Laparoscopic management of impalpable undescended testes: 20 years' experience.

BACKGROUND: Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years. MATERIALS AND METHODS: From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler - Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite. RESULTS: None of the testis atrophied after two-stage Fowler - Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy. CONCLUSIONS: Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler - Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler - Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.

Henna as a durable preoperative skin marker.

BACKGROUND: For many surgical procedures skin marking is required well before surgery and induction of anesthesia. In some cases, the patient may need to be standing or sitting while the skin area is marked. Marking of perforators and varicosities in chronic venous diseases, marking of stoma sites for urinary or fecal diversions are some examples. The side of surgery should ideally be marked preoperatively to avoid wrong side surgery. Marks made with conventional marking pens fade or disappear with preoperative skin preparation, whereas marks made with henna paste, which is orange to dark brown in color, last for up to 3 weeks in spite of regular showers and skin cleansing, even with ethanol. This property of henna encouraged us to use it as a preoperative skin marker. METHODS: Henna paste was used as a preoperative skin marker in 250 patients. In 154 patients with chronic venous diseases, perforators and varicosities were marked during duplex scanning. Henna was used to mark the colostomy site in 28 patients with carcinoma of the rectum prior to abdominoperineal resection of the rectum (APR) (four of them laparoscopic APR) and the aspiration site in 11 patients with liver abscesses and 4 patients with pleural empyemas, under ultrasonographic (USG) guidance. In addition, henna was used to mark the correct side of surgery in 47 patients undergoing unilateral inguinal hernia surgery. Marking was done from 1 to 8 days before surgery. RESULTS: The marking with henna was clearly visible in all the cases even after preoperative skin preparation with ethanol up to 8 days after application. There were no complications associated with the marking. All marks disappeared 4 weeks after application. In terms of successful execution of the desired procedure, the use of henna marking was successful in all the cases. CONCLUSIONS: Henna is an ideal substance for use as a preoperative skin marker. It can be safely and effectively used as a marker for varicose vein surgery, ultrasound-guided identification of lesions, establishing the ideal site for stomas on the abdominal wall, and to identify the correct side of surgery. Markings made with henna are durable and do not fade with routine bathing or preoperative skin preparation. In most cases there are no associated complications. Henna is cheap, safe, and convenient, and indications for its use can be ubiquitous.

Devadhar's operation for complete rectal prolapse: 25 years' experience.

BACKGROUND: Numerous abdominal and perineal operations have been described for the treatment of complete rectal prolapse. We describe our results with Devadhar's rectopexy, which avoids dissection in the presacral space and hence may be expected to have a low risk of sexual and urinary disturbances. METHODS: Case records of 72 consecutive patients (40 men), aged above 18 years, with complete rectal prolapse who were treated with Devadhar's operation were reviewed. RESULTS: The only complication observed was mucosal prolapse in 3 patients. None of the 40 men had erectile dysfunction or retrograde ejaculation after a median follow-up of 10 (range 3-48) months. No patient had disturbance in micturition. Two patients (2.7%) had recurrence of rectal prolapse. In four patients (8.5%), constipation persisted. CONCLUSION: Devadhar's rectopexy for complete rectal prolapse was not associated with disturbances in sexual or micturition function, and low rates of recurrence of prolapse.

Non-parasitic hepatic cysts causing obstructive jaundice: two cases.

Non-parasitic hepatic cysts rarely cause jaundice. We report two patients with such lesions treated by percutaneous drainage.

Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study.

BACKGROUND: Laparoscopic closure of duodenal ulcer perforation may be an alternative to open surgery due to lower morbidity. Most published series have used omental plug for laparoscopic closure. We performed simple closure of the perforation laparoscopically and compared the results with those obtained by open surgery. METHODS: Of 77 consecutive patients with duodenal ulcer perforation 10 were excluded due to their high risk for laparoscopic surgery. 34 (age 18-61 years; one woman) were treated by laparoscopic surgery while 33 (age 23-63 years; two women) underwent laparotomy. Closure of the perforation was achieved by suturing the edges of the perforation. RESULTS: 27 patients had successful closure of perforation by laparoscopy; one had sealed perforation and did not need closure. Conversion to open surgery was necessary in 6 patients (17.8%). Median operating time was 50 minutes (range 25 to 120) and median hospital stay was 4 days (range 4 to 6) for laparoscopy. There was no postoperative leak. Corresponding figures for open surgery were 55 minutes (45 to 75) and 9 days (7 to 13). Patients in the laparoscopy group returned early to work (median 13 days, range 10 to 15 days postoperatively) as against 26 days (21 to 35) in the open surgery group (p < 0.001). CONCLUSION: Laparoscopic closure of duodenal ulcer perforation is safe and effective. It is a better method of treating duodenal ulcer perforation when the patient's condition allows pneumoperitoneum and laparoscopy.