Laparoscopic repair of right sided bochdalek hernia - a case report.

Right-sided Bochdalek hernia in adults is a very rare clinical entity. A case of a 50-year-old female patient is reported, who presented with long history of intermittent breathlessness and right-sided thoracoabdominal pain. The hernia was managed laparoscopically. Contents were colon, omentum, and right kidney. It was successfully repaired using a polypropylene mesh.

Omental gangrene and porto-mesenteric thrombosis in a patient of protein C and protein s deficiency.

Omental gangrene is an infrequent cause of acute abdomen with unclear etiology. Hypercoagualable states like protein C or protein S deficiency have never been implicated in the etiology of omental gangrene. We present this case report of a patient having protein C and protein S deficiency presenting with omental gangrene and extensive porto mesenteric thrombosis.

Herbal enema: At the cost of colon.

Various colonic side-effects of herbal enema have been reported in literature ranging from mild abdominal discomfort to self-limiting haemorrhagic colitis. It rarely requires blood transfusion or subtotal colectomy. We report a 57-year-old male patient developing severe ileo-colitis with persistent massive rectal bleeding immediately after herbal enema administration for the treatment of chronic constipation and was resistant to conservative management. Patient was managed successfully with emergency total laparoscopic colectomy. Post-operative recovery of the patient was excellent.

An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become very popular nowadays among bariatric surgeons because of its surgical simplicity and good postoperative results. We present our experience on LSG as a single stage primary bariatric procedure for morbid obesity and its 1-3-year follow-up results. METHODS: Between March 2008 and March 2011, a total of 110 patients underwent laparoscopic sleeve gastrectomy. Two patients were excluded from the study and thus the prospectively maintained data of 108 patients were retrospectively reviewed and outcomes were recorded. RESULTS: The mean patient age was 39.3 ± 11.1 years, mean body mass index was 44.5 ± 6.8, mean excess body weight was 54.1 ± 16.3 kg, and the mean American Society of Anesthesiologists score was 3.1 ± 0.57. The mean operative time for the LSG procedure was 64.8 ± 10.6 min. The minimum follow-up duration was 6 months and maximum of 36 months. The mean postoperative percent excess body weight loss achieved was 67.5 ± 13.0 at 1 year, 71.1 ± 13.8 at 2 years, and 66.09 ± 14.3 at 3 years. At the end of 3 years, there was 83.3% resolution in diabetes, 85.7% resolution in hypertension, and 85.71% resolution in dyslipidemia. There were no reports of postoperative hemorrhage, gastric leak, deep venous thrombosis, pulmonary embolism, delayed gastric tube stricture, and operative mortality. CONCLUSIONS: LSG is a safe and effective bariatric procedure with low perioperative complications. Before it is considered as a single stage primary procedure, a long-term prospective comparative study with other bariatric procedures is required.

Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair.

BACKGROUND: Laparoscopic ventral hernia repair is evolving rapidly worldwide to become a standard procedure. The purpose of this study was to compare the benefits, effectiveness, and postoperative outcome of laparoscopic transabdominal preperitoneal (TAPP) and intraperitoneal onlay mesh (IPOM) repair of ventral hernia. PATIENTS AND METHODS: Prospectively collected data of 279 patients who underwent laparoscopic ventral hernia repair between January 2005 and December 2009, of whom 68 underwent TAPP and 211 underwent IPOM repair, were retrospectively reviewed. For each patient demographic, preoperative and postoperative data were studied. Statistical analysis was performed by Student's t-test, Fisher exact test, and chi-square test. RESULTS: The study included a total of 279 patients, of whom 68 underwent TAPP procedure and 211 underwent IPOM procedure. Both the groups were comparable in age, sex, body mass index, American Society of Anesthesiologists score, mean fascial defect size, and mean size of mesh. Although the operating time was longer in TAPP group than IPOM group of patients, the overall cost of surgery in IPOM group ($752.3±355.7) was much higher than TAPP group ($903.6±28.0) of patients. Seroma formation was more common in IPOM group than TAPP group (8.5% versus 5.8%). There were 2 (2.9%) recurrences in TAPP group and 7 (3.3%) in IPOM group of patients. Mean postoperative hospital stay (1.5±0.6 versus 1.4±0.7 days, P=.35) and mean follow-up (22.7±13.4 versus 22.5±11.9 months, P=.90) were similar in both groups of patients. CONCLUSION: Besides the cost-effectiveness of TAPP procedure, it reduces the risk of complication related to intra-abdominal position of mesh and fixating devices. Before we label the TAPP repair of ventral hernia as the first choice, a comparative multicentric prospective trial with IPOM repair is warranted.

Sliding inguinal hernias: scope of laparoscopic repair.

BACKGROUND: Sliding hernias are an uncommon type of inguinal hernia. Very little is published in the literature regarding the outcome of laparoscopic repair of sliding hernia. The present series evaluates the feasibility and outcome of laparoscopic repair of these hernias. METHODS: Retrospective analysis of prospectively maintained data of patients with sliding inguinal hernia undergoing laparoscopic repair from January 2003 to July 2010 was done. The patient demographics, clinical presentations, operative details, and complications were studied. Related literature was reviewed. RESULTS: A total of 1136 patients underwent laparoscopic repair of inguinal hernia, of which 54 patients had sliding inguinal hernia (4.7%). Forty-one patients (76%) had left-sided hernia and 13 patients (24%) had right-sided hernias. Mean age of presentation was 63.5 years. Thirty-five patients (64.8%) presented as complicated hernias (27 irreducible, 7 obstructed, and 1 strangulated). Thirty-nine patients had sigmoid colon, 9 patients had cecum, 3 patients had ascending colon, and 3 patients had urinary bladder as the sliding component. Eight patients underwent Lichtenstein repair, 27 patients transabdominal preperitoneal repair, and 19 patients total extraperitoneal repair. Mean operating time of laparoscopic repair was 53 minutes (40-105 minutes). Five procedures (10.8%) were converted to open repair. Overall morbidity was 44.4%. Median hospital stay was 1.5 days (1-14 days). There were no recurrences in up to 7 years follow-up. CONCLUSION: Laparoscopic repair of sliding inguinal hernia is feasible and safe with good outcome. Laparoscopic transabdominal preperitoneal approach is the preferable method.

Laparoscopic transabdominal preperitoneal repair of ventral hernia: a step towards physiological repair.

The laparoscopic ventral hernia repair with preperitoneal placement of mesh minimizes the complications related to the intraperitoneal position of mesh and fixating devices. It allows safe use of conventional and less expensive polypropylene mesh. The prospectively collected data of 68 patients who underwent laparoscopic transabdominal preperitoneal mesh hernioplasty, for different types of ventral hernias between January 2005 and December 2009 was retrospectively reviewed. The study included 68 patients, 16 males and 52 females with a mean age 51.1 ± 11.1 years (range 23-74 years). Most of the hernias (67.6%) were in the midline position. The mean size of the defect was 30.8 ± 24.4 cm2 (range, 4-144 cm2) and the mean mesh size was 237.8 ± 66.8 cm2 (range, 144-484 cm2). The mean operating time was 96.7 ± 16.7 min (range 70-150 min). All repairs were done with polypropylene mesh. The mean postoperative hospital stay was 1.5 ± 0.6 days (range, 1-4 days). Nineteen patients (27.9%) suffered from postoperative complications. Four patients (5.8%) were detected to have seroma formation. There were two recurrences (2.9%). The mean follow up was 22.7 ± 13.4 months (range, 6-48 months). The laparoscopic preperitoneal ventral hernia repair with polypropylene mesh is cheaper and has acceptable postoperative outcomes. Peritoneal coverage of the mesh not only acts as a barrier between mesh and bowel and thereby prevents adhesions, it also provides an additional security of fixation. This is a safe and feasible option of ventral hernia repair in expert hands. However, for proper validation of these conclusions a long term prospective clinical trial is required.

Bilateral arytenoidectomy with lateralisation of vocal folds: review of two cases.

We present a review of two cases of bilateral abductor palsy of vocal cords with cords in paramedian position. The aetiology was not clear. As definitive treatment, arytenoidectomy and vocal cord lateralization on both sides were done by external laryngofissure approach. Objective of this review is to emphasize upon the fact that external procedures under direct vision has still a role to play in the era of endoscopic maneuvers. It can be performed successfully even at centers having limited gadgets. The two procedures of arytenoidectomy and vocal cord lateralization were combined to achieve higher success rate irrespective of fixity of cords. Result seems to be at par with other newer surgical modalities.