Saudi Journal of Laparoscopy

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The prevalence of obesity in Saudi Arabia was 28.7% in 2013, and similar to the west, laparoscopic sleeve gastrectomy (LSG) is nowadays one of the most commonly performed bariatric procedures in Saudi Arabia. Portal vein thrombosis (PVT) was at first thought to be a rare and potentially fatal occurrence postoperatively. Recent data suggest that it is much more prevalent following LSG of all other bariatric procedures, and prognosis is favorable given early diagnosis and treatment. The aim of this article was to describe three cases of PVT post-LSG encountered at our institution and provide a brief review of the literature.

Aim: The aim of the present study was to evaluate the safety of laparoscopic completion cholecystectomy in patients with symptomatic gallbladder stump calculi. Materials and Methods: Ours was a prospective study conducted in three peripheral hospitals over a period of 6 years. All the patients undergoing elective laparoscopic cholecystectomy during this period were enrolled in the study. The outcomes of laparoscopic completion cholecystectomy in patients with gallbladder stump calculi were compared to those undergoing primary laparoscopic cholecystectomy with regards to perioperative morbidity and mortality. Results: A total of 3127 laparoscopic cholecystectomies were performed. Out of them, laparoscopic completion cholecystectomy was done in 36 (1.15%) patients. There were 21 males and 15 females in these 36 patients. The operative time and hospital stay were significantly increased in the completion group. None of our patients in the completion group required conversion. Perioperative complications were seen more often in the patients posted for completion cholecystectomy (6 [6.67%] vs. 207 [6.69%]; P = 0.0026). Bleeding was the most frequent intraoperative complication seen in the patients undergoing completion cholecystectomy. Conclusion: Laparoscopic completion cholecystectomy, though technically demanding, can be safely done even in a peripheral health setup with acceptable morbidity rate.

Context: With advancements in the field of minimally invasive surgery, a variety of general surgical, gynecological, and urological diseases are amenable to treatment by this approach. Combined procedures can be performed for treating coexisting abdominal pathologies. Aims: The study aimed to evaluate our experience of combining multiple minimally invasive procedures in terms of its safety and efficacy. Settings and Design: An observational study was conducted at three hospitals in Kashmir. Materials and Methods: A total of 149 patients underwent combined laparoscopic or combined laparoscopic and endoscopic procedures for the treatment of coexisting abdominal diseases. The outcome was analyzed in terms of mean operative time, postoperative visual analog scale score (0–10), requirement of additional postoperative analgesics, complications, hospital stay, and patient satisfaction. Statistical Analysis: Prospective sample survey analyzing the percentage and mean values. Results: Of 149 patients, 48 (32.2%) were male and 101 (67.7%) were female. Age ranged between 18-58 years in females and 24–70 years in males. The mean operative time ranged between 27 and 115 min. It was the longest in patients who underwent laparoscopic cholecystectomy (LC) with laparoscopically assisted vaginal hysterectomy. The most common organ-specific procedures performed were LC, appendectomy, and ovarian cystectomy in 120, 34, and 15 patients, respectively. Urological procedures were done in 36 patients undergoing either LC or appendectomy. Additional parenteral postoperative analgesics were required in 128 (85.9%) patients. A total of five major and 32 minor complications were noted in 22 (14.7%) patients. Three (2.01%) patients required conversion to open surgery. Orals were started on the 1^st postoperative day in the majority of the patients. The mean hospital stay was 2.4 days (range 1–6 days). Overall, 93.9% of the patients expressed satisfaction to the combined procedure. Conclusions: Simultaneous minimally invasive procedures are feasible for coexisting abdominal pathologies in selected patients with the advantages of single anesthesia and hospital admission, low morbidity, and excellent patient satisfaction.

Laparoscopy has evolved since as early as 1950 to the present state of being the standard approach for most common surgical procedures. It has gained popularity in clinical practice in view of better cosmetics, lesser postoperative pain, shorter hospitalization, and faster recovery. However, the creation of pneumoperitoneum with laparoscopy is associated with various pathophysiological changes, especially involving the cardiovascular and respiratory systems. Electronic databases were searched to obtain the relevant literature with keywords related to laparoscopy from 1985 to 2016. Ninety-three papers were reviewed. Bibliographies were cross-checked and relevant literature was included. The pneumoperitoneum associated with laparoscopy is found to cause a decrease in cardiac output with an increase in pulmonary and systemic vascular resistance. These changes are mainly due to the increase in abdominal pressure which causes elevation of diaphragm with compression of small and big blood vessels. In the lungs, it causes a decrease in functional residual capacity with impaired pulmonary ventilation and perfusion. Increase in intra-abdominal pressure also perils the splanchnic circulation with a decrease in blood flow to the major abdominal organs. Preoperative assessment requires special attention, especially in high-risk patients. General anesthesia with controlled ventilation has proven to the ideal technique. Various pharmacological agents are used with varying success to attenuate the hemodynamic responses to laparoscopy. This article discusses the various consequences of laparoscopy as well as strategies to counteract them. It is essential for the anesthesiologists to have a good understanding of these changes and intervene at appropriate levels in terms of optimization in the preoperative period and management of hemodynamic changes in the perioperative period for a good surgical and patient outcome.

Online since 8^th June, 2016