Mini Laparotomy Research Articles

Cеsarean section scar endometrosis

Endometriosis is defined as a functional endometrial tissue outside the uterine cavity. The ectopic endometrial tissue has been identified after gynecologic laparoscopy or laparotomy procedures in the skin, subcutaneous tissues, abdominal and pelvic wall musculature, and it represents amayor cause of acute or chronic recurrent abdominal or pelvic pain resembling the menstrual cycle. The frequency of abdominal wall endometriosis is approximately 1% of all women who had a cesarean delivery. A 39-year-old patient with a history of one prior Cesarean section, presented with continuous cyclical focal pain at the left part of cesarean scar site for the past 16 months, 23 months after Cesarean section. The patient underwent a mini laparotomy, when endometrioma was completely removed surgically. The PH diagnosis of endometriosis was based on the presence of all elements of the endometrial mucosa (glands, stroma and signs of fresh and old hemorrhage) in an inadequate place (anterior abdominal wall). Endometriosis is difficult to diagnose and it is often mistaken for other conditions such as a suture granuloma, incisional hernia, primary or metastatic cancer. Endometriosis can be prevented only with good surgical techniques and clinical practice as well as the proper care during primary surgery.

Continuous Ambulatory Peritoneal Dialysis Catheter Insertion Technique: A Comparative Study of Percutaneous versus Surgical Insertion.

Continuous ambulatory peritoneal dialysis (CAPD) is a standard renal replacement therapy, but there is a lack of consensus for catheter insertion method and type of catheter used. We retrospectively analyzed 140 peritoneal dialysis catheters (PDC) inserted in 139 CAPD patients by two methods; percutaneous (Group “P,” n = 47) and surgical mini laparotomy (Group “S,” n = 93) technique over a 39-month period, with cumulative experience of 2415 catheter-months: 745 catheter-months for Group “P” and 1670 catheter-months for Group “S.” Break-in period was shorter in Group “P” (P = 0.002) whereas primary nonfunction rate was comparable (P = 0.9). The mean catheter survival was better in Group “S” (17.95 ± 10.96 months vs. 15.85 ± 9.41 months in “P” group, P = 0.05) whereas the death-censored and overall catheter survival was comparable in both groups. PDC removal due to refractory peritonitis was also comparable. Mechanical complications were more in “P” group (P = 0.049), leading to higher catheter removal (P = 0.033). The peritonitis rates were higher in “P” group (1 episode per 24.8 catheter-months vs. 1 episode per 34.8 catheter-months in “S” group, P = 0.026) and related to a higher number of rural patients in the group (P = 0.04). Patient survival was comparable. There was no effect on episodes of peritonitis in those CAPD patients who had diabetic etiology or prior hemodialysis catheter-related sepsis, age, and PDC insertion method.

An evaluation of mini-laparotomy cholecystectomy in the laparoscopic era: a rural experience

Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic cholelithiasis and complications of gallstone disease. Mini laparotomy cholecystectomy (MOC) may be a more appropriate option in the resource constrained rural setting due to its widespread applicability and comparable outcome with LC. The study aimed to provide an epidemiological analysis of gallstone disease in the rural population and to evaluate the outcome of MOC in a rural hospital. A retrospective chart analysis of 248 patients undergoing cholecystectomy in a rural regional referral hospital in KwaZulu-Natal from January 2009 to December 2013 was undertaken. Of the 248 patients, the majority were females (n = 211, [85%]). The most frequent indications for cholecystectomy included: biliary colic (n = 115, [46.3%]); acute cholecystitis (n = 80, [32.3%]); gallstone pancreatitis (n = 27, [10.8%]). Forty cases (16.1%) were converted to open cholecystectomy (OC). The median operative time was 40 minutes (range18-57). Twenty-three morbidities (9.3%) occurred including: bile leaks (n = 6, [2.4%]); bleeding from drain site (n = 1, [0.4%]), incisional hernia (n = 8 [3.2%]) and wound sepsis (n = 8 [3.2%]). The median length of hospital stay in patients who underwent MOC was 48 hours (range: 24-72 hours) and the median time to return to work was 10 days (range: 4-14 days). There was one mortality in the entire cohort. MOC is a safe and feasible operation for symptomatic cholelithiasis when cholecystectomy is indicated. The low operative morbidity and mortality in the context of a high risk patient profile and complicated gallstone disease makes this procedure an alternative to LC where LC is inaccessible.

A comparative study of laparoscopic versus mini laparotomy cholecystectomy

Background: Gallstones are common in Indian population and its treatment has shown a decisive shift from open to minimally invasive route. There is no doubt that laparoscopy require longer and steeper learning curve and higher cost, especially in the absence of health insurance to majority of suburban and rural Indian population. However, preferences of patients are changing rapidly due to better level of awareness and availability of healthcare facility. Aims was to study safety and efficacy of laparoscopic cholecystectomy in patients of cholelithiasis by comparing withresults of mini laparotomy cholecystectomy by comparing use of post-operative analgesia, operative Time, post-operative hospital stay, morbidity and mortality.Methods: It is a prospective randomized study of 100 Patients of cholelithiasis aged between 25 years to 65 years operated during 2016-2017 at Dr. D Y Patil medical college Pune. They were divided into mini laparotomy and laparoscopic cholecystectomy group by draw a lot method. Patient’s written valid informed consent for the particular procedure was taken and the pros and cons of both the procedure were explained in detail to the patient. This study was done after due clearance of ethical committee.Results: The median (range) operation time for laparoscopic cholecystectomy was 50-175 min (mean=103.98 min) and 35-95 min (mean=70 min) for mini laparotomy cholecystectomy (p<0.001). During the study period operation time for laparoscopic cholecystectomy showed a tendency to become shorter. The use of Injectable analgesics in case of laparoscopic cholecystectomy (Mean no. of days=1.5) is considerably less than mini laparotomy cholecystectomy (Mean no. of days=3.36). Conversion rate in literature in laparoscopic cholecystectomy ranges from 3% to 15% in well trained hands. In our series it is 6% in spite of being a teaching and training institution.Conclusions: Minimally invasive surgery is better than mini laparotomy cholecystectomy in terms of post-operative pain, analgesic requirement and early return to work. However, mini laparotomy cholecystectomy is preferred method for Surgeons in the beginning of their career and in case of difficult cholecystectomy.

An original and effective technique to improve exposure in open surgery

BackgroundExposure, especially when the organs are enlarged, remains one of the most important issue in open surgery. Considering this constraint appears critical in the progress of the surgical procedure. We highlight our technique which affords optimal exposure and improves manipulation and extraction of enlarged organs.ResultsThis original and effective technique is derived from an obstetrical device used to perform an assisted vaginal delivery. It improves exposure, reduces tissue manipulation, and enhances removal of the surgical specimen during hysterectomies and myomectomies. It can be similarly helpful sometimes to grasp and remove (by mini laparotomy) enlarged adnexa during laparoscopic procedures. Moreover, this trick appears particularly suited in case of obese patients.ConclusionThis new technique procures a real benefit for both the patient and the surgeon in terms of ergonomics and safety.

Minilaparotomy Versus Laparoscopic Myomectomy After Cessation of Power Morcellation: Rate of Wound Complications

Study ObjectiveAfter the US Food and Drug Administration statement warning against electronic morcellation devices, gynecologic surgeons are performing laparoscopic and robotic myomectomies with minilaparotomy incisions for tissue morcellation and removal. No data exist that focus on the superficial wound complications as a result of these larger incisions. The objective of this study is to compare the rate of wound complications for myomectomy via minilaparotomy versus laparoscopic or robotic myomectomy. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingKaiser Permanente Northern California, a large integrated healthcare delivery system. PatientsWomen > 18 years of age who underwent a myomectomy from either complete laparoscopic or robotic approach (LR) were compared with minilaparotomy myomectomy (MM), comprising complete minilaparotomy (ML) and laparoscopic or robotic assisted by a minilaparotomy for morcellation purposes only (LRM) from January 2011 through December 2014. InterventionMyomectomy via LR, complete ML, and LRM. Measurements and Main ResultsMedical records were reviewed for outcomes of interest, including superficial wound complications and surgical and demographic data. After exclusion criteria were met, 405 cases were included in the study; 270 cases were classified as MM, which included ML (n = 224), or LRM (n = 46). One hundred thirty-five cases were classified as LR. Parametric and nonparametric analyses were used to compare the 2 groups. There was no significant difference between the groups insofar as patient morbidity, including the primary outcome of wound complications and other postoperative complications; emergency visits; or readmissions. There were 2 (1.5%) wound complications in the LR group and 7 (2.6%) in the MM group (p = .72). Similarly, there were no significant differences in the subcategories of wound complications, including cellulitis, seroma, hematoma, skin separation, wound infection, or postprocedure wound complication. The distribution of estimated blood loss was significantly different between LR and MM groups with an interquartile range of 50 to 150 mL in the LR group versus 50 to 300 mL in the MM group (p < .01). The MM group experienced a shorter procedure time with a median procedure time of 125 minutes compared with 169.5 minutes in LR surgeries (p < .01). The LR group demonstrated a significantly shorter median length of hospital stay (LR 5.0 hours vs MM 23 hours; p < .01). ConclusionCompared with MM, LR is associated with a shorter length of hospital stay and longer operating time but no reduction in wound complication or other patient morbidity.

Comparison of Morcellation Techniques at the Time of Laparoscopic Hysterectomy and Myomectomy

Study ObjectiveTo compare perioperative outcomes associated with the use of 3 techniques for tissue removal at the time of laparoscopic hysterectomy and myomectomy. DesignA retrospective cohort study (Canadian Task Force classification II-2). SettingAn academic hospital in Boston, MA. PatientsWomen who underwent a laparoscopic or robot-assisted laparoscopic hysterectomy or myomectomy involving tissue morcellation in 2014. InterventionsOne of 3 morcellation techniques: electronic power morcellation (PM), manual vaginal morcellation via the vagina (VM), or manual morcellation via minilaparotomy (ML). Measurements and Main ResultsOf the 297 cases included in this study (137 myomectomies, 62 total laparoscopic hysterectomies, and 98 laparoscopic supracervical hysterectomies), 96% of the cases were performed by fellowship-trained surgeons using conventional laparoscopy. Containment bags were used at the time of tissue extraction in 77% of the cases. Baseline characteristics and perioperative outcomes were similar in all groups. In hysterectomy cases, the average specimen size was largest in the ML group (591 ± 419 g in the ML group compared with 368 ± 293 g in the PM group and 449 ± 175 g in the VM group, p = .0009). After multivariate regression, no significant difference was found in blood loss, length of stay, or complications. The operative time was shorter in the PM group compared with the ML group by 16 minutes (mean = 140 minutes [95% confidence interval, 130–149 minutes] compared with 156 [95% confidence interval, 146–167], p = .02); this association remained significant once additionally adjusting for the use or nonuse of containment bags (p = .05). ConclusionWe did not detect a significant difference between the 3 morcellation techniques when comparing the perioperative complications although the longest operative times were noted for the minilaparotomy approach. All 3 morcellation techniques represent viable options for tissue extraction at the time of minimally invasive surgery.

Comparative study on Post-Operative complication between mini laparotomy cholecystectomy and standard conventional open cholecystectomy operated patient

Comparative study on Post-Operative complication between mini laparotomy cholecystectomy and standard conventional open cholecystectomy operated patient

Mini Cholecystectomy: a comparison with Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique.

Retrieval of the gastric specimen following laparoscopic sleeve gastrectomy. Experience on 275 cases

Severe obesity leads to a high incidence of complications and a decrease in life expectancy, especially among younger adults. Laparoscopic sleeve gastrectomy (LSG) first intended as the first step of biliopancreatic diversion with duodenal switch is gaining a per-se procedure role because of its effectiveness on weight loss and comorbidity resolution. Different techniques have been described for specimen extraction in LSG. In this article we report the technique adopted in 275 LSGs performed in our department.In the first 120 LSGs performed from 2007, the specimen was extracted through a mini laparotomy. In the following 155 cases the technique has been simplified: the grasped specimen has been withdrawn through the 15 mm trocar site.We registered in the fist group six cases of wound infection (5%), ten cases of hematoma (8.3%) and four cases of port site hernia (3.3%). In the second group only one case of hematoma (0.6%, p = 0.01) but no cases of wound infection (p = 0.01) or port site hernia, (p = 0.03) although we registered a specimen perforation during retrieval in 16 patients, were reported.The technique described in the 155 cases of the control group has shown to be more effective than the technique we used in the case group, allowing significantly lower operative time (112.9 ± 1.0 vs 74.9 ± 9.1 p < 0.001) and complications, and providing unchanged costs.

RISK FACTORS OF CARDIAL COMPLICATIONS OF THE EARLY POSTOPERATION PERIOD IN PATIENTS WITH ABDOMINAL AORTA ANEURYSM

Aim. To find out the risk factors for cardial complications of the early postoperation period (EPP) in patients operated for non-complicated abdominal aorta aneurysm (AAA) of atherosclerosis origin. Material and methods. Totally 95 patients studied, of those 88 (88,4%) males, mean age — 67,6±7,1 y. with non-complicated ААА of the atherosclerotic origin. All patients had cardiovascular comorbidities. At baseline all patients were selected into two groups: 1 group — 52 patients 46 (88,5%) men, mean age — 66,8±7,9 y., taking drugs with negative chronotropic effect (beta-blockers, non-dihydropyridine calcium channel antagonists); 2 group — 43 patients, 38 (88,4%) men, mean age 68,5±6,1 y., not taking these drugs. In the each of the groups were two subgroups according the operation approach: minilaparotomy (MLT) or median laparotomy (LT). As an endpoint, we used myocardial infarction (MI), acute heart failure (ACF), cardiac rhythm and conduction disorders. Patients with MI, ACF and cardiovascular mortality were regarded as combined endpoint. Patients with transient myocardium ischemia, without significant increase of the level of cardiospecific enzymes, were regarded as intermediate point of the study. Results. Of 95 operated patients with EPP in 17 (18%) there was endpoint and in 30 (31,6%) — intermediate point. By the stepped discriminate analysis we set the risk factors for endpoint and intermediate point: left ventricle myocardium remodelling (LV), angina pectoris of III functional class, arterial hypertension of the 3 grade with target organs involvement (LV hypertrophy), heart rate ≥84 bpm in postoperation period. Conclusion. In patients with non-complicated AAA of atherosclerotic origin the assessment of baseline cardial status, postoperation period pharmacotherapy, LV remodelling parameters (by EchoCG) and the use of MLT leads to the decrease of the risk of cardial complications of EPP.

Adnexal Mass Requiring Surgical Intervention in Adolescent Girls

Adolescence starts with the beginning of physiologically normal puberty, and ends when an adult identity and behavior are admitted. This period of development corresponds roughly to the period between the ages of 10 and 19 years, which is compatible the World Health Organization’s definition of adolescence. Most of the adnexal masses during this period are functional ovarian cysts and benign neoplasms, and conservative surgery is suggested in the case of a cystic mass smaller than 8 cm. In all adolescents with adnexal masses, the preoperative evaluation should include a comprehensive medical record, physical examination, and imaging methods such as ultrasonography and laboratory examinations. The aim of this study was to evaluate preoperative findings, surgical procedure and histopathologic findings of the adolescent patients who had surgery for adnexal mass in our clinic. Totally 41 patients were included into study. Age, menstrual history, complaints during admission, images of the masses that were detected with different modalities, laboratory findings, applied surgical procedure and pathology findings were recorded. Among the symptoms that lead patients to admit hospital, abdominal pain was the first that was in 23 patients (56.1%). As we evaluate type of operation, 12 patients (29.3%) had laparoscopy, 29 patients (70.7%) had exploratory laparotomy operation. Mini laparotomy was the most often used incision type in 17 patients (41.5%). 34 patients (82.9%) had only cystectomy as an organ preserving surgery and most common histopathologic diagnosis was functional cyst in 14 patients (34.1%). In conclusion; since most pelvic masses in the adolescent period have benign character, surgery in this period should be minimally invasive and organ preserving for future fertility concerns and avoid from premature menopause.

Mo1584 Why Is Your Patient With Crohn's Disease Still Smoking? Impact of Smoking on Surgical Outcomes

S A T A b st ra ct s the rectum in the low pelvis (n=1) and associated hiatal hernia with transverse colon being prolapsed (n=1). In 5 patients, a mini laparotomy was needed for fistula management: one patient tolerated the pneumoperitoneum poorly, in 3 patients the fistula was difficult to dissect laparoscopically and in one patient a large phlegmon was present. The conversion rate was 9 % (3/35) for the bladder fistulas and 0% for the vaginal fistulas, there were no major intraoperative complication, no postoperative anastomotic leaks or bleeding and no mortality. There were 9 minor complications (21%), including postoperative ileus (n=4), wound infection (n=1), urinary tract infection (n=3) and deep venous thrombosis (n=1). Conclusion: Laparoscopic surgery of sigmoid diverticulitis complicated by entero-vesical and -vaginal fistula is feasible and safe; this approach offers short hospitalization like in uncomplicated cases and favorable short term outcome

English

BACKGROUND: Ovarian torsion presents as acute abdominal pain and early surgical management is required to prevent further adnexal damage. It accounts for 3% of all cases of acute abdominal pain in adult women. As signs and symptoms can mimic other acute abdominal conditions, the preoperative diagnosis often remains a challenge for primary care physicians. AIMS AND OBJECTIVES: To study the characteristics of adnexal torsion and factors influencing adnexal preservation. MATERIAL AND METHODS: All 14 patients were admitted in a tertiary endoscopic surgical unit with the complaints of pain in abdomen, nausea and vomiting of varying duration. The minimum duration of symptoms was 3 days and a maximum of 1 year. All patients were evaluated by ultrasound examination preoperatively. The time interval between the onset of symptoms and definitive surgery varied from 3 days to one year. Laparoscopic approach was offered to all patients except one where the patient was antenatal at 10 weeks of gestation. RESULTS: Out of 14 patients the youngest patient was a neonate 28 days old and oldest was 68 years of age. Most patients (n=9) were between 10 to 30 years of age. Intra operatively complete torsion (torsion of both ovary and fallopian tube) was found in 9 cases, 3 were torsion of hydrosalpinx and one case was torsion of a paraovarian cyst. One case was torsion of the adnexa in antenatal period. Adnexal congestion and edema was the most common finding (n=6) simulating hemorrhagic cyst. One patient the oldest in series age 68 years had torsion of an ovarian mass which was histologically confirmed as mucinous cystadenoma. Two patients had ovarian dermoid where ovary was salvaged in one by doing cystectomy and in the other a salpingoophorectomy was performed. In one patient it was torsion of parovarian cyst where cyst wall excision was performed. In antenatal at 11 weeks gestation a mini laparotomy was performed under epidural analgesia and detorsion was performed. In all 4 patients who had hydrosalpinx (n=3) and parovarian cyst (n=1), a salpingectomy and cyst excision was performed respectively. In rest with complete torsion (n=9, excluding fetal adnexal torsion) ovarian preservation was possible in 4 patients (44.45%) and 5 patients (55.55%) required oophorectomy. CONCLUSION: Adnexal torsion affects all ages of women and ovarian preservation is possible, if detorsion is possible. Delay in diagnosis prevents ovarian preservation. Though limited by small sample size it indicated that ovarian debulking may not be needed and detorsion relieves the venous congestion and edema. Laparoscopic approach remains the gold standard for the management of adnexal torsion and enables quick recovery.

Superior Mesenteric Vein Thrombosis as a complication following Jejunal lymphoma resection: A Case Report

We report a 65 year old female who presented with Left iliac fossa mass for three months with pain for ten days. Ultrasound and CT scans have revealed a lymphoma involving the descending colon. Colonoscopy was normal. At mini laparotomy, the mass was found to be arising from jejunum, with impending obstruction. A Jejunal resection was carried out. Following stable first three post-operative days, the patient developed septicemia. Review CT scan revealed, non-perfused, gangrenous bowel. At relook laparotomy, there was extensive small bowel gangrene along the drainage territories of Superior mesenteric vein. Patient succumbed to septic shock on fourth post-operative day.

Mini Laparotomy with O Ring Wound Retractor Is a Minimal Invasive Approach for Resection of Dermoid Cysts in Pediatric Patients

To demonstrate the use of a mini laparotomy incision with an O ring wound retractor as a plausible minimally invasive procedure for removal of ovarian dermoids(mature teratomas) in preventing intraoperative rupture/spillage of cysts and preserving ovarian tissue in pediatric patients.

Chirurgische Aspekte der Peritonealdialyse

Peritoneal dialysis (PD) has wide clinical range since die 70ies. Clinical data report a significantly higher 2 year survival rate for PD compared to patients treated with hemodialysis. Nevertheless, currently only about 10 % of patients suffering from end-stage renal disease are treated with PD. Long-term function of the catheter is based on patient's compliance as well as optimal surgical catheter implantation. Beside the classic "open" surgical approach by mini laparotomy new minimal invasive techniques of catheter implantation were developed during the last years. Advantages of laparoscopic techniques are the possibility for combined intraperitoneal procedures and optimal placement of the catheter. Most of surgery-related complications are caused by leakage or migration, infection is very rare. Several studies did not find an advantage of minimal invasive procedures regarding complications.This review should give an overview on currently established surgical techniques for PD-catheter implantation.

The role of mini laparotomy in patients with uterine myomas

The role of mini laparotomy in patients with uterine myomas

Some wounds are hard to heal: an interesting presentation of Ehlers-Danlos syndrome

A 17-year-old female patient was admitted for an elective mini laparotomy and cystectomy of the right ovary for the treatment of chronic supra-pubic abdominal pain. The procedure went without complication and she was discharged the next day. She was re-admitted a month later as an acute case with wound dehiscence. HIV serology, thyroid function, immunoglobulin, protein electrophoresis and electrolyte levels were all normal. There were no obvious signs of infection and the bacterial swabs failed to culture an organism. Despite conservative measures with regular dressing, oral antibiotics and input from the tissue viability team the wound failed to epithelialise. The wound was debrided and re-sutured a total of three times and the patient received 24 days of intravenous antibiotics. After input from various teams a diagnosis of Ehlers-Danlos syndrome was made, allowing for appropriate management and wound healing.

Comparison of Mini Laparotomy with Conventional Laparotomy as the Surgical Approach in Stage I-III Colorectal Cancer Patients: Appealing Outcomes

Mini laparotomy is technical for the resection of colorectal cancer (CRC) in selected patients. The aim was to compare clinical outcomes of mini laparotomy with conventional laparotomy in CRC patients. Between january 2007 and june 2010, 138 patients and 117 patients underwent elective resection using either mini laparotomy or conventional laparotomy respectively. Mini laparotomy involved a colorectal resection performed through a skin incision ≤8 cm in length. Clinicopathological factors, operative procedure and postoperative course were retrospectively analyzed to compare clinical outcomes between the two groups. Mini laparotomy seems to be an attractive alternative for resection of CRC in selected patients. Clinicopathological and histopathological features were similar between both groups, whereas intraoperative blood loss, operative time and harvested lymph-node numbers in conventional laparotomy were significantly greater (p=0.003, p=0.008 and p=0.024, respectively). Postoperative relapse, complications and hospitalization were significantly better in the mini laparotomy (all p<0.001). In comparison of postoperative complications between convention and mini laparotomy, ileus was more frequently encountered in conventional group (p=0.001). Interestingly, the disease-free survival and overall survival in mini laparotomy group were significantly better than control group (p=0.001 and p=0.017, respectively). Compared to conventional laparotomy, mini laparotomy seems a feasible, minimally invasive and attractive alternative in selected patients.