Patients In Laparoscopic Group Research Articles

Assessment of Pre-Operative Predictive Factors Favoring Conversion from Laparoscopic to Open Cholecystectomy in Acute Cholecystitis

Abstract Background Acute cholecystitis refers to inflammation of the gallbladder. The pathophysiologic mechanism of acute cholecystitis is blockage of the cystic duct. Accurate diagnosis of cholecystitis requires a multifactorial, systematic approach that involves a detailed history, physical exam, serologic tests, and imaging. The (Tokyo guidelines 2018) diagnostic criteria for acute cholecystitis is widely used now days and well accepted. Objective To asses pre-operative predictive factors favoring conversion of laparoscopic cholecystectomy into open cholecystectomy in acute cholecystitis such as: (TLC- history of DM and previous abdominal surgery -gall bladder wall thickness _ pericholecystic fluid collection and loss of gallbladder wall enhancement on CT). Patients and Methods This study included 100 patients admitted to Ain Shams university hospitals diagnosed with acute cholecystitis, underwent laparoscopic cholecystectomy, half of them converted to open cholecystectomy, the two groups are compared to each other to figure out preoperative factors favoring conversion cholecystectomy Results Obesity (BMI≥30 kg/m2) in this study has shown to be associated with risk of conversion in this study. In converted group there is 25 (50%) patients who are obese compared to 14 (28%) patients in laparoscopic group with P-value of 0.04. In our study we haven’t assessed the role of intraoperative findings on conversion rate. We chose not to include this factor in our analysis to make primary concern regarding pre-operative factors. Conclusion Obesity, DM, previous abdominal surgery, loss of gallbladder wall enhancement in CT study and prolonged prothrombin time are risk factors of conversion cholecystectomy in acute cholecystitis. Appropriate management of risk-related preoperative factors may improve patients’ outcomes making in mind the concept of conversion to open cholecystectomy should not be viewed as a complication or a failure but just the opposite. It is showing good judgment to complete the operation in the safest manner possible.

Laparoscopic-Assisted Fertility-Sparing Surgery for Growing Teratoma Syndrome of the Ovary: Experience From a Tertiary Center

Study ObjectiveThe main objective is to evaluate the feasibility of laparoscopic fertility-sparing surgery in women with growing teratoma syndrome. DesignRetrospective cohort study. SettingChinese tertiary university hospital. PatientsPatients with growing teratoma syndrome who underwent fertility-sparing surgery between January 2015 and August 2023. InterventionsBaseline characteristics and surgical outcomes were evaluated, including clinical information, surgical procedures, operative time, intraoperative blood loss, complications, length of hospital stay, and follow-up information. Measurement and Main ResultsTwenty-six patients with ovarian growing teratoma syndrome underwent fertility-sparing surgery: 12 had laparoscopic surgery and 14 underwent laparotomic surgery. In the laparoscopic group, the median age of the patients during initial management of immature teratoma or mixed malignant ovarian germ cell tumor was 14.0 years (interquartile range: 13.0-24.5 years). Eleven patients were nulliparous. The primary ovarian tumor was pure immature teratoma in 10 patients and mixed ovarian germ cell tumor in 2 patients. Complete laparoscopic tumor resection was achieved in 11 patients. Patients in laparoscopic group had shorter median operative time (76.5 vs 180.0 minutes, p = 0.001), lower estimated blood loss (20.0 vs 400.0 ml, p < 0.001), decreased postoperative hospital stay (2.0 vs 7.0 days, p < 0.001), compared with laparotomic surgery. There was no conversion to laparotomy and no perioperative complications. Histological examination confirmed mature teratoma in all cases. During a median follow-up of 21.9 months (interquartile range: 7.6-44.9 months), 11 patients were alive without disease and 1 was alive with disease. One pregnancy was achieved postoperatively. ConclusionLaparoscopic fertility-sparing surgery may represent a feasible option in well-selected patients with ovarian growing teratoma syndrome. Surgery should be performed in gynecologic oncology centers by experienced staff trained in endoscopic procedures. More research and long-time follow-up are needed to determine the oncological outcomes and safety of laparoscopic surgery in this population.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ±0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive. Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ± 0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

Comparison of Laparoscopic Versus Open Resection in Management of Colorectal Carcinoma

Objective: is to compare the impact of laparoscopic and open colorectal surgery in terms of infection, hospital stay and blood loss. Study Design: Randomized controlled trial. Place and duration: Study was conducted at the general surgery department of Nishtar hospital, Multan from January 2020 to January 2021. Methodology: Three hundred and ten patients were enrolled in the study and divided into two groups. One group was treated with laparoscopic technique and the second group treated with open surgical technique. Main variables of study were infection rate, duration of hospital stay and mean blood loss. SPSS version 23 was used for data analysis. Mean and standard deviation for numerical data and frequency and percentages for categorical data were calculated. P value ≤0.05 was considered as significant. Results: In 16.8% patients of laparoscopic group, infection occurred and 20.6% patients in open group. But the difference was statistically insignificant, (p=0.382). The mean hospital stay in laparoscopic group was 11.21±2.53-day and14.78±3.01 days in open group. The difference was statistically significant. (p=0.000). Conclusion: Laparoscopic technique is associated with reduced rate of infection; hospital stay, and blood loss as compared to open surgery of colorectal carcinoma. Laparoscopic surgical method is preferred over open method.

Outcome of Laparoscopic Repair of Duodenal Ulcer Perforation Compared with Open Technique

Background: The surgical treatment of perforated duodenal ulcers is not controversial; however, the best surgical strategy is still up for debate. The perforation closure with an omental patch or without it during surgery is the basis of perforated duodenal ulcers treatment. Laparoscopic surgery can now be used to repair a perforated duodenal ulcer due to developments in minimal access surgery. Aim: In this analysis, the results of open versus laparoscopic repair of perforated duodenal ulcers were compared in terms of operating time, length of hospital stays, postoperative pain and complications after the operation, among other factors. Methods: This prospective comparative study was held at the surgical department of Agha Khan University Hospital, Karachi for one-year duration from January 2022 to December 2022. Patients were divided randomly into two groups, A and B, who underwent operations using laparoscopic and conventional methods, correspondingly, and results were compared. Results: This study found that men between the ages of 51 and 60 were most frequently affected. Laparoscopic group patients experienced much less post-operative pain, need less analgesics, minimum wound infection, and less stay in hospital than open group patients (p 0.05). Conclusions: Laparoscopic repair when performed on carefully chosen patients for perforated duodenal ulcers, it is safe, practical, and produces better outcomes than open surgery. Keywords: Omental patch, laparoscopic repair, open repair, perforated duodenal ulcer

Comparison of Post-Operative Pain after Lap Mesh Hernioplasty and Open Mesh Hernioplasty

Objective: To compare the outcome of two tension free methods of hernia repair: laparoscopic mesh repair versus open mesh technique in terms of severity of chronic post-operative pain. Material and methods: In this randomized controlled trial, total 100 male patients with inguinal hernia, age between 20-60 years were selected from Department of Surgery, Arif Memorial Teaching Hospital Lahore. Duration of study was 6 months (from April 2021 to October 2021). Chronic pain was compared between the groups. Results: In our study, mean age in group A and B was 41.84+8.92 years and 43.18+8.58 years respectively. Chronic pain was recorded in 4%(n=2) patients in Laparoscopic group (Group-A) and 28%(n=14) patients in Lichtenstein group (Group-B) while 96%(n=48) patients in Laparoscopic group (Group-A) and 72%(n=36) patients in Lichtenstein group (Group-B) had no chronic pain. Difference was significant (P=0.001). Pain intensity shows that 96%(n=48) patients in Laparoscopic group (Group-A) and 16%(n=8) patients in Lichtenstein group (Group-B) had no pain while moderate pain was reported in 4%(n=2) patients and 72%(n=36) patients respectively in Laparoscopic group and Lichtenstein group and severe pain was noted in Group-B as 12%(n=6), p value was 0.001. Group A was subjected to Laparoscopic Mesh repair and Group B hernia was repaired by Lichtenstein repair Conclusion: We concluded that laparoscopic mesh repair versus open mesh technique in terms of severity of chronic post-operative pain, laparoscopic mesh repair is found with significant lower pain. Keywords: Laparoscopic mesh repair, inguinal hernia, open mesh, severity of chronic post-operative pain.

Application of laparoscopic and open gastrectomy in enhanced recovery after surgery for gastric cancer: analysis of data from multiple centers in China

To evaluate the clinical efficacy of laparoscopic and open gastrectomy in enhanced recovery after surgery (ERAS) for gastric cancer. We retrospectively collected the clinicopathological data of gastric cancer patients undergoing radical gastrectomy at 12 Chinese medical centers between January, 2015 and December, 2017. We analyzed the clinical outcomes of a total of 1569 patients, including 552 patients undergoing open surgery, 1004 receiving laparoscopic surgery, and 43 experiencing conversion of laparoscopic surgery to open surgery. The operative outcomes and postoperative complications of the patients in laparoscopic group and open surgery group were analyzed. The primary outcome was the short-term postoperative complications. The secondary outcomes included operation time, estimated blood loss, number of lymph node dissection, time to first liquid diet intake, time to first passage of flatus and defecation, time to ambulation, postoperative hospitalization days and occurrence of readmission within 30 days. Of the total of 1569 patients, 1037 (66.1%) were males and 532 (33.9%) were females, with a mean age at diagnosis of 58.4±11.3 years. A total of 105 patients (6.7%) underwent proximal gastrectomy, 877 (55.9%) underwent distal gastrectomy, and 587 (37.4%) underwent total gastrectomy. In the overall patients, the operation time was 274.7±80.7 mins, blood loss was 150 (20-1300) mL, and the number of lymph nodes dissected was 29.9±13.5. The time to first ambulation, flatus, defecation and liquid food intake were 2.3±1.2, 3.4±1.6, 4.8±1.8 and 5.5±3.1 days, respectively. The postoperative hospital stay was 11.4±5.0 days. The incidence of postoperative complications (Clavien-Dindo score ≥Ⅱ) was 6.5%, and the rate of readmission within 30 days after discharge was 1.1%. Subgroup analysis of the patients based on the surgical approach (conversion of laparoscopic surgery to open surgery was considered open surgery) showed no significant differences in the extent of gastrectomy between laparoscopic and open surgery groups (P > 0.05). Compared with those in the open surgery group, the patients having laparoscopic gastrectomy had a greater number of lymph nodes retrieved with earlier ambulation, first flatus, defecation and oral intake and a shorter postoperative hospital stay (P < 0.05). The laparoscopic group had a lower intraoperative blood loss but a longer operation time than the open surgery group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). Compared with open surgery, laparoscopic surgery in ERAS can shorten the time to ambulation, first flatus, defecation, and oral intake and the length of hospital stay. Laparoscopic surgery can achieve the same oncological outcomes as open surgery without increasing postoperative complications.

Laparoscopic vs. open resection of gastrointestinal stromal tumors (GISTs) from gastric origin: different approaches for different diseases.

Although minimally-invasive techniques are currently recognized as effective and validated treatment for small gastric gastrointestinal stromal tumors (GISTs), the role of laparoscopy is not yet established. The aim of this study was to evaluate the outcomes of laparoscopic treatment of gastric GISTs compared to the results obtained in a group of patients treated with conventional surgery. A retrospective analysis was performed, using a prospectively maintained comprehensive database of 100 patients treated for gastric GIST in the period from 2000 to 2015. Thirty-six patients were treated laparoscopically, and 64 patients underwent conventional surgery. The analyzed medical data included clinical and pathological features of removed tumors, perioperative parameters as well as short and long-term results of surgical treatment. Histopathological examination confirmed radical resections for all patients. No deaths were reported in the 90-day postoperative period. Patients in laparoscopic group had significantly shorter length of hospital stay (5.5 vs. 7 days, P<0.0001), fewer extended and combined surgical procedures (11.2% vs. 34.4% and 2.8% vs. 39%; P=0.02 and P<0.001, respectively), and a smaller tumor size compared to laparotomic group (3 vs. 6 cm, P<0.0001). The median postoperative follow-up for the entire study population was 42 months. During this period, 11 patients died and 4 of them developed a tumor recurrence. None of them was in the laparoscopic group. Laparoscopy in the treatment of gastric GISTs has unquestionable advantages, but its choice is strictly related to tumor features.

Laparoscopic vs Open Gastrectomy: an Updated Meta-analysis of Randomized Control Trials for Short-Term Outcomes.

The aim of this meta-analysis was to compare short-term outcomes of laparoscopic and open gastrectomy for gastric cancer. EMBASE, MEDLINE, PubMed, and the Cochrane Database were searched for randomized control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30-day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2 gastrectomies, lymph node retrieval, operative time, wound complications, and intraabdominal complications. Systemic review and meta-analysis were done according to MOOSE and PRISMA guidelines. Eleven RCTs consisting of 4614 patients were included in the study. A total of 2452 patients were there in laparoscopic gastrectomy group while 2162 patients were included in open gastrectomy group. Morbidity was significantly low in laparoscopic group (p = 0.003). There was no significant difference in mortality between the two groups (P = 0.75). There were fewer wound complications in laparoscopic group and no difference intra-abdominal complications in both groups. Blood loss was significantly lesser in laparoscopic group (p < 0.001). Hospital stay was similar in both groups (p = 0.30). Operative time was significantly higher in laparoscopic group (p < 0.001). Laparoscopic group patients had a lesser number of lymph node retrieval compared to open group (p = 0.002). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies (p = 0.64). Laparoscopic gastrectomies were associated with lesser wound-related complications without decreasing hospital stay with a smaller number of lymph nodes retrieval.

Laparoscopic versus open surgical management of patients with chronic pancreatitis: Amatched case-control study.

Background:The safety and feasibility of laparoscopic surgery in patients with chronic pancreatitis (CP) have been established, but its outcome has not been compared to that of open surgery.Patients and Methods:This retrospective study was conducted on patients with CP who were treated by a single surgical team from 2012 to 2018. The medical records of patients with surgical treatment of CP were reviewed. Patients were divided into laparoscopic group (LG) and open group (OG). Both the groups were matched for age and procedures. The matched groups were compared.Results:The total number of unmatched patients was 99 and post matching, there were 38 patients in each group. The demographic, aetiological, clinical and laboratory parameters were comparable. The number of each surgical procedure including bilio-enteric anastomosis was also similar. Lateral pancreaticojejunostomy was the most common surgical procedure in both the groups. An additional surgical procedure (bilio-enteric bypass) was required in 10.5% of the patients in LG and 21% of the patients in OG groups (P = 0.3). Significantly lower blood loss (100 vs. 120 ml) and higher operation time (300 vs. 210 min) were observed in LG. The post-operative complication rate was 7.9% in LG group versus 10.5% in OG group. More than 85% of the patients in both the groups had a significant relief from pain. The impact of exocrine and endocrine insufficiency was not remarkable in both the groups. The requirement of an additional surgical procedure was associated with a high conversion rate.Conclusions:The outcomes of laparoscopic surgery in patients with CP were similar to that of open surgery, and requirement of an additional surgical procedure is associated with a high conversion rate.

Benefits of simultaneous laparoscopic colorectal surgery and liver resection for colorectal cancer with synchronous liver metastases: Retrospective case-matched study

IntroductionLaparoscopic surgery for colorectal cancer and liver tumors are accepted as alternative procedure to open surgery. However, few studies reported outcomes of simultaneous laparoscopic surgery of these two procedures. The aim of this study was to compare short-term outcomes between laparoscopic and open approach. Materials and methodsBetween June 2010 to December 2019, simultaneous laparoscopic cases were retrospectively matched (1:2) to open cases. Peri-operative and short-term outcomes were compared between both groups. ResultsTwelve patients in laparoscopic group were matched to 24 patients in open group according to age, gender, body mass index, american society of anesthesiologists physical status, preoperative laboratory data, number and size of liver metastases and extent of colorectal and liver resection, Most patients in each group had left-sided colon or rectal cancer and underwent wedge liver resection. The mean number of liver metastases was 1.3 vs 1.5 and size of liver metastases was 2.2 ± 1.4 vs 2.7 ± 1.1 cm in laparoscopic compared to open group. Estimated blood loss and length of hospital stay were significantly lower in laparoscopic group. However, operative time was significantly longer in laparoscopic group. Peri-operative complication was not significant difference between both groups and there was no mortality. ConclusionSimultaneous laparoscopic colorectal surgery and minor liver resection is feasible and safe. Laparoscopic approach has better peri-operative outcome in term of shorter length of hospital stay compared to open approach.

Long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma: Retrospective case-matched study

BackgroundOnly few studies compared laparoscopic to open liver resection regarding degree of liver injury, inflammatory response and long-term outcomes. The aim of this study was to compare peri-operative and long-term outcomes between these two procedures in patients with hepatocellular carcinoma. Material and methodsLaparoscopic cases were retrospectively matched to open cases. Peri-operative and long-term outcomes were compared. ResultsTwenty-seven patients in laparoscopic group were matched to 27 patients in open group. On the first postoperative day, white blood cell count, serum AST and serum ALT in laparoscopic group were significantly lower than open group. Median follow up time was 58.07 months. The 1-, 3- and 5-year disease free survival and overall survival were not significantly different between laparoscopic and open group. ConclusionsLaparoscopic liver resection in patients with hepatocellular carcinoma has potentially lesser degree of postoperative inflammatory response and liver injury, but similar survival outcomes compared to open liver resection.

A COMPARATIVE STUDY OF PULMONARY FUNCTION TEST IN LAPAROTOMY AND LAPAROSCOPIC SURGERIES

Background and Aims- Respiratory complications account to majority of post-operative outcomes after abdominal surgeries. Data on exact prevalence and probability after different surgeries is scanty. Aim of our study is to evaluate pre and post operative differences objectively by using spirometry in patients undergoing upper abdominal laparoscopic and laparotomy surgeries. Methods- Seventy-one patients consecutively undergoing surgeries were enrolled, of which 36 underwent laparoscopic and rest open laparotomy. Patients were subjected to spirometry pre and post operatively, and FVC, FEV1, FEV1/FVC, VC were calculated. This cross sectional data was analysed using paired “t” test, Students “t” test and Chi square. Results- Preoperative FEV1,ERV, TLC, PEFR were significantly better in laparotomy than laparoscopic group (p value &lt;0.05). Age, sex and BMI were not significant determinants. Post operatively the laparoscopic group had better outcomes than laparotomy group. The exact mechanisms were not known but minimal scar length, lesser damage to diaphragm and muscles, younger age of patients in laparoscopic group and early postoperative rehabilitation could be possible explanations Conclusions- Present study demonstrates that laparoscopic surgeries has less adverse effects on postoperative pulmonary function than laparotomy surgeries. This may correlate with lower post op respiratory complications in laparoscopy group

Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival

BackgroundColorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer.MethodsFrom January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model.ResultsNinety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05).ConclusionIn elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

Relevance of laparoscopic appendicectomy in Indian scenario: An analytical study

Introduction: This article by means of data analysis obtained from our study have tried to evaluate feasibility and acceptability of laparoscopic appendicectomy in Indian scenario. Objective: Through this prospective study an effort have been made to find ideal technique for appendicectomy which can serve masses in low middle income group countries like India where patient load outnumber resources both in expertise and facilities. Methods: A prospective analysis of two groups of population which have undergone appendicectomy (laparoscopic versus open conventional) was done as per inclusion criteria. Results obtained were analysed on grounds of cost benefit, time taken for surgery, pain, post-operative complications, hospital stay, time to resume routine activities, subjective cosmesis and finally patients preference. Data obtained was statistically analysed. Results: The mean age of patients in laparoscopic group was 22.5 years and 27.6 years in open appendicectomy group. Out of 287 patients included as per inclusion criteria 69.69% (200) patients opted for open appendicectomy. Mean operative time for laparoscopic procedure was more than open conventional procedure (98 minutes compared to 51 minutes). Post-operative complications and median length of hospital stay were comparable in both groups. There was no significant statistical difference related to pain, time duration to resume routine activities, and subjective cosmesis. Cost of overall procedure in laparoscopic appendicectomy was significantly higher than open conventional group. Conclusion: conventional open appendicectomy is reliable, easy, safe and cost-effective technique and its use can dramatically reduce cost burden of surgery as compared to laparoscopic surgery.

Study of early cholecystectomy for mild and moderate acute cholecystitis as per Tokyo Guideline

Background: According to Tokyo Guidelines, 2007 operative management of acute cholangitis and cholecystitis to be administered earlier with preference of laparoscopic cholecystectomy over conventional open cholecystectomy.Aims and Objectives: This study was done to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of operation, post operative recovery, analgesic requirement, complications encountered, duration of hospitalization, and patient satisfaction.Materials and Methods: A prospective randomized trial of 50 patients conducted at B.S.M.C.H, Bankura from January 2013 to July 2014, who admitted with a diagnosis of acute calculous cholecystitis, were randomized to undergo open and laparoscopic cholecystectomy with 25 patients in each group.Result: The commonest presenting complaint in both the groups was pain in the right upper quadrant followed by vomiting and dyspepsia. The duration of laparoscopic method was significantly more than open method (median 120min v/s 90min respectively).The duration of pain and analgesic, antibiotic requirement was less in laparoscopic group compared to open group. The intra operative complications were more for the laparoscopic procedure. Wound infection was seen in none of laparoscopic patient but only in 2 patients of open procedure. Two patients of laparoscopic group required conversion to open procedure. The postoperative compliance is better in laparoscopic patients compared to open patients and hospital stay is also significantly less.Conclusion: The laparoscopic procedure was costly compared to open procedure. But this difference was overcome by the other costs incurred in postoperative period of open procedure. The laparoscopic procedure offered better cosmetic compared to open method.Asian Journal of Medical Sciences Vol.9(3) 2018 21-26

Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study

PurposeIn spite of the unique advantages of minimally invasive treatment, laparoscopic surgery is not recommended in T4 colon cancer patients with the concern of technical feasibility and suboptimal oncologic outcomes. We used the database of our center to reevaluate laparoscopic surgery's value in T4 colon cancer and compared with open surgery in both short- and long-term outcomes. MethodsWe conducted a retrospective and propensity score-matched study of pathological T4 colon cancer patients who received laparoscopic surgery or open surgery from March 2011 to August 2015. ResultsA total of 411 pathological T4 colon cancer patients were identified. Propensity score matching (PSM) resulted in 86 patients in laparoscopic group and 86 patients in open group. Our study showed longer operation time, less blood loss and less length of postsurgical stay compared with open surgeries (167 ± 56 min vs. 111 ± 50.1 min, P < 0.001; 72 ± 61.5 mL vs. 113 ± 113.9 mL, P = 0.004; 7.3 ± 2.1 days vs. 7.9 ± 2.1 days, P = 0.046, respectively). 7 (8.2%) patients underwent conversions to open surgery. 5-years of DFS and OS showed no statistic difference between the two groups. The 1-, 3-, and 5-years OS rates were 89.4%, 77.5% and 73.2% for laparoscopic surgery and 95.2%, 82.7% and 73.9% for open surgery (P = 0.618). The 1-, 3-, and 5-years OS rates were 89.5%, 77.2% and 61.7% for laparoscopic surgery and 91.7%, 75.3% and 66.8% for open surgery (P = 0.903). ConclusionOur analysis demonstrates that there is no statistic difference in short- and long-oncologic outcomes in our center and it is a reliable evidence to support the clinical application of laparoscopic surgery in T4 colon cancer patients. Still, considering the lack of randomized controlled trails, conducting large prospective multi-center population-based studies is not only required, but also pressing.

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

Background: Despite potential benefits of robotic liver surgery, it is still considered a “development in progress” technique. Methods: The outcomes of 14 patients undergoing robotic right hepatectomy were analyzed and compared with the results of 20 laparoscopic right hepatectomies consecutively performed by the same young surgeon. Results: The overall mean operative time was less in robotic arm (425 ± 139 vs. 565.18 ± 183.73, p = 0.022) and the estimated blood loss was similar (335.15 ± 139.8 vs. 423.95 ± 205.15, p = 0.17); no blood transfusion was required. Two patients in robotic group and 5 in laparoscopic group (p = 0.454) underwent conversion to open surgery; the overall morbidity was 21.4 and 15% in studied arms, respectively (p = 0.634). Pathology reports showed a mean surgical margin of 26.02 ± 3.9 in robotic arm, 28.76 ± 4.6 for laparoscopic, (p = 0.079) and we achieved a R0 resection rate of 91.66 and 85%, respectively. Reoperation and 90-days mortality rate were both null in robotic arm. One patient in laparoscopic group was reoperated due to postoperative hemorrhage. One-year overall and disease free-survival rate were 92.3 and 84.6%, respectively in robotic arm and 90 and 85% in laparoscopic arm. Conclusions: Robotic right hepatectomy is a safe and feasible technique providing promising short-term outcomes and oncological results also in the initial phase of learning curve.

Laparoscopic management of urachal cysts.

The urachus and the urachal remnants represent a failure in the obliteration of the allantois at birth that connects the bladder to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Urachal cyst are the most common urachal anomaly in the pediatric population. The traditional surgical approach is a semicircular infraumbilical incision or a lower midline laparotomy. In a 10 years period at Pediatric Surgery Department of Vicenza 16 children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms. Eight underwent open excision; eight were treated by laparoscopic surgery. The average age was 5.5 years (range, 4 months-13 years) in open group and 10 years (range, 1 month-18 years) in laparoscopic group. Mean operative time was 63 minutes (range, 35-105 minutes) in open group, 50 minutes (range, 35-90 minutes) in laparoscopic group. There were no postoperative complications. The patients of laparoscopic group were all discharged after few days (range, 2-4 days). Pathological examination confirmed a benign urachal remnant in all cases. Reporting our experience since comparing the two surgical approaches we want to describe the technique step by step of laparoscopic urachal cyst excision as minimally invasive diagnostic and surgical techniques. Laparoscopy represents a useful alternative for the management of persistent or infected urachus, in particular when there's the suspect despite the lack of radiological evidence. The morbidity associated with this approach is very low as the risk or recurrence. Laparoscopy in the management of urachal cyst is safe effective and ensures good cosmesis with all the advantages of minimally invasive approach.