRACT
No scalpel vasectomy (NSV), a minimal invasive technique for vasectomy is simple, safe, fast, more effective and less expensive operation for male sterilization with better patient compliance. In this study 280 patients were operated for NSV in sub district hospital of J&K State w.e.f. January 2009 to December 2010. Mean age of patients was 35.95 years. Mean time taken for surgery was 23 minutes. Complications were recorded and included bleeding during surgery 4 cases (1.43%), scrotal hematoma 3 cases (1.07%), wound infection 3 cases (1.07%) and minor scrotal pain 4 cases (1.43%). One patient in our study had chronic testicular pain. There was no decrease in sexual desire and satisfaction in any patient followed up and no case of failure of vasectomy was detected. NSV is becoming standard method of vasectomy around the world with less complications and discomfort, smaller scar and fast recovery time with positive post operative psychological state. India, where population control is major concern, this technique should be popularized to increase its acceptance among general population.