Publications (9)16.44 Total impact
-
Article: Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy.
[show abstract] [hide abstract]
ABSTRACT: Laparoscopic surgery in pregnant patients have been reported in the literature, laparoscopic cholecystectomy being the most common. A pregnant patient in her second trimester of pregnancy underwent emergency laparoscopic cholecystectomy for empyema of gallbladder. The distended gallbladder was decompressed before dissection was commenced. There was no morbidity conversion, or complications for either mother or child related to general anaesthesia. The major advantages of the minimally invasive therapy can be utilized in the surgical disorders of the pregnant patient.Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 01/2009; 18(12):781-3. · 0.34 Impact Factor -
Article: Laparoscopic excision of an infected "egg-shelled" retroperitoneal pseudocyst.
[show abstract] [hide abstract]
ABSTRACT: Primary retroperitoneal pseudocysts are rare entities. Though laparoscopic approach has been described in their treatment, open surgical excision is still the mainstay of treatment for these lesions. We present a case of infected retroperitoneal pseudocyst and its successful laparoscopic excision. The patient was an 80-year old female. Contrast enhanced CT scan of the abdomen and ultrasonography confirmed a large retroperitoneal cyst. Laparoscopic resection was accomplished after puncturing and decompressing the cyst. There were no complications or conversion. The operating time was 176 minutes. The patient was discharged 3 days after surgery. Histopathology revealed a pseudocyst. Retroperitoneal pseudocysts can be resected laparoscopically with careful and meticulous laparoscopic dissection, utilizing the advantages of laparoscopy.Journal of gastrointestinal and liver diseases: JGLD 01/2009; 17(4):465-8. · 1.81 Impact Factor -
Article: Laparoscopic right hemicolectomy for goblet-cell carcinoid of the appendix: report of a rare case and literature survey.
[show abstract] [hide abstract]
ABSTRACT: Tumors of the appendix are rare entities, and the majority of them are discovered accidentally during an investigation for other conditions. Laparoscopic surgery for appendiceal goblet-cell carcinoid (GCC) has only been reported once before. Our patient was incidentally discovered to have an appendiceal tumor and was referred to us for laparoscopy. The tumor involved the body of the appendix and was adherent to the cecum. A laparoscopic hemicolectomy was successfully performed for the patient. Postoperative recovery was uneventful. Histopathology confirmed an appendiceal goblet-cell carcinoid. Immunohistochemistry was negative for the neuroendocrine markers, CK20 and CK7. GCC is a rare tumor of the appendix. Hemicolectomy is indicated in specific situations, such as local involvement or tumor size >2 cm. In our patient, the tumor was adherent to the cecum and tumor size was 5 cm. Therefore, a laparoscopic right hemicolectomy was performed primarily. There are several reports in the literature supporting both the laparoscopic and open approaches. Laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2008; 18(3):417-21. · 1.40 Impact Factor -
Article: Laparoscopic suture gastropexy for gastric volvulus: a report of 14 cases.
[show abstract] [hide abstract]
ABSTRACT: Gastric volvulus is an uncommon condition that affects mostly older men. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. This sometimes causes the stomach to herniate into the thorax, giving rise to respiratory compromise. A patient can have acute or chronic disease. We present our series of 14 patients who were managed with simple laparoscopic suture gastropexy. We managed 14 patients with gastric volvulus during the past ten years; 2 patients had primary type and 12 had secondary type gastric volvulus. Elective surgery was performed for the ten patients with chronic volvulus and emergency surgery was done for the four patients with acute volvulus. One of the patients with diaphragmatic hernia was six months pregnant and presented with acute symptoms. All patients recovered well from surgery, including the pregnant patient. The average hospital stay was five days; the pregnant woman was discharged on the sixth postoperative day. Symptoms of chronic gastric volvulus resemble those of reflux disease, whereas the acute condition is a surgical emergency. Gastric volvulus is a rare disease, so chances of laparoscopic management are also rare. There are also combined endoscopic and laparoscopic approaches for treatment; even percutaneous endoscopic gastrostomy has been tried with good results. In secondary volvulus, the diaphragmatic defect has to be repaired, preferably with mesh. Gastropexy is performed in all cases. Even though worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Based on our experience, laparoscopic management seems to be safe and feasible in acute and gastric volvulus.Surgical Endoscopy 07/2007; 21(6):863-6. · 4.01 Impact Factor -
Article: Laparoscopic management of drain-site incisional hernias following laparotomies--a simple suture technique.
[show abstract] [hide abstract]
ABSTRACT: Herniation through drain sites is a rare but recognized complication of surgical drainage and are actually considered to be a type of incisional hernia. Incisional hernias form following surgery through the incision site or previous drain sites, or through laparoscopic trocar insertion sites. In this paper, we present 13 such patients with incisional hernia of the main laparotomy wound and at the drain site, and 1 patient with an isolated drain-site hernia. A laparoscopic meshplasty with a simple suturing of the drain-site defect was performed. Incisional hernias are reported to occur in approximately 4%-10% of patients following open surgical procedures. There are several studies that have proven the efficacy of laparoscopic repair of incisional hernias, when compared to open procedures. The main predisposing factor regarding incisional hernias is probably the presence of a sepsis during the previous laparotomy, which was why the drainage tube was kept in the first place. The laparoscopic approach is useful for repairing the main incisional hernia, as well as drain-site hernias, simultaneously. We cut costs by avoiding tacking devices and use intracorporeal suturing instead.Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2007; 17(3):331-4. · 1.40 Impact Factor -
Article: Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position--experience of 130 patients.
[show abstract] [hide abstract]
ABSTRACT: To evaluate outcomes after minimally invasive or thoracolaparoscopic esophagectomy (TLE) with thoracoscopic mobilization of the esophagus and mediastinal esophagectomy in prone position. Esophagectomies are being performed increasingly by a minimally invasive route with decreased morbidity and shorter hospital stay compared with conventional esophagectomy. Most series report thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in the left lateral position with respiratory complications up to 8% and prolonged operative time, probably because of inadequate stance of the surgeon during the thoracoscopic part. This study shows the potential of the thoracoscopic part of the procedure in prone position to ease these difficulties. From January 1997 through April 2005, TLE was performed in 130 patients. All patients had histologically proved squamous cell carcinoma of the middle third of the esophagus. Only one (0.77%) patient received neoadjuvant chemotherapy. The thoracoscopic part of the procedure was performed in prone position with excellent ergonomics, translating into less operative time and better respiratory results. We performed a minilaparotomy to retrieve the specimen owing to bulky tumors. Feeding jejunostomy and pyloromyotomy were performed in all patients. There were 102 men and 28 women. Median age was 67.5 years (range 38 to 78 years). There was no conversion to open method. Median ICU stay was 1 day (range 1 to 32 days) and median hospital stay was 8 days (range 4 to 68 days). Perioperative mortality was 1.54% (n = 2). Anastomotic leak rate was 2.31% (n = 3). There was no incidence of tracheal or lung injury and a very low incidence of postoperative pneumonia. At mean followup of 20 months (range 2 to 70 months), stage-specific survival was similar to open and other minimally invasive series. TLE with thoracoscopic part in prone position is technically feasible, with a low incidence of respiratory complications and less operative time required. It provides comparable outcomes with other techniques of minimally invasive esophagectomy and most open series. In our experience, we observed a low mortality rate (1.54%), hospital stay of 8 days, and low incidence of postoperative pneumonia. It has the potential to replace conventional and other techniques of minimally invasive esophagectomy.Journal of the American College of Surgeons 08/2006; 203(1):7-16. · 4.55 Impact Factor -
Article: Laparoscopic mesh splenopexy (sandwich technique) for wandering spleen.
[show abstract] [hide abstract]
ABSTRACT: Wandering spleen is a rare clinical condition caused by incomplete fusion of the 4 primary splenic ligaments, allowing the spleen to be mobile within the abdomen, predisposing to splenic torsion along the vascular pedicle leading to splenomegaly and infarction, often diagnosed in an emergency setting. The wandering spleen diagnosis was achieved by ultrasound in our case. We successfully treated the patient with laparoscopic splenopexy because the size was almost normal, and no infarction or evidence of hypersplenism was present. We used the sandwich technique in which 2 meshes sandwich the spleen. This technique was found to be highly satisfactory as a treatment for wandering spleen. The patient was discharged on the third postoperative day with no intraoperative or postoperative complications. Laparoscopy usually confirms the diagnosis. Recommended surgical procedures are splenopexy or splenectomy. Splenopexy is feasible, less invasive, and does not diminish splenic function.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 11(2):246-51. · 0.98 Impact Factor -
Article: Laparoscopic resection for benign tumors of the stomach.
[show abstract] [hide abstract]
ABSTRACT: Of all gastric tumors, less than 5% are benign. The traditional treatment of symptomatic and some asymptomatic benign tumors has ranged from mucosal resection to limited gastrectomy. Since the advent of laparoscopy, many different laparoscopic approaches to resection of benign gastric tumors have now been described in the literature. We reviewed our experience with laparoscopic approaches to surgical resection of 7 benign gastric tumors. The tumor locations were the body (posterior wall), 3 cases; body (anterior wall), 1 case; lesser curvature, 1 case; fundus, 1 case, and antrum, 1 case. Laparoscopic wedge resection was done in 6 cases. The seventh patient underwent a Billroth I procedure because he had leiomyoma at the antrum. There was no conversion to laparotomy. The mean operative time was 105+/-15 minutes, and mean blood loss was 50+/-15 mL. The mean length of hospital stay was 5 days. There were no complications or mortalities. Tumor size ranged from 2 cm to 6 cm in the greatest diameter. There has been no tumor recurrence with a mean follow-up of 26 months. Laparoscopic approach is slowly carving a niche for itself in the treatment of benign tumors of the stomach. The basic principles are obtaining a precise preoperative pathological diagnosis; accurate tumor localization; achievement of tumor-free margins; avoidance of spillage of stomach contents, careful dissection of tumors in the esophagogastric junction, and preventing tumor seeding. Based on ours and other studies, laparoscopic resection of benign gastric tumors is safe and feasible.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 11(1):81-6. · 0.98 Impact Factor -
Article: Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.
[show abstract] [hide abstract]
ABSTRACT: Superior mesenteric artery (Wilkie's) syndrome is a rare condition. Only 400 cases have been reported so far. The symptoms may be acute or chronic, the chronic form being more common. Vomiting is the most common symptom. About 15 causal factors have been found. Conservative management is the rule for acute cases. Surgery is indicated for chronic cases and failure of conservative management. Laparoscopy has been used in only 8 cases so far. We report the ninth case of superior mesenteric artery syndrome managed by laparoscopic duodenojejunostomy. The patient was a 14-year-old boy with chronic symptoms since childhood. The procedure was relatively straightforward. The case is being reported for its rarity and the possibility of laparoscopic management. Laparoscopic severing of Treitz's ligament is another surgical option, though gastrojejunostomy is of no use. Conservative management is useful only in acute cases. Duodenojejunostomy is the procedure of choice and is effective in 90% of patients. We conclude that it is very effective in this condition, especially laparoscopically.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 10(4):531-4. · 0.98 Impact Factor
