simple technique of inserting an intra- abdominal drain in laparoscopic surgery

We describe a simple technique for introducing any size of intra-abdominal drain in laparoscopy through a 3-5 mm port site without any of the drawbacks of other techniques practiced. Setting is usually of a conventional laparoscopic surgery with various ports positioned depending on the procedure performed. At the end of the procedure a 5 mm port site cannula is usually chosen to pull in an intra-abdominal drain by railroading, under vision, Railroading method of insertion of intra-abdominal drain in laparoscopy is always successful with no failure rate and no associated complications. When indicated, this is the simplest method of inserting an intra-abdominal drain after laparoscopic surgery

Laparoscopic assisted two port open appendicectomy

The laparoscopic appendicectomy can be performed using one to several ports. We present our experience of two port laparoscopic assisted open appendicectomy. The objective was to assess the results retrospectively in terms of complications and its limitations. Between years 1998-2007, a two port laparoscopic assisted appendectomy was attempted in 2380 adult patients with suspected appendicitis. The patients with localized or generalized peritonitis were included. The appendicectomy was performed via an assisted two port method using 10 mm umbilical optical port and another 10 mm port in right iliac fossa. The children aged 12 and below and pregnant patients were excluded. All patients had their laparoscopic appendicectomy within 48 hours of admission. Two port laparoscopic assisted appendicectomy was successful in 86.9% of cases. Acute appendicitis was the cause of acute abdomen in 88.9% of the patients. The accessory port was required in 8.5% of patients to complete the appendicectomy and the conversion rate to open was 4.6%. The mean operation time was 25 minutes and the mean hospital stay was 1.5 days. The port site infection was seen in 14, bleeding in 20, parietal wall abscess in three cases and intra-abdominal abscesses in 4 patients. This approach is simple, can be converted to total intracorporeal by inserting accessory port or to open appendicectomy when required and has advantage of full laparoscopy of abdomen. It has its limitations in cases of extreme obesity, thick mesentery, gangrenous appendix, very large and thick appendix, and difficulty in finding the appendix, control of bleeding, division of adhesions and to deal with other associated pathology. Cost was minimized by using non-disposable port. The overall morbidity was low. There were no specific complications related to this technique and incidence of port site infection was similar to other approaches of laparoscopic appendicectomy

Ten-year retrospective comparative analysis of laparoscopic repair versus open closure of perforated peptic ulcer

Aim of this study was to compare the result of open and laparoscopic repair of perforated peptic ulcers in terms of operation time, postoperative pain, hospital stay, and wound infection. Clinical notes of 152 patients who underwent the operative closure of perforated peptic ulcers from 1996 to 2006 were available for study. All patients were offered laparoscopic approach from 1998 onward. Repair was done using omentum patch. Open approach was used in 57 patients and laparoscopic in 95 patients. Results were analyzed in terms of requirement of analgesia, hospital stay, return to work, complications, and mortality. Closure was successful in all cases using omentum patch. There was no conversion to open in laparoscopic group. The mean operation time was less in laparoscopic versus open [P<0.001]. The mean number of analgesic injection given were 3 and the hospital stay was 4 days in laparoscopy, the corresponding figure in laparotomy were 6 and 9 respectively [P<0.001]. Total numbers of complication in laparoscopic repair were 9 compared to 35 in open [P=0.011]. Two patients died in each group. Incidental significant incidences of perforations was observed in men [P<0.001], fasting during Ramadan [P<0.001], smokers [P<0.001], past history of peptic ulcer disease [P=0.007], and use of non-steroidal anti-inflammatory drugs [P=0.035]. Compared to open approach, laparoscopic repair required shorter operation time, lesser analgesia, had fewer complications, shorter hospital stays and early return to work

Laparoscopic cystogastrostomy for a giant pseudocyst of pancreas

An unresolved, large, symptomatic pseudocyst of pancreas requires drainage. Conventionally a pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus which could be stomach, duodenum or jejunum. Recently the various minimal invasive approaches have been increasingly used to treat this condition. Depending on the expertise available, cyst can be also drained endoscopically or laparoscopically. We present this case of long standing large pseudocyst treated laparoscopically. The Internal drainage of a pseudocyst of pancreas is safe and feasible laparoscopically with excellent results

Laparoscopic repair of inguinal hernia

We present our experience of laparoscopic repair of inguinal hernia using transabdominal preperitoneal [TAPP] and total extra peritoneal [TEP] technique at this district hospital since June 1999. We had no significant morbidity and no recurrences. In both these techniques the entire inguinal floor is dissected to expose-all four potential hernial sites and covering them with prolene mesh. Initially we utilized TAPP approach and then gradually changed to TEP as we gained experience and got familiar with laparoscopic anatomy. Total extra peritoneal is now our standard approach for inguinal hernia. Laparoscopic repair is superior to open in terms of more rapid recovery, early return to work, less postoperative pain, lesser hospital stay, lesser recurrence and consumer acceptance