Port Site Infection Research Articles

Laparoscopic Access: Direct Trocar Insertion Versus Open Technique.

Creation of pneumoperitoneum and laparoscopic entry into the abdominal cavity are crucial initial steps of laparoscopic surgery and associated with bowel and major vessel injuries. Various methods have been described in literature such as Veress needle, open access technique (OAT), direct trocar insertion (DTI), and optical port. There is no consensus on the safest method of gaining access to the peritoneal cavity to create a pneumoperitoneum. DTI technique appears to be not well accepted by many due to the fear of causing injuries as it is a blind procedure. To compare the outcome of DTI in terms of feasibility and complications with a well-established and widely practiced OAT for a laparoscopic procedure. Nine hundred fifty-five participants were randomized to be in either of the two groups, that is, Group "A" for DTI and Group "B" for OAT. The primary endpoint was major complications (bowel, major vessel, and solid organ injury) and the secondary endpoint was port access time and minor complications directly related to access. Patients were assessed on the first postoperative day, at the time of discharge, 3 months, 6 months, and a year after discharge, for complications. There was no statistical difference in major complications between DTI and OAT groups, however, DTI was found to be superior to OAT in terms of port access time (P = .01), umbilical port-site hernia, port-site infection, and port-site pain (P = .01). This study further strengthens the literature on DTI being a good and safe technique of laparoscopic access. The technique of DTI is still underutilized and needs to be adopted by surgeons without fear.

Can We Prevent Port Site Infections? Our Experience at a Tertiary Care Centre

Can We Prevent Port Site Infections? Our Experience at a Tertiary Care Centre

The efficacy of direct trocar versus veress needle method as a primary access technique in laparoscopic cholecystectomy

Objective: The objective of this study was to compare the safety and efficacy of direct trocar method and veress needle as the primary entry technique to establish pneumoperitoneum. Study Design: This was a randomized controlled study. Patients and Methods: A randomized controlled study was done on 150 patients who complained from gallstones and attended to our surgical team, from the period of May 1, 2013 to May 31, 2017, the patient age range was 19–65 years with a mean age of 41 ± 0.9 years, after confirming the diagnosis of gallstones, informed consent was obtained from the patients. Those with previous abdominal surgery or serious comorbidities were excluded from the study. A total of 150 patients were divided randomly with 75 patients had the access into their abdomen by veress needle and the other 75 patients by direct trocar method. Variables comparing the safety and efficacy of the two methods were studied. Results: Direct trocar method was faster (2.3 ± 1.1 standard deviation [SD] min) than veress technique (5 ± 0.9 SD min), CO2leak occurs just in one case of trocar method while it does not occur in veress technique, extraperitoneal insufflations occur in four cases (5.3%) operated by veress method, and only in one case of direct trocar method, port site infection develops in two cases (2.6%) of direct trocar method and in single case of veress cannula. Only one case of port site hematoma occurs in direct trocar method. Conclusion: Direct trocar method is a safe, fast, and easily done technique for the establishment of primary entrance into the peritoneal cavity and hence pneumoperitoneum, there were no significant variations in minor complications and without major ones.

Is laparoscopic totally extra peritoneal repair of hernia (TEP) superior than trans-abdominal preperitoneal (TAAP) mesh repair of inguinal hernia- our experience from a tertiary care hospital, Kolkata

Background: The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP a mesh is placed through peritoneal incision over possible sites of hernia by going into peritoneal cavity, where as in TEP the peritoneal cavity is not entered and a mesh is used to seal the hernia from outside the peritoneum.Aims and Objectives: The aim of the current study was to compare the outcome of Total Extra- peritoneal (TEP) versus Trans-abdominal Pre-peritoneal (TAPP) repair of inguinal hernia, where both can be done.Materials and Methods: The current randomized control study was conducted among eighty patients of inguinal hernia. Of these, the sampling was done through random allocation of patients for TEP (Group-I) and TAPP (Group-II), comprising forty patients in each group. All patients irrespective of group were observed for pain (by VAS Score), mean operative time, duration of hospital stay, days taken to resume their normal activities, intra-operative and early post-operative complications and recurrence if any.Results: The pain in both groups was insignificant until one day but highly significant differences (p<0.0001) were observed by end of day 2 and 1 month, showing higher degree of pain in TAPP with respect to TEP procedure. The differences in mean operative time for surgery was highly significant (p<0.0001) with mean time of 86.72 min (TAPP) and 99.72 (TEP). The duration of hospital stay was higher in TAPP (5.2 days) compared to TEP (2.6 days). The mean time to return to normal activities was 10.8 days (TAPP) and 6.2 days (TEP) which was highly significant (p<0.0001). The recurrence though occurred only in one patient in TEP group which was negligible. The other post-operative complications was seroma (8 cases; TAPP) versus (1 case; TEP) and it was highly significant (p<0.0001). The port site infection was in 20 % patients (8/40) in TAPP compared to 2.5% (1/40) in TEP group.Conclusion: The TEP is comparatively superior than TAPP procedure in terms of post-operative complications, duration of hospital stay and return to normal activities.Asian Journal of Medical Sciences Vol.9(6) 2018 20-24

Gastric Banding: Complications Identified by CT.

Laparoscopic adjustable gastric banding (LAGB) used to be a common procedure at the turn of the century and is still frequently encountered on CT scans in common clinical practice. Our aim is to present the frequency and spectrum of complication associated with LAGB, as observed in CT. After approval of our institutional review board, a retrospective search for LAGB in CT interpretations using the term "band" between December 2011 and April 2017 was conducted. CT scans were reviewed to identify complications. The findings were divided into two groups: symptomatic, in which the complications caused acute symptoms for which CT scans were conducted, and incidental, in which complications were incidentally identified. The frequency of complications was calculated. We identified 160 patients who underwent LAGB and performed a CT scan. Complications were identified in 69/160 (43.1%) patients, with a total of 83 findings: 47/160 (29.4%) esophageal dilatation, 13/160 (8.2%) pulmonary complications, 6/160 (3.8%) abdominal abscesses, 5/160 (3.1%) small bowel obstructions, 4/160 (2.5%) intragastric band erosions, 4/160 (2.5%) tube disconnections, 3/160 (1.9%) port site and tube course infections, and 1/160 (0.6%) small pouch bezoars. When compared with patients' referral notes, 38/83 (45.8%) of the findings were associated with acute symptoms, whereas 45/83 (54.2%) of the findings were incidental. Eighteen percent of the incidental complications were clinically important. Complications were found in 43% of CT scans of patients who underwent LAGB; less than half of the findings were symptomatic. Some of the incidentally identified complications had substantial clinical importance.

Evaluation of Laparoscopic Combined Sleeve Gastrectomy and Mini-Gastric Bypass in Treatment of Morbid Obesity

AbstractBackground: Combined sleeve gastrectomy and MGB is a modified bariatric procedure composed of the standard procedures of sleeve gastrectomy and MGB that can be performed by laparoscopic technique. This combined procedure is still a novel technique with assumed beneficial effects based on the theory and former experiences with both techniques individually.Aim of Study: Assessment of the efficacy of combined sleeve gastrectomy and MGB in treatment of morbidly obese patient as regard weight reduction and control of co-morbidities.Patient and Methods: From January 2016 to January 2018, laparoscopic combined sleeve gastrectomy and MGB was performed in 20 patients at the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University, Egypt.Results: The study population included 18 females and 2 males with a mean age of 33.13±7 years. The mean pre-operative Body Mass Index (BMI) was 54. 13±60kg/m2. All procedures were completed laparoscopically. Comorbidities: The mean operative time was 153±27.7 minutes and the mean postoperative hospital stay was 6.1±5.8 days. Early compli-cations were encountered in 4 cases (20%) including 3 port site infections (15%), stable line leakage 5 days after operation was recorded in 1 case (5%). Late complications included 6 cases (30%). Pre-operative obesity related co morbidities; hypertension in 2 cases, diabetes mellitus in 3 cases, Dyslip-idaemia in 4 cases and arthrealgia in 7 cases. The mean BMI 18 months after surgery was 29.23±3.4kg/m2, and the EWL% ranged between 51.45% and 98.2% with a mean of 80.68±10.55 18 months after operation. Most of the co-morbidities improved or resolved; 100% for hypertension and diabetes mellitus, 75% for dyslipidemia and 71.4% for artheralgia.Conclusion: Despite the short duration of follow-up for most of the patients, combined SG and MGB can be considered an effective surgical procedure for treatment of morbid obesity in terms of weight reduction and control of co-morbidities. A higher cost is expected for this procedure due to the larger number of cartridges used. Like other bariatric procedures, this novel procedure was attended with post-operative complications mainly staple line leakage, biliary reflux, stomal ulcer, nutritional deficiencies and symptomatic gallbladder stones.

Port Site Infections Following Laparoscopic Cholecystectomy

Background: Port site infections (PSIs) following laparoscopic cholecystectomy is an infrequent complication. Among the causes of PSIs Mycobacterium tuberculosis is rare but it has been increasingly recognized in the recent years. Lack of awareness of this complication leads to prolonged morbidity. Early diagnosis and treatment is important for theresolution of the disease.Methods: This was an observational descriptive study carried out on patients who underwent laparoscopic cholecystectomy. In patients of PSIs, Gram and AFB staining with culture & sensitivity of pus and biopsy of abscess wall or sinus tract were obtained as per need to reach the diagnosis. Patients were treated accordingly.Results: The rate of PSIs was 3.92% in this study. Age, sex & body weight have no impact on PSIs. Diabetes mellitus, hypertension, hypothyroidism, acute cholecystitis & spillage of bile or stone during the procedure increases the rate of PSIs. Epigastric port was affected more than that of other ports. Among the causes of port site infections in 55.18% cases it was with Gram +ve bacteria, in 34.49% cases with Gram -ve bacteria, in 1.72% cases atypical mycobacteria, in 5.17% cases Mycobacterium tuberculosis & in 3.44% cases no organisms were found. Most of the PSIs developed early within one month & responded well with antibiotics. Diagnosisof port site tuberculosis was established by histopathological examination of tissue from abscess wall or sinus tract & treated as per WHO guide line. No recurrence noted at 2 years follow up.Conclusion: Port site tuberculosis after laparoscopic cholecystectomy is a rare entity. The present study is an attempt to make surgeons aware of this rare complication. Early diagnosis and proper treatment are prerequisites to the successful outcome. Strict adherence to well established sterilization protocol is a must for the prevention.Bangladesh J Medicine Jul 2018; 29(2) : 51-58

Surgical Instrument Reprocessing in Resource-Constrained Countries: A Scoping Review of Existing Methods, Policies, and Barriers.

Surgical infections are a major cause of morbidity and mortality in low- and middle-income countries (LMICs). Inadequately reprocessed surgical instruments can be a vector for pathogens. Little has been published on the current state of surgical instrument reprocessing in LMICs. We performed a scoping review of English-language articles in PubMed, Web of Science, and Google Scholar databases describing current methods, policies, and barriers to surgical instrument reprocessing in LMICs. We conducted qualitative analysis of all studies to categorize existing practices and barriers to successful surgical instrument reprocessing. Barriers were non-exclusively categorized by theme: training/education, resource availability, environment, and policies/procedures. Studies associating surgical infections with existing practices were separately evaluated to assess this relationship. Nine hundred seventy-two abstracts were identified. Forty studies met criteria for qualitative analysis and three studies associated patient outcomes with surgical instrument reprocessing. Most studies (n = 28, 70%) discussed institution-specific policies/procedures; half discussed shortcomings in staff training. Sterilization (n = 38, 95%), verification of sterilization (n = 19, 48%), and instrument cleaning and decontamination (n = 16, 40%) were the most common instrument reprocessing practices examined. Poor resource availability and the lack of effective education/training and appropriate policies/procedures were cited as the common barriers. Of the case series investigating surgical instrument reprocessing with patient outcomes, improperly cleaned and sterilized neurosurgical instruments and contaminated rinse water were linked to Pseudomonas aeruginosa ventriculitis and Mycobacterium port site infections, respectively. Large gaps exist between instrument reprocessing practices in LMICs and recommended policies/procedures. Identified areas for improvement include instrument cleaning and decontamination, sterilization aspects of instrument reprocessing, and verification of sterilization. Education and training of staff responsible for reprocessing instruments and realistic, defined policies and procedures are critical, and lend themselves to improvement interventions.

Study of diagnostic and therapeutic utility of video assisted thoracoscopic surgery

Background: Video-assisted thoracoscopic surgery (VATS) is rapidly becoming a popular method for diagnostic and therapeutic purposes. Many diseases of the chest can now be diagnosed by VATS due to ease of look and biopsy. Hence the present study was undertaken to determine diagnostic and therapeutic utility of VATS in different chest pathologies.Methods: In this prospective study, total 36 patients of different age group were subjected to VATS procedure, to measured operative time, intra and post- operative complications, post-operative pain and hospital stay. Then patient was followed up at 15 days, at 1 month, 3 month and at 6 months.Results: VATS was successfully carried out in 28 patients as the only procedure whereas 8 patients required conversion to thoracotomy. Average operative time for patients operated by VATS only was 94.9 minute and for patients operated by VATS converted to thoracotomy was 175.5 minute. Most common intraoperative complication was bleeding (16.66 %) followed by anaphylactic shock observed in only one patient. Most common postoperative complication was prolonged air leak (5.55%) followed by port site infection (2.77%) and postoperative bleeding (2.77%). At 24 hours postoperatively, average pain score observed in VATS group was 3.73 and in thoracotomy group was 6.28. The mean postoperative hospital stay for patients operated by VATS was 7.28 days and for patients operated by VATS converted to thoracotomy was 10.36 days. There was significant difference observed in diagnosis of various chest pathologies by radiological investigations and VATS.Conclusions: VATS should be offered as the first approach to various chest pathologies requiring surgical intervention and preferred over thoracotomy when feasible.

Our Early Experience with Laparoscopic Sleeve Gastrectomy in Adolescents

Background: Laparoscopic sleeve gastrectomy (LSG) is a very effective bariatric procedure indicated in the treatment of morbid obesity. Methods: Between July 2015 to November 2017, 58 adolescents with morbid obesity (42 female and 16 male) underwent LSG. The mean preoperative weight was 126.4 ± 26.7 (range 90-210) Kg. The mean body mass index (BMI) was 45.1 ± 7.9 (range 36.2-59.5) Kg/m2. Results: The mean operative time was 35 (range 33-68) minutes. The mean length of hospital stay was 1.2 (range 1-3) days. There were no intraoperative complications. The %EWL (excess body weight loss) was 50.2% ± 19.3% and 73.3% ± 20.1% at six months and 1 year respectively. The mean postoperative BMI was 33.8 ± 6.8 Kg/m2 and 27.6 ± 5.1 Kg/m2 at six months and 1 year respectively. The overall complication rate was 10.3% (6 patients). Two patients (3.4%) had postoperative bleeding and managed conservatively. Three patients (5.2%) suffered from port site infection. One of them had persistent vomiting and upper abdominal pain for 3 days after operation. Vomiting and pain improved after drainage of an abscess at the site of the 15 mm trocar. The other two improved with antibiotics. Finally, one patient was readmitted 4 days after surgery for persistent severe nausea, vomiting, and dehydration. This patient resolved with inpatient medical treatment. There were no postoperative mortalities. Conclusion: LSG can be regarded as a simple, safe, effective bariatric procedure in adolescents.

Incidence of Superficial Port Site Infection in Laparoscopic Cholecystectomy in relation to Spilt Stone and Bile Spillage

Introduction: Laparoscopic cholecystectomy is the choice of operation for symptomatic gallstones. Gallstone and bile spillage can occur during laparoscopic cholecystectomy during dissection by cautery or due to perforation of gall bladder by grasper. The complication of spilt stone and bile may range from simple superficial surgical site infection, adhesion, obstruction, abscess formation to none.
 Methods: This study was conducted at Western Regional Hospital (WRH), Pokhara from July 2015 to December 2016. A total of one hundred and twenty patients who underwent laparoscopic cholecystectomy were included. All patients’ age, sex, pre-operative ultrasound findings, intra operative spillage of stone and bile and post-operative superficial surgical site infection were noted. Statistical analysis was done using Microsoft Excel software and SPSS-21. Result obtained from the study was discussed with reference to current world literature.
 Results: Out of one hundred and twenty patients, one hundred and nine were female and eleven were male with mean age of 42.68 years. Spillage of stones and bile occurred in twelve patients (10%). Spillage of stone and bile was common with multiple stones. Only four patients (one male and three females) developed superficial port site infection (3.3%). Two patients among spillage and two among non spillage developed superficial surgical site infection (p<0.05). Most common organism was Staphylococcus aureus followed by Escherichia coli.
 Conclusion: The incidence of split stone or bile is 10 % and is common with multiple gallstones. The chance of superficial surgical site infection is more in male patients and with spillage of stone and bile.

Atypical mycobacterial infections following laparoscopic surgery

Three cases of atypical mycobacterial infection were encountered following laparoscopic surgery at the Colombo North Teaching Hospital over a period of eighteen months from September 2014 to April 2016. The patients presented with port site infections and sinus tract formation three to four weeks after laparoscopic surgery performed in the same operating theatre. These cases were clinically suspected as atypical mycobacterial infection. The Ziehl Neelsen stain showed acid fast bacilli with atypical morphology and cultures grew mycobacteria other than tuberculosis (MOTT). Histology of tissues showed chronic granulomatous inflammation. The infections resolved with surgical intervention and long term antibiotic therapy. Erroneous practice of disinfection of laparoscopic instruments with formaldehyde was thought to be the cause of these infections. No cases were reported after implementing protocols for proper cleaning and disinfection of laparoscopes.

3:00 PM Abstract No. 191 Risk factors for chest port infections in patients with solid cancers: multivariate analysis of 1158 patients

To identify risk factors for chest port (port) infections in patients with solid cancers. A retrospective chart review of 1158 adult patients (≥ 18 years old) with solid cancers (male/female: 551/607, mean age: 58.1 years) who had a port placed between January 2012 and December 2015 was conducted to identify patients port infections. Port placement was generally avoided in patients with severe neutropenia (absolute neutrophil count or ANC<500/μL). The most frequent site of cancer was lung (n = 258, 22.3%) followed by breast (n = 240, 20.7%). Port infections included port site (local) and blood stream infections. The patients were divided into two groups based on the records of port infections (infection vs non-infection). Variables including the patients’ demographics, medical history, laboratory data at the time of port placement, medication used, and port characteristics were compared between groups. To elucidate risk factors for port infections, multivariate proportional subdistribution hazard regression analyses were performed. A total of 389,815 catheter-days (median per patient: 522 catheter-days) were observed. Port infections were identified in 80 patients (6.9%) including 45 with port-site, 27 with bloodstream, and 8 with both. The infection rate was 0.21/1000 catheter-days. The median time to infection was 244 days (Range, 11-828 days). The infection group had significantly more patients with history of prior port placement (p = .01) and use of double lumen port (P = .001), and significantly shorter median duration of follow-up (P = .001) compared to the non-infection group. In backward stepwise multivariate analyses, prior port placement (p = 0.03, HR = 2.23, 95% CI [1.08-4.62]), use of double-lumen port (p = 0.01, HR = 2.08, 95% CI [1.15-3.74]) thrombocytopenia (platelet count<150,000/μL) (p = 0.01, HR = 2.16, 95% CI [1.19-3.90]) remained statistically significant. Neutropenia (ANC<1500/μL) was not the risk factor. Solid cancer patients with thrombocytopenia or a history of prior port need to be closely monitored for port infections. A single lumen port would be advised in these subgroups.

Role of Laparoscopy in Appendicular Mass among Pediatric Age Group With or Without Perforation: Early Outcome

AbstractBackground: Laparoscopic appendectomy is a safe, fea-sible and effective technique for complicated appendicitis such as mass, abscess and perforation in pediatric patients. Laparoscopic approach had several advantages over open appendectomy in that, it allow proper and wide visualization of the abdominal cavity.Aim: Our aim is to evaluate the feasibility and safety of laparoscopy in cases of appendicular mass among pediatric age group with or without perforation.Material and Methods: This study was carried out on fourty children presented by complicated appendicitis (perfo-ration, mass or abscess) with history less than 72 hours, aged between 4 and 18 years and scheduled for laparoscopic ap-pendectomy. Antibiotic regimen consisted of daily intravenous administration of (cefotiam, 80mgkg/24h) for 5 days intrave-nously and metronidazole (20mg/kg/24h) for 5 days intrave-nously, oral antibiotics (cefuroxime + metronidazole) were continued for another 1 week.Results: Intraoperative findings were 17 cases acute perforated appendicitis, 13 cases appendicular mass, two patients were converted to open appendectomy. Analysis revealed presence of gangrenous appendicitis in 75% and suppurative (Phlegmonous) appendicitis in 25% of all appen-dices. Post-operative complications were encountered in form of intraperitoneal collection in one, fever in five, umbilical port site infection in two cases.Conclusions: Laparoscopic appendectomy is a safe, fea-sible and effective technique for complicated appendicitis such as mass, abscess and perforation in pediatric patients. Laparoscopic approach had several advantages over open appendectomy in that, it allow proper and wide visualization of the abdominal cavity, moreover, it is very useful in reaching an exact diagnosis in complicated cases with experience and gentle handling.

Editorial: Port-site infections due to non-tuberculous mycobacteria (atypical mycobacteria) in laparoscopic surgery

Editorial: Port-site infections due to non-tuberculous mycobacteria (atypical mycobacteria) in laparoscopic surgery

Pre-Operative Skin Antisepsis with Chlorhexidine Gluconate and Povidone-Iodine to Prevent Port-Site Infection in Laparoscopic Cholecystectomy: A Prospective Study.

Skin preparation with antiseptic agents is commonly recommended for incisional site cleansing before surgery. We present the result of a prospective case series submitted to a scheduled pre-operative antiseptic procedure combining chlorhexidine gluconate and povidone-iodine before elective laparoscopic cholecystectomy. Consecutive patients underwent pre-operative standardized cleansing of the operation site combining chlorhexidine gluconate and povidone-iodine. Patients were reviewed one week and four weeks post-operatively. Post-operative infection was observed in seven patients (4.3%). All observed infections were port-site infections, always located at the level of the umbilical incision. In all cases infections involved skin and subcutaneous tissue. Staphylococcus aureus was isolated in five patients (71.4%) and miscellaneous aerobic gram-positive bacteria in two subjects (28.6%). Post-operative hospital stay was the only factor significantly associated with the development of port-site infections. Port-site infections are a common complication after elective laparoscopic cholecystectomy. The proposed pre-operative disinfection procedure is effective in reducing port-site infections. Reducing hospital stay may contribute to limiting the occurrence of this complication.

Transperitoneal laparoscopic pyeloplasty: a single center experience of 28 cases

Background: To evaluate prospectively the results obtained in 28 patients undergoing laparoscopic pyeloplasty through transperitoneal access.Methods: From January 2014 to June 2016, twenty-eight patients between 12 and 55 years old underwent laparoscopic pyeloplasty for primary ureteropelvic junction (UPJ) obstruction via a transperitoneal approach. Eighteen cases had the obstruction on the left side and the other ten on the right side. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function. Anderson-Hynes dismembered pyeloplasty was performed in 25 patients and Fenger technique in the other 3 cases. Three patients had non-obstructing renal stones and underwent concomitant pyelolithotomy. Patients were evaluated clinically and by imaging in the postoperative period at 3 and 6 months and then followed-up annually.Results: The operative time ranged from 190 to 330 min. The average blood loss was 70 mL. Analgesic requirements were also minimal with patients requiring PCA for an average of 1.1 days. Average days to free fluids were 1.5 days. The mean hospital stay was 3.76 days. The time to return to normal activities ranged from 7 to 12 days. Crossing vessels were identified in 16 patients, intrinsic stenosis in 14 patients and 5 patients had high implantation of the ureter. There were no conversions to open. One patient had longer urinary fistula (9 days), 2 patients had prolonged ileus and 3 patients had port site infection. The follow up ranged from 6 to 72 months. From the later postoperative complications, 2 patients had re-stenosis. The success rate was 92.85%.Conclusions: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

Subfascial Endoscopic Perforator Surgery: A safe and novel minimal invasive procedure in treating varicose veins in 2nd trimester of pregnancy for below knee perforator incompetence.

Aim:Aim of this study is to evaluate the results of Subfascial Endoscopic Perforator Surgery(SEPS) in treating varicose veins in 2nd trimester of pregnancy for below knee perforator incompetence.Materials and Methods:A case series was undertaken at our institute from the period January 2010 to January 2014 on 45 pregnant women. Pregnant women with failed conservative management for varicose veins were subjected to SEPS in 2nd trimester Perioperative parameters like operative time, intraoperative complications, post-operative complications, hospital stay, pain relief, ulcer healing duration and recurrence rate were studied. All the patients were reviewed and followed up for a minimum period of 3 years.Results:During the study period.total of 45 pregnant women were enrolled in the study. The median age of the patients was 26 years (range 22 years - 30 years). The mean operative time was 90±10 minutes. The post-operative hospital stay was 1-2days. There were no intraoperative complications like bleeding or gas embolism. There were no post-operative complications like seroma or abscess, port site infection, deep vein thrombosis and gas embolism. Mean healing duration of ulcers following surgery was 7-8 weeks. No patient complained of temporary or permanent paraesthesia. Every patient was subjected to follow up for a minimum period of 3 years. 5(11.1%) patients with recurrence were documented in the study.Conclusion:SEPS is a safe, cost effective and novel minimal invasive procedure in treatment of varicose veins in 2nd trimester of pregnancy for below knee perforator incompetence.

444 - Severe Postoperative Infection of an Urachal Remnant after a Primary Umbilical Closed Approach

Study Objective: The primary approach for gynecologic laparoscopic surgery is commonly performed at the umbilicus because of cosmetic benefits and the low incidence of port-site complications. We report a patient who underwent laparoscopic surgery and developed postoperative severe port-site infection following the primary closed approach at the umbilicus due to the presence of an asymptomatic urachal remnant.

Lap Band Eroding Into the Stomach: A Troubling Complication

69 y/o white female presented with nausea, vomiting, and abdominal; pain, She had a h/o Lap Banding done to loose weight many years ago. She started having abdominal pain associated with post prandial fullness for the last few months, Her admiting vital signs were unremarkable except for tachycardia. Initial work up revealed Hemoglobin 8.9 and CT Abdomen showed a Lap Band close proximity to the diaphragm and spleen. The Lap band appears to be localized to the approximate level of EG junction. A Foreign body like material appeared to be proruding through the wall of the stomach at the cardiac end of the stomach, assessed as the band was cutting through the stomach. CT abdomen didn't show any intrabdominal air or fluid collection. She was reffered to surgery, she had removal of the Lap Band with stomach repair and Gastrostomy placement, which was eventually removed, once she started tolerating oral feeding. The Lap Band is one of the very common procedures offered to the obese patient to help them loose weight. The possible complications associated with Lap Band surgery include constipation, dysphagia, nausea and vomiting, bowel or stomach perforations, hiatal hernias, and in few cases acid reflux with could lead to GERD. Port problems can also occur as a complication after surgery in which there could be port site infection, port leak, port flipping, as well as port migration. Serious complications include embolism, gastric leaks, esophageal dilation, pouch dilation, and certain band issues such as erosion, slippage, leak, and intolerance. In few cases, lap band leads to erosion of the stomach and could potentially result in leakage or rupture of the stomach wall. This is due to the lap band rubbing against the stomach wall which erodes the lining. Our Case again reminded us of the one of the very troubling complication of the Lap Banding