Background Splenic flexure mobilization has been considered the standard of practice in cases of low anterior resection;however,it has been observed in southern Indian state population, splenic flexure mobilization is may not be necessary for all patients of Dravidian ethnicity. Methods We evaluated the 26 patientswho underwent Laparoscopic Reconstituting Subtotal cholecystectomy during July 2019 to Jan 2022. Preoperative parameters (Age, Gender, diagnosis,location of tumor and Neoadjuvant therapy) and postoperative parameters (Duration of surgery,Hospital Stay, complications, recurrence of malignancy) were compared.Aim of the study was to evaluate the outcome of Low anterior rection without splenic flexure mobilization. Results There was no statistically significant difference in terms of intraoperative,postoperative complications and oncological outcome when splenic flexure mobilization not done.The operative time was similar in the both groups (P>0.05).The Postop complication rate was lower after robotic than after laparoscopic (9% vs. 25.5%, P=0.07). Post operative complications observed in 6 patients (23%) including wound infection, wound dehiscence, anastomotic leak and anastomotic stricture. 5 post op complications were seen in laparoscopic cases;however,this was not statistically significant.On a median 24 month follow-up,the local recurrence rates did not differ significantly between the 2 groups (5 for LAP vs. 1 for Robotic). Conclusion Resection of rectal cancers by minimally invasive approach (Lap and Robotic) without the routine use of SFM do not increase postoperative morbidity or oncologic risk in our subset of patients all of whom belong to the same Dravidian ethnicity. Compared to robotic surgery, patients with laparoscopic surgery had more postoperative complications though the oncologic clearance was comparatively similar.Hence,we suggest that Splenic flexure mobilization need not be done for patients of Dravidian ethnicity as they possess small to medium stature, genetically. This needs to be validated by larger randomized studies.
Background: Laparoscopic subtotal cholecystectomy has vital benefit in preventing severe bile duct injuries and outweighs the morbidity associated with subtotal gall bladder removal in certain circumstances. We Methods: evaluated the 81 patients who underwent Laparoscopic Reconstituting Subtotal cholecystectomy during July 2019 to Jan 2022. Preoperative parameters (Age, Gender, DM, Smoking, Alcohol, Fatty Liver) and postoperative parameters (Duration of surgery, Hospital Stay, Postoperative Bile leak, Postoperative ERCP stenting, retained stone, Mortality) were compared. Aim of the study was to evaluate outcome of the surgery and to identify the risk factors of bile leak. Results: Bile leak occurred in 5 patients (6.2%). All patient who had bile leak had fatty liver (p = 0.019, chi square test). Four out of five patients were diabetic (p = 0.079, 2 test). Four of five patients who had leak were above 50 yrs. of age group (P= 0.517, chi square test). Mean duration of surgery was higher for both Diabetic patients and Fatty liver patients, but statistically significant results were seen for Diabetics only (T test p=0.008). Laparoscopic recon Conclusion: stituting Subtotal Cholecystectomy is safe approach for the difficult cholecystectomy and with minimal/no risk of retained stones. Diabetes mellites and fatty liver are the risk factors to predict difficult cholecystectomy and we suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with Asymptomatic cholelithiasis.
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