Laparoscopic cholecystectomy is the gold standard in gallbladder surgery all over the world today. The operation is routinely performed using four or three ports of entry into the abdomen. We have now modified this procedure and introduced a new innovative two-port method of gallbladder removal. Between September 1997 and November 1997, 50 consecutive patients (41 females and 9 males; mean age 41 years) with calculus cholecystitis underwent our new two-port procedure. In this operation, only the supraumbilical port (10 mm/5 mm) and the epigastric port (10 mm) were used for access. The gallbladder was manipulated through three strategically placed traction sutures, passed through the fundus, the body, and the neck area of the gallbladder, respectively. The operating time required was 35 to 125 minutes, with an average time of 56 minutes. None of the patients required conversion to the four-port technique. All patients were on liquids after 6 hours. The average hospital stay was 1.31 days. Postoperative pain was significantly reduced, and the procedure was cosmetically more acceptable to the patient.
Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Abdominal complications, though rare, are reported to occur in 5-47%. VP shunt obstruction or malfunction leads to raised intracranial pressure, which requires immediate intervention. Recently we have used the laparoscope to manage abdominal complications of VP shunt in two patients. The first patient had hydrocephalus secondary to tubercular meningitis. She developed recurrent intraabdominal cerebrospinal fluid (CSF) pseudocysts, possibly due to subtle peritoneal infection. In the second patient, who developed hydrocephalus following subarachnoid haemorrhage, the lower end of the shunt was malfunctioning due to retraction into the extraperitoneal tissues. The distal end of the VP shunt was revised in both patients with the help of a laparoscopically assisted technique. Thus, a conventional laparotomy, along with its various associated postoperative problems, was avoided without compromising the quality of surgery.
Ventral hernia is a common surgical problem. The traditional open surgical repair has the disadvantage of excessive morbidity, long hospital stay and high recurrence rates. Laparoscopic ventral hernia repair (LVHR) is gaining acceptance but there is no standardized technique for the repair of these hernias. We have introduced an innovative technique of 2-port laparoscopic mesh repair for ventral and incisional hernias. Between January 2002 and September 2008, 168 patients underwent the 2-port repair of ventral hernias at our institution, with Bard polypropylene mesh in 162 cases and Gore-tex expanded polytetrafloroethylene mesh in 6 patients. The average size of the defects was 10.2 cm (6.6-24.8 cm). Mean operating time was 61.4 min (48-102 min). The mean post-operative hospital stay was 1.2 days. Prolonged ileus over one day occurred in 22 patients while 6 patients had urinary retention in the post-operative period. There were 6 recurrences (3.94%) in the mean follow up period of 42 months (6-62 months). Seroma formation occurred in 5.3% cases but all of them subsided within 6 weeks without any active intervention. In conclusion we recommend that the 2-port LVHR is a technically sound procedure which is less invasive and with comparable complication rates to the 3 or 4 port hernia repair.
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