Combined Procedures in Laparoscopic Surgery

Abstract

With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30-280 minutes). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1-21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different coexisting pathologies without significant addition in postoperative morbidity and hospital stay.

Combined Procedures with Laparoscopic Cholecystectomy

“…We had no recurrence of the hernias during our follow up period (range 3months to 3years) [11]. Wadhwa et al in their study had a mean operative time of 62 mins for laparoscopic cholecystectomy and ventral hernia repair [12] We require 70 mins for the same. Their time for laparoscopic cholecystectomy with hysterectomy was 80 mins while ours was 100 mins.…”

“…Laparoscopy has come a long way since then & today myriad procedures are performed laparoscopically. Each of the procedure performed laparoscopically benefits from decreased post operative pain, early ambulation, and early return to oral feeds, early discharge and early return to work [12]. Patient benefits from the single exposure to anaesthesia, single hospital stay, and single break from work.…”

“…Minimal access surgery has the advantages of decreased hospital stay less post operative pain and morbidity, early return to work & better cosmesis [12]. Here we evaluate the safety & efficacy of a number of surgeries combined with laparoscopic cholecystectomy.…”

Synchronous Cholecystectomy and Totally Extraperitoneal (TEP) Herniorrhaphy Using an Umbilical Incision

“…Synchronous operation can provide patients with the advantage of single hospital stay and single anesthetic exposure resulting in convenience and cost effectiveness although combining procedures cause longer operation time, longer anesthesia, and risk of increased blood loss. 7 For LESS synchronous operations of cholecystectomy and TEP herniorrhaphy, only one umbilical incision was required although they were located in the both extremities of abdomen. If conventional laparoscopic techniques were adopted, it would require more than six port incisions, three or four for upper abdomen and three for lower abdomen.…”

“…1 With advancement of laparoendoscopic single-site surgery (LESS) a number of procedures of abdomen can be performed in a single surgery. 2 For the synchronously diagnosed gallstones and inguinal hernia, combined operation of cholecystectomy and totally extraperitoneal (TEP) herniorrhaphy would be the most minimally invasive treatment in the era of LESS. But anatomically, the gallbladder and inguinal hernia is located in the both extremities in the abdomen.…”