Prasanna Kumar Reddy

3D Laparoscopy - Help or Hype; Initial Experience of A Tertiary Health Centre

INTRODUCTION To evaluate the advantages of 3D laparoscopy and compare its significance with conventional 2D laparoscopy during various operative procedures. METHODS During present study, two groups were formed. Group A included patients who were operated using 3D laparoscopic imaging and Group B consisted of operated patients by 2D laparoscopy. Operative performance of both the groups was compared in terms of operative time and quality of imaging. RESULTS Operative time interval for various procedures was significantly less in Group A as compared to Group B. Also, imaging quality was far superior with use of 3D imaging system especially in terms of depth perception. CONCLUSION Advantages of 3D laparoscopy are well appreciated during operative procedures as previously documented by other studies in training models.

Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience

CONTEXT: Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management. AIMS: Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date. Herein, we present our experience with laparoscopic management of pancreatic necrosis in 28 patients. MATERIALS AND METHODS: A retrospective study of 28 cases [20 men, 8 women] was carried out in our institution. The medical record of these patients including history, clinical examination, investigations, and operative notes were reviewed. The mean age was 47.8 years [range, 23-70 years]. Twenty-one patients were managed by transgastrocolic, four patients by transgastric, two patients by intra-cavitary, and one patient by transmesocolic approach. RESULTS: The mean operating time was 100.8 min [range, 60-120 min]. The duration of hospital stay after the procedure was 10-18 days. Two cases were converted to open (7.1%) because of extensive dense adhesions. Pancreatic fistula was the most common complication (n = 8; 28.6%) followed by recollection (n = 3; 10.7%) and wound infection (n = 3; 10.7%). One patient [3.6%] died in postoperative period. CONCLUSIONS: Laparoscopic pancreatic necrosectomy is a promising and safe approach with all the benefits of minimally invasive surgery and is found to have reduced incidence of major complications and mortality.

Mesh erosion after laparoscopic posterior rectopexy: A rare complication

Laparoscopic posterior mesh rectopexy (LPMR) is now an accepted surgical treatment for complete rectal prolapse. It is associated with complications such as partial mucosal prolapse, fecal impaction, constipation, and rarely recurrence. Erosion of the mesh into the rectum after LPMR is very rare. We report herein the case of 40-year-old man who presented with mesh erosion into the rectum and managed successfully by the laparoscopic excision of mesh. This is probably the first such case managed by the laparoscopic approach.

Laparoscopic completion cholecystectomy: A retrospective study of 40 cases

Throughout the world, laparoscopic cholecystectomy is a widely accepted surgical treatment for both acute and chronic cholecystitis. It provides total relief of pre‐surgical symptoms in up to 85% of patients. However, about 5% of patients may experience severe episodes of upper abdominal pain similar to those that they had prior to cholecystectomy; this is known as post‐cholecystectomy syndrome. Gallbladder remnant with calculi is one of the causative factors. However, there have been only a few case series related to this reported in literature to date. Herein, we present our experience with laparoscopic management of gallbladder remnant with calculi in 40 cases.

Laparoscopic Nissen fundoplication in situs inversus totalis: Technical and ergonomic issues.

We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT). A 34-year-old man was diagnosed with SIT on performing chest X-ray and abdominal sonography as a routine preoperative investigations. He presented with chronic gastro-esophageal reflux disease (GERD) inadequately controlled by medications. The laparoscopic procedure was performed using five ports placed in a mirror-image configuration and with the patient in the modified lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case. In SIT, this position provides the least visual disorientation from the reversed abdominal organs. We recommend that preoperative detection of SIT is essential to understand the symptomatology of the patient and for planning of any upper abdominal laparoscopic procedure.

Transfascial Suture Hernia: A Rare Form of Recurrence After Laparoscopic Ventral Hernia Repair

Laparoscopic repair of ventral or incisional hernia is among the most commonly performed minimally invasive procedures. Different modes of recurrence have been reported in literature, including missed defects, mesh migration, mesh infection, etc. Transfascial suture fixation in addition to tackers is an established method to prevent recurrence due to mesh migration. We report possibly the third case of recurrent ventral hernia with multiple defects at transfascial suture sites of previous laparoscopic ventral hernia mesh repair. The patient was treated by laparoscopy with a large intraperitoneal PROCEED mesh, covering the new hernia defects and older mesh.

Percutaneous drainage of gastric remnant dilatation after laparoscopic Roux-en-Y gastric bypass.

Roux‐en‐Y gastric bypass is a commonly performed bariatric procedure worldwide. Gastric remnant dilatation is an uncommon early complication of this procedure that can be fatal if treatment is delayed, as it can cause peritonitis and death. Herein we report a gastric bypass patient who presented with profound shock 3 months after the surgery. After resuscitation and evaluation, she was diagnosed as having a massive dilatation of gastric remnant, which we managed with percutaneous drainage.

Gallstone causing pseudoaneurysm of accessory right hepatic artery.

A 64-year-old man presented with pain in abdomen, jaundice and melena; physical examination revealed a palpable gallbladder. Ultrasonography was suggestive of gallbladder (GB) mass. CECT abdomen showed pseudoaneurysm of accessory right hepatic artery arising from superior mesenteric artery (Fig. 1) with rupture into GB lumen. There was extension of GB lumen into cavity within segments 5 and 4 of liver with large calculus within GB. Two units of blood were transfused. CT angiography showed pseudoaneurysm of accessory right hepatic artery arising from superior mesenteric artery as first branch (Fig. 2). Embolization of accessory hepatic artery was done. After few days, he presented with pain abdomen, fever and jaundice. Diagnostic laparoscopy showed large calculus occupying the entire GB. The stone was extracted and cholecystectomy was done by excising the GB up to Hartman pouch. We did not explore the area around the aneurysm. The patient made an uneventful recovery. Hemobilia should be considered in patients presenting with upper abdominal pain and upper gastrointestinal bleeding. Less than a third of patients present with Quinke’s triad: abdominal pain, jaundice and melena

Symptomatic "H" type duplex gallbladder.

A case of ductular type duplex gallbladder is presented that was diagnosed by magnetic resonance cholangiopancreatography and managed by laparoscopy.

Contoured 3D Mesh in Laparoscopic Inguinal Hernia Repair: Does it Reduce Inguinodynia?

Background: Inguinal hernia repair is currently performed by a large variety of surgical prosthesis. Post- surgical pain and recurrence can occur due to the mesh inflammation, shrinkage and various method of fixation of mesh. Chronic pain may be incapacitating and can affect the quality of life. Laparoscopic transabdominal preperitoneal meshhernioplasty using self-fixating and anatomically contoured mesh is a new and innovative technique. Aim: The aim of our study is to identify the incidence of pain, recurrence and morbidity after repair of inguinal hernia with anatomically contoured 3D mesh. Method: Our study is a prospective observational study including 48 patients of inguinal hernia from Sep 2013-Sep 2015 with laparoscopic transabdominal preperitoneal mesh hernioplasty using anatomically contoured mesh, proprietary name BARD 3D Max LIGHT Mesh was done in 111 hernias. All 48 patients were analyzed with Visual Analog Scale (VAS) at 7th postoperative day, 1stmonth and 3rd month. Result: A total of 48 patients were included in the study, and all repaired with 3 D mesh. On comparing the grades of VAS score on follow- up of three month , 47 patients ( 97.9%) were reported no pain and one patient (2.1%) was reported having mild pain ( p=0.011) (Figure 1) . All the patients were discharged on 1stpostoperative day and 46 patients (95.8%) were returned to normal activity without pain in 1 month. In our study at the end of 3 months mean VAS score (n= 48) was .0417± .20194. No patient reported swelling and recurrence on 3 month follow-up.Aim: The aim of our study is to identify the incidence of pain, recurrence and morbidity after repair of inguinal hernia with anatomically contoured 3D mesh. Method: Our study is a prospective observational study including 48 patients of inguinal hernia from Sep 2013-Sep 2015 with laparoscopic transabdominal preperitoneal mesh hernioplasty using anatomically contoured mesh, proprietary name BARD 3D Max LIGHT Mesh was done in 111 hernias. All 48 patients were analyzed with Visual Analog Scale (VAS) at 7th postoperative day, 1stmonth and 3rd month. Result: A total of 48 patients were included in the study, and all repaired with 3 D mesh. On comparing the grades of VAS score on follow- up of three month , 47 patients ( 97.9%) were reported no pain and one patient (2.1%) was reported having mild pain ( p=0.011) (Figure 1) . All the patients were discharged on 1stpostoperative day and 46 patients (95.8%) were returned to normal activity without pain in 1 month. In our study at the end of 3 months mean VAS score (n= 48) was .0417± .20194. No patient reported swelling and recurrence on 3 month follow-up.Background: Inguinal hernia repair is currently performed by a large variety of surgical prosthesis. Post- surgical pain and recurrence can occur due to the mesh inflammation, shrinkage and various method of fixation of mesh. Chronic pain may be incapacitating and can affect the quality of life. Laparoscopic transabdominal preperitoneal meshhernioplasty using self-fixating and anatomically contoured mesh is a new and innovative technique. Aim: The aim of our study is to identify the incidence of pain, recurrence and morbidity after repair of inguinal hernia with anatomically contoured 3D mesh. Method: Our study is a prospective observational study including 48 patients of inguinal hernia from Sep 2013-Sep 2015 with laparoscopic transabdominal preperitoneal mesh hernioplasty using anatomically contoured mesh, proprietary name BARD 3D Max LIGHT Mesh was done in 111 hernias. All 48 patients were analyzed with Visual Analog Scale (VAS) at 7th postoperative day, 1stmonth and 3rd month. Result: A total of 48 patients were included in the study, and all repaired with 3 D mesh. On comparing the grades of VAS score on follow- up of three month , 47 patients ( 97.9%) were reported no pain and one patient (2.1%) was reported having mild pain ( p=0.011) (Figure 1) . All the patients were discharged on 1stpostoperative day and 46 patients (95.8%) were returned to normal activity without pain in 1 month. In our study at the end of 3 months mean VAS score (n= 48) was .0417± .20194. No patient reported swelling and recurrence on 3 month follow-up.Background: Inguinal hernia repair is currently performed by a large variety of surgical prosthesis. Post- surgical pain and recurrence can occur due to the mesh inflammation, shrinkage and various method of fixation of mesh. Chronic pain may be incapacitating and can affect the quality of life. Laparoscopic transabdominal preperitoneal meshhernioplasty using self-fixating and anatomically contoured mesh is a new and innovative technique. Aim: The aim of our study is to identify the incidence of pain, recurrence and morbidity after repair of inguinal hernia with anatomically contoured 3D mesh. Method: Our study is a prospective observational study including 48 patients of inguinal hernia from Sep 2013-Sep 2015 with laparoscopic transabdominal preperitoneal mesh hernioplasty using anatomically contoured mesh, proprietary name BARD 3D Max LIGHT Mesh was done in 111 hernias. All 48 patients were analyzed with Visual Analog Scale (VAS) at 7th postoperative day, 1stmonth and 3rd month. Result: A total of 48 patients were included in the study, and all repaired with 3 D mesh. On comparing the grades of VAS score on follow- up of three month , 47 patients ( 97.9%) were reported no pain and one patient (2.1%) was reported having mild pain ( p=0.011) (Figure 1) . All the patients were discharged on 1stpostoperative day and 46 patients (95.8%) were returned to normal activity without pain in 1 month. In our study at the end of 3 months mean VAS score (n= 48) was .0417± .20194. No patient reported swelling and recurrence on 3 month follow-up.Background: Inguinal hernia repair is currently performed by a large variety of surgical prosthesis. Post- surgical pain and recurrence can occur due to the mesh inflammation, shrinkage and various method of fixation of mesh. Chronic pain may be incapacitating and can affect the quality of life. Laparoscopic transabdominal preperitoneal meshhernioplasty using self-fixating and anatomically contoured mesh is a new and innovative technique. Aim: The aim of our study is to identify the incidence of pain, recurrence and morbidity after repair of inguinal hernia with anatomically contoured 3D mesh. Method: Our study is a prospective observational study including 48 patients of inguinal hernia from Sep 2013-Sep 2015 with laparoscopic transabdominal preperitoneal mesh hernioplasty using anatomically contoured mesh, proprietary name BARD 3D Max LIGHT Mesh was done in 111 hernias. All 48 patients were analyzed with Visual Analog Scale (VAS) at 7th postoperative day, 1stmonth and 3rd month. Result: A total of 48 patients were included in the study, and all repaired with 3 D mesh. On comparing the grades of VAS score on follow- up of three month , 47 patients ( 97.9%) were reported no pain and one patient (2.1%) was reported having mild pain ( p=0.011) (Figure 1) . All the patients were discharged on 1stpostoperative day and 46 patients (95.8%) were returned to normal activity without pain in 1 month. In our study at the end of 3 months mean VAS score (n= 48) was .0417± .20194. No patient reported swelling and recurrence on 3 month follow-up.