Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis.

INTRODUCTION: Whether the incidence rate of deep venous thrombosis (DVT) between laparoscopic and open colorectal cancer surgery the same or not were under the debated without conclusion. The aim of this study was to compare the incidence of DVT after laparoscopic or open colorectal cancer surgery by meta‑analysis. MATERIALS AND METHODS: The open published articles comparing the incidence of DVT after laparoscopic or open colorectal cancer were collected in the data bases of Medline, the Cochrane central register of controlled trials and CNKI. The relative risk (RR) was pooled by using random or fixed effect mode to evaluate the incidence of DVT between laparoscopic or open colorectal cancer surgery. RESULTS: After searching the databases, 9 randomized clinical studies with 2606 colorectal cancer cases were included in this meta‑analysis. The mean operation time was 201.8 ± 17.28 min with its range of 180.0–224.4 min in the laparoscopic surgery group and 148.1 ± 18.8 min with its range of 135.0–184.0 min in the open surgery group. The operation time for laparoscopic surgery group were significant lower than in the open surgery group (P < 0.05). The RR of DVT between the laparoscopy and open surgery groups was 0.71 with its 95% confidence interval of 0.35–1.45 (P = 0.35). CONCLUSIONS: The operation time in laparoscopic colorectal cancer surgery was statistical longer than in the open colorectal cancer surgery, but the DVT risk of the two surgery approach was not different according to this meta‑analysis.

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.

[Comparing the early complications of surgical wounds in two methods of open surgery and laparoscopy in Milad Hospital]

Incidence of early wound related complications was assessed in laparoscopic versus open abdominal surgeries. Complications of surgical wounds [esp. wound infections] are considered as a major problem in surgery wards. Complications of surgical wounds are classified as early and late. Common and early complications are hematoma, seruma and wound in fection. Medical records of 104 elective laparoscopic [A] and 106 diagnosis matched open surgeries [B] including appendectomy, cholecystectomy, ventral hernia repair, and bariatric surgery were prospectively reviewed. Study data included patients' sex, age, wound class, type of operation, and occurrence of early wound related complications. Surgical wounds were evaluated for presence of early complications during the post-op period and 10 to 15 days after the operation. The two groups were not different with respect to age, sex and wound classes. No patients in group A and 7 patients in group B developed wound infection. [P<0.05] Incidence of Hematoma was similar in the two groups; one case in each. No patient in the two groups experienced seruma and wound dehiscence. Gender, age and wound classes were not associated with higher rates of wound complications. Laparoscopic surgery significantly reduced the incidence of early wound complications, specially wound infection, and is a safe and effective alternative to conventional open procedures

Laparoscopic management of children with non-palpable testis

To show the advantages and limitations of laparoscopy in management of the non-palpable testis. Herein, we report our experience with diagnostic and interventional laparoscopic procedures in children with non-palpable testes. Between 1997 and 2001, 28 children underwent 30 laparoscopic procedures for evaluation and management of 36 non-palpable testes. Pneumoperitoneum was achieved using a Veress needle inserted infraumbilically in all cases. Examination of the abdomen and pelvis was performed with a 30°, 5 mm laparoscope. When intervention was deemed necessary, 2 to 3 additional 5 mm ports were inserted under direct visual control. For dissection, laparoscopic microscissors and electrosurgical dissection were used. The mean patient age was 3.6 years [12 months -14 years]. A total of 12 diagnostic procedures [localization] were performed on 12 patients and 15 inguinal exposures were done based on the laparoscopic findings [14 orchiopexy and 1 orchiectorny]. Tlie testes were absent in six more patients and farther surgery avoided. Twelve laparoscopic interventions were done on 10 patients: 9, one stage laparoscopically assisted orchiopexy, 1, two-staged orchiopexies, 1, laparoscopic Fowler-Stephen orchiopexy and, laparoscopic orchiectcmy. All procedures were performed on outpatient basis or with an overnight stay. There were 4 complications: injury of the spermatic vessels which did not affect the viability of the testis in one instance, two testes had atrophied at 4 weeks and 6 weeks follow-up, and one testis had retracted to the level of the pubic tubercle at 9 months. Laparoscopy is a useful tool in the management of the non-palpable testes. For an intracanalicular testis, an inguinal orchiopexy is recommended. For intra-abdominal testes, a laparoscopic orchiopexy is the technique of choice at our institution

Laparoscopic findings in infertility

A study was carried out over a period of 12 months from 1.1.95 to 31.11.95, in which 200 [female] patients were subjected to laparoscopy to evaluate various factors regarding infertility. The study highlighted various symptoms of infertile patients [female] and obvious pathologies seen with the laparoscope such as tubal adhesions, uterine diseases, status of ovaries or any associated condition like endometriosis or pelvic inflammatory disease. The study also illustrates the complications occurring during the laparoscopic procedures

Thoracic epidural versus intraperitoneal local anaesthetic for postoperative pain relief after laparoscopic or open cholecystectomy

Laparoscopic cholecystectomy [LPC] is increasingly used to treat symptomatic cholelithiasis. In this study, we compared the effects of cholecystectomy by subcostal incision to those of LPC on lung function and endocrine metabolic response. The effects of thoracic epidural analgesia and intraperitoneal local anaesthetics [0.25%] bupivacaine 20 ml for LPC were studied as well. Forty patients undergoing elective cholecystectomy under general anaesthesia were allocated into four study groups, group I, cholecystectomy by subcostal incision [CSI], group II, LPC, group III, LPC and epidural analgesia with 0.5% bupivacanie followed by continuous epidural infusion of 6 ml of 0.5% bupivacaine. Group IV, 0.25% bupivacaine 20 ml administered I.P., forced vital capacity [FVC] and forced expiratory volume in one second [FEV 1] were measured with the patients in a half-setting position. In all groups, sustained decrease in FVC, FEV1 were observed up to 24 hours after surgery. Reduction of FVC was significantly more in group I compared with groups II, III and IV [p < 0.05]. Two hours after surgery, FVC was decreased significantly in groups I, II, III and IV to 29.1, 58.3, 63.6 and 59% of the preoperative values respectively. At that time, FEV1 decreased to 27, 55, 60 and 56% of the preoperative values in groups I, II, III and IV respectively [p < 0.05]. In all groups, plasma glucose and cortisol levels increased after surgery compared with the baseline levels [p <0.05]. At 240 minutes after surgery, a small but significant decrease of cortisol was measured in group III [p < 0.05]. Patients in groups I, II and IV, received significantly more fentanyl during surgery and morphine postoperatively compared with patients in group III [p <0.05]. In group III, epidural analgesia decreased visual analogue pain scores [p <0.05], but there was no difference in pain scores between group I, II and IV. In conclusion, the endocrine metabolic response is not abolished after LPC. Thoracic epidural analgesia decreased postoperative pain and attenuated the metabolic endocrine response, but it did not improve lung function after LPC. Nevertheless, pulmonary function is significantly better after LPC than after cholecystectomy via subcostal incision

El valor de la laparoscopia en cirugía general: analisis de 350 casos / The value of the laparoscopy in general surgery

La laparoscopia es un método simple y seguro en el diagnóstico y tratamiento de las afecciones intraabdominales. El análisis de nuestra experiencia durante 4 años desde enero de 1987 a diciembre de 1990 de 350 casos demuestra que el método tiene un 95 por ciento de utilidad, para la toma de decisiones, con pocas complicaciones, 3 casos (0,8 por ciento) y sin mortalidad (0 por ciento). Esto concuerda con la experiencia mundial. El realizar el procedimiento de una manera fácil con anestesia local en 322 casos (92 por ciento) permite abarcar una gran población de pacientes en nuestro Hospital, lo cual servirá a su vez para disminuir los costos y entrenar a nuestros residentes