Feasibility and safety of redo laparoscopic repair of recurrent inguinal hernia following previous endolaparoscopic repair.

BACKGROUND: Laparoscopic redo inguinal hernia (LRIH) repairs are fraught with challenges as the pre-peritoneal space is violated due to previous surgery and the presence of mesh. The purpose of this study was to present the feasibility and safety of LRIH in a series of patients with recurrent inguinal hernia following previous endolaparoscopic repair and present technical experiences and clinical outcomes in this subset of patients. PATIENTS AND METHODS: This was a retrospective study from a prospective database of 16 patients who underwent LRIH between March 2014 and December 2020. The decision to do a redo laparoscopic surgery was undertaken after a detailed discussion with the patient. The operative details, challenges faced and tips to overcome difficulties have been explained in detail. RESULTS: Out of 16 patients (mean age 49.5 years, all men), 15 underwent laparoscopic redo trans-abdominal pre-peritoneal (TAPP) mesh repair and 1 underwent laparoscopic enhanced-view totally extra-peritoneal (eTEP) mesh repair. The mean operating time was 68.5 min for unilateral, 115 min for bilateral TAPP and 90 min for eTEP. The main contributing factors for recurrences were mesh migration, insufficient size of the mesh and inadequate fixation. There was no conversion to open repair. The duration of stay was 1-2 days. There was no documented re-recurrence during the follow-up period of 2-9 years. CONCLUSION: Based on our experience, redo laparoscopic inguinal hernia mesh repair after previous endolaparoscopic repair is feasible, effective and safe in experienced hands.

Laparoscopic subcutaneous onlay mesh repair for ventral hernia: Our early experience.

Introduction: Repair of the ventral hernia is an ongoing challenge in surgery, and a number of surgical techniques have been developed ranging from direct suturing techniques to the use of various mesh types in different planes of the abdominal wall to close the defect and strengthen the musculofascial tissue. Laparoscopic subcutaneous onlay mesh (SCOM) repair is a novel procedure developed recently for ventral hernia repair. We would like to share our experience with laparoscopic SCOM repair. Patients and Methods: This is a prospective observational study of patients who have undergone ventral hernia repair at Bangalore Endoscopic Surgery Training Institute and Research Centre from June 2020 to June 2022. A total of 20 patients are included in this study. Statistical Analysis Used: The data were entered into MS Excel and analysed. Results: A total of 20 patients underwent SCOM repair with a defect size measuring up to 8 cm × 8 cm and a mean operative time of 117 min. Three patients had seroma formation and one patient had surgical site infection. No recurrence is seen after 1-year 2-month follow-up. Conclusion: SCOM repair is the newer approach to ventral hernia repair with the advantage over open onlay mesh repair in terms of less pain and better cosmesis. SCOM repair avoids intraperitoneal dissection which may lead to visceral injuries as well as subsequent intraperitoneal adhesions. The acceptance of such surgeries would depend on further long-term studies.

Persistent Müllerian duct syndrome: A surgical surprise and management during laparoscopic transabdominal pre-peritoneal repair.

Persistent Müllerian duct syndrome is an intersex disorder which occurs due to the failure of regression of Müllerian structures in genotypical and phenotypical males. It is a rare disorder of male internal pseudohermaphroditism with normal secondary sexual characters and XY karyotype. We report a male patient with the diagnosis of bilateral inguinoscrotal hernia with cryptorchidism scheduled for laparoscopic bilateral transabdominal pre-peritoneal (TAPP) mesh repair with bilateral orchidopexy. Intra-operatively, there was a rudimentary uterus with tubes on both sides. Bilateral testicular biopsy was taken to confirm the presence of testicular tissue and to exclude malignancy and ovarian tissue. Hernia surgery was deferred in the first stage. After 2 weeks, he underwent laparoscopic bilateral orchidopexy with TAPP mesh repair. At 6-year follow-up, there is no recurrence of hernia or features of malignancy in the retained testis.

Does length of common limb influence remission of diabetes? Short-term results.

BACKGROUND: Despite strict patient selection criteria, diabetes remission is not seen in all patients after gastric bypass. Can length of the common limb influence diabetes remission? AIM: To find if any correlation exists between the length of the common limb and remission of diabetes. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: Twenty-five consecutive patients with Type II diabetes mellitus and a fasting C-peptide >1 ng/ml who underwent laparoscopic Roux-en-y gastric bypass were included. All patients had standard limb lengths and length of the common limb was measured in all patients. Patients were followed up and glycated haemoglobin (HbA1c) was repeated at 6 months postoperatively. Pre- and postoperative HbA1c were then correlated with the lengths of common limb to look for any relation. STATISTICAL ANALYSIS: Descriptive and inferential statistical analysis, analysis of variance (ANOVA). RESULTS: Of the 25 patients, 15 were females and 10 were males. The mean age was 44.16 years and the mean body mass index (BMI) was 43.96 kg/m(2). Preoperative HbA1c varied from 5.8 to 12.3%. Length of the common limb varied from 210 to 790 cm (mean 470.4 cm). HbA1c at 6 months ranged from 4.8 to 7.7% (mean 5.81%). On comparison of preoperative and 6 months postoperative HbA1c and correlating with the length of common limb, we found that patients with a common limb of length <600 cm had a statistically significant improvement in HbA1c compared to those with >600 cm length (P = 0.004). CONCLUSION: A shorter common limb does appear to have better chances of resolution of Type II diabetes mellitus in our study, thus paving the way for further studies.

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"Peritonitis fibrosa incapsulata", first described in 1907, is a condition characterized by encasement of the bowel with a thick fibrous membrane. This condition was renamed as "abdominal cocoon" in 1978. It presents as small bowel obstruction clinically. 35 cases of abdominal cocoon have been reported in the literature over the last three decades. Abdominal cocoon is more common in adolescent girls from tropical countries. Various etiologies have been described, including tubercular. It is treated surgically by releasing the entrapped bowel. We report a laparoscopic experience of tubercular abdominal cocoon and review the literature.

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Superior mesentric artery syndrome is a rare cause of high small bowel obstruction, caused by compression of the transverse part of the duodenum in between the superior mesentric artery and aorta. Patients present with chronic abdominal pain, vomiting and weight loss. We report a case of superior mesenteric artery syndrome, managed laparoscopically with laparoscopic duodenojejunostomy.

Training and assessment of psychomotor skills for performing laparoscopic surgery using BEST-IRIS virtual reality training simulator.

In this article, we present the results of a pilot study that examined the performance of people training on a Virtual Reality based BEST-IRIS Laparoscopic Surgery Training Simulator. The performance of experienced surgeons was examined and compared to the performance of residents. The purpose of this study is to validate the BEST-IRIS training simulator. It appeared to be a useful training and assessment tool.