Journal of Minimal Access Surgery最新文献

Abstract: Adult gastroduodenal intussusceptions are very rare. Presentation of gastric gastrointestinal stromal tumours (GISTs) as gastroduodenal intussusception is atypical and clinically difficult to diagnose due to non-specific symptoms. We report the rare case of an elderly male who presented with clinical features of gastric outlet obstruction. Diagnostic imaging and endoscopy revealed a gastric antral GIST leading to gastroduodenal intussusception. Due to the irreducibility of the intussusception, the patient underwent laparoscopic distal gastrectomy as definitive management. Laparoscopic management in such cases is feasible with equally good oncological outcomes as compared to open surgery, with better cosmetic outcome and faster recovery.

Abstract: Hernia surgery is the most common procedure done by surgeons. The author describes the various pathways to becoming a hernia specialist, considering the strengths, weaknesses, opportunities and threats as in a business model.

Introduction: Adequate analgesia is of utmost importance for apposite in patients undergoing laparoscopic ventral hernia repair (LVHR) for smooth recovery. TAP block and port-site infiltration (PSI) are two most commonly employed methods for pain relief. Therefore, this study was done to compare laparoscopic-guided TAP block versus PSI for post-operative analgesia, hospital stay and rescue dose of analgesic in LVHR.

Patients and methods: This single-blinded randomised controlled trial was done in a tertiary hospital of Delhi from 1 April 2023, to 1 August 2024. A total of 60 patients were enrolled. Randomisation was done using computer-generated random number table, and allotment was done using sequentially numbered opaque sealed envelopes. All patients >18 years of age with anterior abdominal wall hernia undergoing LVHR were included in the study. Patients with a history of opioid usage, patients with alcohol abuse within the past 6 months, patients with hernia size >6 cm were excluded from the study. Two groups included: test group (Group A) - laparoscopic-assisted TAP block (LTAP) and control Group (Group B) - port-site local anaesthesia infiltration (PSLAI).

Results: In LVHR, the use of TAP blocks showed superior pain management compared to PSLAI (significantly lower VAS scores at 6, 12 and 24-h post-surgery in the LTAP group [P = 0.0031, 0.0037 and 0.00012, respectively]). LTAP was associated with a shorter hospital stay (P = 0.016) and less need for rescue analgesia (P = 0.031).

Conclusion: Laparoscopic transverse abdominis plane block is superior to port-site local anaesthesia infiltration in providing effective post-operative analgesia.

Introduction: Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the anatomical alterations inherent to LSG can lead to significant nutritional challenges. These modifications in gastrointestinal physiology may result in various micronutrient deficiencies, particularly affecting iron, Vitamin B12 and folate status.

Patients and methods: We conducted a prospective cohort study of 70 patients undergoing LSG at our tertiary care centre. Participants underwent comprehensive nutritional assessment at baseline and regular intervals postoperatively (6, 12 and 24 months). We measured serum levels of key micronutrients, including iron, Vitamin B12 and folate, while simultaneously tracking supplement adherence. Statistical analysis incorporated both univariate and multivariate approaches to identify patterns and risk factors for nutritional deficiencies.

Results: Our analysis revealed distinct gender-specific patterns in nutritional deficiencies. Female patients demonstrated significantly higher rates of iron deficiency throughout the study period, with prevalence rates of 58%, 50% and 36% at 6, 12 and 24 months, respectively. Vitamin B12 deficiency showed a progressive increase in both genders, while supplement adherence declined markedly from 96% at 6 months to 42% at 24 months. Multivariate analysis identified female gender, younger age and poor supplement adherence as significant risk factors for nutritional deficiencies.

Conclusion: Post-LSG nutritional deficiencies present a significant clinical challenge, particularly for female patients. Our findings emphasise the critical importance of long-term nutritional monitoring and the need for targeted supplementation and adherence-enhancing intervention strategies to improve supplement adherence.

Abstract: Lumbar hernias (LHs) are exceedingly rare, with definite management being surgery immediately upon diagnosis when the patient is medically fit. Herein, we report the case of a male patient in his mid-40s who presented with acquired left LH secondary to transabdominal percutaneous drainage of necrotic collection in a case of necrotising pancreatitis as a part of a step-up approach. He underwent robotic transabdominal preperitoneal repair using 15 cm × 12 cm polypropylene mesh. He was discharged on the second post-operative day. The patient returned to regular activity within 10 days, and at 2-month follow-up, he continued with routine daily activities. Robotic repair of the LH is feasible and safe with the advantage of having a three-dimensional high-definition vision, better ergonomics, intuitive motion, higher precision, tremor filtration and self-camera control.

Introduction: Acute appendicitis is one of the most common causes of abdominal pain in children and is considered the most frequent paediatric surgical emergency. The incidence progresses from extremely low in the neonatal period to a peak incidence between ages 12 and 18 years. Prompt diagnosis and management are imperative to prevent serious complications such as perforation, peritonitis, intra-abdominal abscess formation and bowel obstruction. Laparoscopy has improved intra- and post-operative outcomes for children with appendicitis. This study was conducted to evaluate demographics and complications of laparoscopic appendicectomy in Indian children.

Patients and methods: This is a retrospective cohort study encompassing 714 consecutive patients of appendicitis operated over 15 years (2006-2021) by a single surgeon at a high-volume private paediatric surgical centre in Western India. Data collected included age and gender, duration of surgery and post-operative variables such as length of stay and early or delayed interventions, if any. The patients were categorised into two groups: complicated appendicitis and non-complicated appendicitis, depending on the operative findings. Patients with acutely inflamed appendix without perforation, peritonitis or collection and patients with chronically inflamed appendix were categorised as non-complicated appendicitis. Patients with perforated or gangrenous appendicitis, appendicular lump and appendicitis with intraperitoneal collection were categorised as complicated appendicitis. Additional pathologies found and treated during the surgery were also documented. The statistical analysis was performed using IBM SPSS Statistics 28.0.0.0.

Results: The total cohort of patients who underwent laparoscopic appendectomy in the study was 714. The number of male patients was significantly greater than the female population (P < 0.001). The total number of cases of non-complicated appendicitis was 580 (81.23%). Patients with uncomplicated appendicitis had a mean age of 9.12 ± 3.65 years, while those with complicated appendicitis had a mean age of 7.49 ± 3.58 years. Additional pathologies such as simple ovarian cyst, Meckel's diverticulum and Enterobius vermicularis were found in 11.55% of uncomplicated cases. Post-operative complications were observed to be higher in the complicated group (27.6%) compared to the uncomplicated group (1.72%).

Conclusion: This study shows that acute appendicitis affects our study population at a mean age of 8.84 years, with a majority of males (64.14%). It also shows that complicated appendicitis has a higher incidence of post-operative complications of 27.6% and prolonged hospital stay. A multicentre research across various states in India can help establish a clear outlook regarding the demographics of complicated and uncomplicated paediatric appendicitis in the country.

Introduction: Surgeons in the operating theatre frequently need to split their attention, such as when switching between the monitor and radiological images during endoscopic surgery. This split attention can lead to cognitive overload, potentially impacting performance. Despite this, limited research has been conducted on how split attention affects surgical outcomes.

Patients and methods: This study examines the impact of split attention on surgical performance in a simulation-based training environment with two conditions: A far-condition (where information sources were spaced farther apart) and a near-condition (where sources were positioned closer together). A total of 53 participants (13 experienced surgical residents and 40 beginners) completed ten trials in each condition.

Results: The results indicated that split attention led to diminished performance in beginners but not in residents. These findings suggest that expertise plays a crucial role in managing cognitive load for surgeons.

Conclusion: The study highlights the need to develop training curricula that promote the automation of surgical skills through practice, allowing surgeons to allocate more cognitive resources effectively.

Abstract: Migration of cholecystectomy surgical clip into the common bile duct with subsequent stone formation is a rare phenomenon, one which may lead to complications including obstruction, pain, nausea, vomiting and fever. The mechanism of migration is largely unknown but may result from a combination of factors including necrosis, intra-abdominal pressure or poor surgical technique with migrated clip serving as a nidus for stone formation. We present a 55-year-old woman with clip-induced stone impacted at the distal common bile duct 12 years post-cholecystectomy and a review of the literature related to cholecystectomy clip stone formation. In addition, we reviewed relevant English language case reports and literature reviews by searching PubMed using search terms 'stone', 'clip', 'cholecystectomy' and 'biliary'. There was no limit to the date of publication. Our study found 68 unduplicated cases of clip-induced stones which had a wide range of onset and presenting systems. Further research is needed to identify risk factors, methods of prevention and benefits of early detection screening.

Abstract: Epigastric hernia with divarication of recti is uncommon in children, and the aetiology remains incompletely understood - as does the optimal management strategy - whether to repair epigastric hernia alone or both defects. We present an innovative technique utilising subcutaneous endoscopic surgery to address both epigastric hernia and divarication in children. Our approach yields excellent cosmetic outcomes, avoids the need for a larger laparotomy scar and mitigates the risks associated with the transperitoneal laparoscopic approach. It is a viable option with all the advantages of minimally invasive surgery for repairing epigastric hernia and divarication of recti in symptomatic cases, particularly when the aetiology is uncertain and multiple defects are anticipated. Its use may be extrapolated to isolated diastasis recti as working in subcutaneous space involves lesser risk with excellent cosmesis.

Abstract: This report describes the rare case of transverse testicular ectopia (TTE) associated with polyorchidism in a 16-month-old male, successfully managed through laparoscopic surgery. The patient presented with bilateral cryptorchidism, a palpable mass in the right inguinal canal and an absent left-side gonad. Ultrasound revealed three gonad-like structures. Laparoscopy identified duplicated and fused testes at the right deep inguinal ring, and a third testis in the right inguinal canal. Minimally invasive techniques positioned the duplicated testes in the right hemiscrotum and the single testis in the left hemiscrotum. Post-operative follow-up confirmed optimal scrotal positioning, with normal growth. This rare case underscores the efficacy of laparoscopy in diagnosing and managing rare paediatric conditions, providing valuable insights for surgeons facing cryptorchidism or scrotal masses.