Journal of Minimal Access Surgery最新文献

Abstract: Broad ligament hernias (BLHs) are rare internal hernias that can lead to serious complications if left untreated. In this case report, we present the case of a BLH in a female patient and discuss its clinical presentation, diagnosis and management. A 40-year-old woman presented with subacute intestinal obstruction symptoms, including the inability to pass flatus and faeces and recurrent bilious vomiting. A computed tomography (CT) scan confirmed small-bowel obstruction adjacent to the uterus within the left broad ligament. Diagnostic laparoscopy revealed a loop of obstructed small intestine within the broad ligament, which was released and found to be healthy. The defect between the broad and infundibulopelvic ligaments was closed with sutures. The patient had an uneventful recovery and was asymptomatic at a 6-month follow-up. BLHs can be congenital or acquired, with acquired defects often resulting from previous surgeries or pregnancy-related causes. The clinical presentation typically involves the symptoms of bowel obstruction, and a CT scan is the diagnostic modality of choice, showing characteristic findings such as closed-loop obstruction and bowel dilation. Laparoscopic management offers the advantages of faster recovery and less morbidity. Closure of the defect using nonabsorbable sutures is the standard surgical approach, although a wide opening of the defect has also been described. Recurrence is a possibility, particularly if absorbable sutures are used for closure. This case report highlights the importance of early diagnosis and intervention in BLHs to prevent the complications and emphasises the role of laparoscopy in their management.

Introduction: To assess the feasibility and safety of placing a small-sized tube as drainage in patients after uniportal thoracoscopic lung resection.

Patients and methods: Patients who received uniportal video-assisted thoracoscopic surgery (U-VATS) lung resection were identified in our database. Patients placed small-sized tube drainage were compared with those placed conventional chest tube in terms of characteristics, operation modality, post-operative pulmonary complications, post-operative pain, chest tube duration and post-operative hospital stay. Propensity score matching was performed.

Results: Of the 217 enrolled patients, 173 were assigned to the conventional tube group and 44 were assigned to the small-sized tube group. Rates of post-operative pulmonary complications were relatively low and similar between the two groups. After propensity score matching, operation duration was shorter (1 h vs. 1.21 h, P = 0.01) was shorter, and the maximum value of the Visual Analogue Scale (VAS) score after operation (1 vs. 1.5, P = 0.02) and the overall average value of VAS score after operation (0.33 vs. 0.88, P = 0.006) was lower in small-sized tube group. No significant difference was observed in chest tube duration (2 vs. 2, P = 0.34) and post-operative hospital stay (3 vs. 3, P = 0.34).

Conclusions: Compared to conventional chest tubes, small-sized tubes for post-operative drainage after U-VATS lung resection may be a safe and promising approach for reducing post-operative pain.

Introduction: The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities. However, the procedure requires overcoming a learning curve, and with increased adoption, new complications have emerged. One significant complication is the rupture of the posterior rectus sheath (PRS). In this article, we present our modifications of the technique to reduce tension during PRS closure.

Patients and methods: The study included 105 patients who underwent endolaparoscopic extraperitoneal repairs for ventral hernias using two different techniques. Group A ( n = 68) underwent the original technique, whereas Group B ( n = 37) underwent the modified technique. The modifications in Group B included preserving the peritoneal bridge between the two PRS and the hernia sac, conducting a complete dissection of the space of Bogros and adopting a transverse or oblique closure of PRS along the lines of least tension. To assess the efficacy of these modifications in preventing PRS rupture, we compared the results of both groups.

Results: Our findings indicate that following all the technical steps of the modified technique resulted in a reduced need for transversus abdominis release for PRS closure and a lower incidence of PRS rupture in the postoperative period. However, to further validate the effectiveness of these modifications, a larger follow-up period and a bigger sample size are required.

Conclusions: The adoption of the modified technique can help achieve a tension-free PRS closure.

Abstract: Peritoneal encapsulation (PE) is a rare congenital disorder described as an accessory peritoneal lining covering a part or whole of the small bowel. Some theorise the encapsulation is due to the formation of adhesion between the physiological hernia and the caudal duodenum. While others have stated it is a defect in the reduction of the physiological hernia. Patients usually present at different stages of intestinal obstruction at any point of time during life. There are also reports on post-humous diagnosis on autopsy. PE is a rare surgical entity, hence not much evidences are available on how to tackle this condition by minimally invasive approach. Here, we report a case of PE in a 43-year-old male who presented with features of intermittent sub-acute intestinal obstruction and was managed by laparoscopic surgery at our institute.

Introduction: Petersen's hernia is a rare and serious complication that can occur after radical gastrectomy and digestive tract reconstruction for gastric cancer. This article summarises the symptoms, diagnosis and treatment of Petersen's hernia after surgery for gastric cancer.

Patients and methods: A retrospective analysis was conducted on 11 male patients who were diagnosed with Petersen's hernia and underwent surgical treatment at our hospital from January 2020 to December 2022. Their clinical manifestations, perioperative conditions and follow-up after treatment were collected.

Results: The median age was 58.5 years (range: 45-73), and the median time since gastrectomy was 24 months (range: 4-125). Open distal gastrectomy (45.5%) and open total gastrectomy (27.3%) were the most common procedures. Roux-en-Y (81.8%) was the predominant anastomosis method. All patients underwent emergency surgery within a median time of 30 h (range: 4-45). Intestine necrosis occurred in 36.4% of cases, with a perioperative death rate of 27.3%.

Conclusion: Petersen's hernia after gastric cancer surgery can quickly lead to necrotising intestinal obstruction and poor prognosis. Enhanced abdominal computed tomography should be performed as soon as possible, and early exploratory laparotomy should be done to avoid intestinal necrosis. Routine closure of the mesenteric defect after gastric cancer resection can prevent the occurrence of Petersen's hernia. This article highlights the need for increased awareness and preventive measures to minimise the occurrence of Petersen's hernia in gastric cancer patients. It emphasises the importance of early detection and appropriate management strategies for improved patient outcomes.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) facilitates the removal of common bile duct (CBD) calculi by endoscopy. When ERCP fails, exploration of CBD is required for the clearance of CBD calculi. The optimum way for the exploration of CBD is by choledochoscopy. Dedicated flexible or rigid choledochoscopes are expensive and available only in few places in India. Since 1991, we subjected patients with suspected CBD calculi to ERCP, followed by laparoscopic cholecystectomy (LC). Patients in whom ERCP failed to clear CBD were subjected to open exploration of CBD using any easily available, suitable, straight rigid scope for choledochoscopy.

Patients and methods: Since March 1991, out of 8866 patients with cholelithiasis, 862 underwent ERCP. Ninety-six patients in whom ERCP failed to clear CBD underwent open exploration of CBD. In each case of exploration of CBD, choledochoscopy was performed using a straight rigid scope, either a cystoscope, paediatric cystoscope, hysteroscope or 5-mm laparoscopy telescope with a 5-mm cannula.

Results: The CBD clearance was complete in 95 patients, and one patient had an impacted calculus at the ampulla. CBD explorations were followed by choledochoduodenostomy, T-tube placement or suturing of choledochotomy. No residual calculi were observed after such exploration.

Conclusion: From our results, we advocate the following algorithm for CBD calculi in resource-limited settings. Subject patients with CBD calculi to ERCP followed by LC. In case of failed ERCP, open exploration of CBD with choledochoscopy using any suitable rigid scope. Dedicated flexible or rigid choledochoscope is not essential. This approach is cost-effective and successful.

Abstract: The limited data on post-operative analgesia management after laparoscopic cholecystectomy in the paediatric population make it difficult for clinicians to manage pain in this group. Administration of a modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) has recently been identified as a technique providing effective analgesia on the anterior and lateral thoracoabdominal wall. Unlike thoracoabdominal nerve block through the perichondrial approach block, the local anaesthetic (LA) with M-TAPA block provides effective post-operative analgesia in abdominal surgery by affecting T5-T12 dermatomes, just like when applied to the lower part of the perichondrium. As far as we know, all patients in previous case reports were adults, and we did not come across any study on the effectiveness of M-TAPA in paediatric patients. We present our case who did not need any additional analgesic during the post-operative 24 h after an M-TAPA block was administered before paediatric laparoscopic cholecystectomy.

Abstract: Morbid obesity in infancy or early childhood is a challenging disease to manage. Here, we present the case report of the successful management of a 2-year-old girl child with morbidly obesity who was bedridden and had sleep apnoea and underwent laparoscopic sleeve gastrectomy. Bariatric surgery in this age group comes with a lot of decision-making challenges and technical and ethical considerations, and literature is scant on paediatric bariatric surgery. We describe the case and associated challenges in detail in this report.

Abstract: Endoscopic tattooing with India ink is a common practice before the laparoscopic resection of polyps/tumours. Sometimes, due to inadvertent intramuscular instead of submucosal injection, it may lead to peritoneal spillage precluding the laparoscopic approach and warrant open resection. There are a few reports of post-operative abdominal sepsis. We report a case where spillage led to open conversion due to poor visibility and post-operative abdominal sepsis necessitating a change of antibiotics and prolonged hospital stay. Surgeons should be aware of these complications from this apparently innocuous step. We also did a review of the literature to see how this can be prevented and what alternative approaches have been developed.