ABSTRACT
Aim of Study:Laparoscopiccolorectal surgery has gained popularity around the Globe. Laparoscopiccolectomy significantly improves the short term and long term outcomes of patients. The bowel anastomosis after laparoscopic resection of the tumour can be done in two ways -extracorporeal anastomosis and Intracorporeal anastomosis. Our study observed and evaluated the data of the patients who underwent these two techniques.Materials and Methods:A prospective observational study was conducted in the department of General Surgery, SMHS hospital of Government Medical College, Srinagar. A total of 32 patients were studied out of which 20 patients had undergone intracorporeal anastomosis and 12 patients had undergone extracorporeal anastomosis. The aims of the study were to assess the operative time, post-operative ileus, length of hospital stay, anastomoticleak and other anastomotic complications,wound infections and extraction site hernias.Results:The patients in our study were in the range of 30-85 years with a mean age of 59.18 ± 14.92. and 59.4% of patients were males and the rest 40.6% were females, with male/female ratio of 1.46:1. There was no significant difference in mean operative time between the intracorporeal group and extracorporeal group (188±9.78 minutes’ vs.180.3±13.8 minutes). The patients in the intracorporeal group had earlier return of bowel function than extracorporeal group as reflected by earlier appreciation of flatus and tolerance to orals. This had led to the shorter hospital stay of the intracorporeal group than the extracorporeal group of patients (median of 5 days vs. 6.5 days) The wound infection rate was 6.3 percent in our study, 5.0% in the intracorporeal group and 8.3% in the extracorporeal group. Only 1 out of the total 32 patients developed mesenteric twist to the extracorporeal group (1 out of 12 patients). We observedno leak or incisional hernia in either groups.Conclusion:Intracorporeal anastomosis in laparoscopic colorectal surgeries leads to earlier return of bowel function, earlier resumption of orals and shorter hospital stay than the extracorporeal anastomosis. There does not exist a significant difference between the two modes of anastomosis in terms of anastomotic and wound related complications
ABSTRACT
Background:Acute gastro-esophageal reflux disease is a common ailment in kashmiripopulation. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD.Aims and Objectives:The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophagealrefluxdisease in termsof operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms.Materialsand Methods:The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the studyhad symptomatic gastro-esophageal reflux(documented by endoscopy) with either persistent symptomsdespite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informedconsent was taken before surgery in the language, the patients understood.Results:This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and postoperative complications. The postoperative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months).The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion:We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who areat a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by thesurgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring