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Arumugaswamy PR, Chumber S, Rathore YS, Maitra S, Bhattacharjee HK, Bansal VK, Aggarwal S, Dhar A, Asuri K, Kataria K, Ranjan P. Low-pressure pneumoperitoneum with deep neuromuscular blockade versus standard pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy for gallstone disease: a non-inferiority randomized control trial. Surg Endosc 2024; 38:449-459. [PMID: 38012441 DOI: 10.1007/s00464-023-10558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Low-pressure pneumoperitoneum (LPP) is an attempt at improving laparoscopic surgery. However, it has the issue of poor working space for which deep neuromuscular blockade (NMB) may be a solution. There is a lack of literature comparing LPP with deep NMB to standard pressure pneumoperitoneum (SPP) with moderate NMB. METHODOLOGY This was a single institutional prospective non-inferiority RCT, with permuted block randomization of subjects into group A and B [Group A: LPP; 8-10 mmHg with deep NMB [ Train of Four count (TOF): 0, Post Tetanic Count (PTC): 1-2] and Group B: SPP; 12-14 mmHg with moderate NMB]. The level of NMB was monitored with neuromuscular monitor with TOF count and PTC. Cisatracurium infusion was used for continuous deep NMB in group A. Primary outcome measures were the surgeon satisfaction score and the time for completion of the procedure. Secondarily important clinical outcomes were also reported. RESULTS Of the 222 patients screened, 181 participants were enrolled [F: 138 (76.2%); M: 43 (23.8%); Group A n = 90, Group B n = 91]. Statistically similar surgeon satisfaction scores (26.1 ± 3.7 vs 26.4 ± 3.4; p = 0.52) and time for completion (55.2 ± 23.4 vs 52.5 ± 24.9 min; p = 0.46) were noted respectively in groups A and B. On both intention-to-treat and per-protocol analysis it was found that group A was non-inferior to group B in terms of total surgeon satisfaction score, however, non-inferiority was not proven for time for completion of surgery. Mean pain scores and incidence of shoulder pain were statistically similar up-to 7 days of follow-up in both groups. 4 (4.4%) patients in group B and 2 (2.2%) in group A had bradycardia (p = 0.4). Four (4.4%) cases of group A were converted to group B. One case of group B converted to open surgery. Bile spills and gallbladder perforations were comparable. CONCLUSION LPP with deep NMB is non-inferior to SPP with moderate NMB in terms of surgeon satisfaction score but not in terms of time required to complete the procedure. Clinical outcomes and safety profile are similar in both groups. However, it could be marginally costlier to use LPP with deep NMB.
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Affiliation(s)
- Prasanna Ramana Arumugaswamy
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Yashwant Singh Rathore
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Souvik Maitra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Hemanga Kumar Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Anita Dhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Krishna Asuri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Piyush Ranjan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Rai SK, Sarangi SS, Asuri K, Prajapati OP, Goyal A, Bansal VK. Laparoscopic ultrasonography along with staging laparoscopy as a tool for staging in patients with hepatopancreaticobiliary malignancy - A prospective cohort study from a tertiary care centre. J Minim Access Surg 2024; 20:96-101. [PMID: 38240385 PMCID: PMC10898638 DOI: 10.4103/jmas.jmas_354_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/22/2023] [Accepted: 07/15/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Staging laparoscopy (SL) plays an important role in avoiding unnecessary non-therapeutic laparotomy in radiologically resectable hepatopancreaticobiliary (HPB) malignancy patients. The limitation of SL is to detect deep-seated malignancy. The addition of laparoscopic ultrasonography for identifying metastatic lesions or locally unresectable disease improves the diagnostic yield of SL. PATIENTS AND METHODS This prospective, observational study was conducted in a single unit of the tertiary care centre between 2017 and 2019. All the patients of HPB malignancy who were radiologically resectable underwent SL and laparoscopic intraoperative ultrasonography. Metastatic disease patients were either underwent palliative bypass procedures or abandoned depending on the condition of the patient. Patients who had resectable disease underwent standard surgical procedures. RESULTS Forty patients of HPB malignancy with potentially resectable on radiological imaging underwent SL and diagnostic ultrasonography. Out of 40, 21 patients had periampullary, 14 had carcinoma gallbladder and 5 patients had distal cholangiocarcinoma. Metastatic lesions were identified on laparoscopy in eight patients and the diagnostic yield of SL is 20%. Addition of laparoscopic ultrasonography identified one haemangioma which was false positive on laparoscopy and underwent the radical standard procedure. Four patients were unresectable so the procedure was abandoned and another three patients underwent a bypass procedure. CONCLUSION Laparoscopic ultrasonography during SL can detect deep-seated metastatic lesions and decide the management in resectable disease.
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Affiliation(s)
- Sanjeet Kumar Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Shakti Swaroop Sarangi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Asuri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Om Prakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Roy NB, Khan WF, Krishna A, Bhatia R, Prakash O, Bansal VK. A comparative study to evaluate abdominal wall dynamics in patients with incisional hernia compared to healthy controls. Surg Endosc 2023; 37:9414-9419. [PMID: 37672111 DOI: 10.1007/s00464-023-10408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Incisional hernia is a common complication following abdominal surgery. It causes change in function of core abdominal muscles leading to change in abdominal wall dynamics. This study aims to objectively measure and compare preoperative abdominal wall dynamics with surface electromyography (sEMG) in incisional hernia patients with healthy individuals. MATERIALS AND METHODS In this prospective comparative study, two groups of participants as cases and controls were evaluated for their abdominal wall dynamics by using sEMG. Both cases and controls were evenly matched in terms of age and gender. Statistical analysis was done with STATA 14.1 and p value of < 0.05 was considered significant. RESULTS Demographic profile was comparable between the two groups. Mean BMI of cases was higher than controls. The most common index procedure was lower segment cesarean section. The strength and power of all three abdominal wall muscles (rectus abdominis, external oblique, internal oblique) were significantly diminished among cases compared to controls. CONCLUSIONS Abdominal wall dynamics can be objectively and correctly interpreted from sEMG of abdominal wall core muscles in patients with incisional hernia. This study shows that there is a decrease in abdominal wall strength and power in patients suffering from incisional hernia in comparison with healthy controls.
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Affiliation(s)
- Nilanjan Barman Roy
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Washim Firoz Khan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Renu Bhatia
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Om Prakash
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Bansal D, Krishna A, Prajapati O, Kumar S, Sagar R, Subramaniam R, Misra MC, Bansal VK. A Prospective Study Comparing Quality of Life after Laparoscopic Donor Nephrectomy versus Open Donor Nephrectomy. Saudi J Kidney Dis Transpl 2022; 33:345-352. [PMID: 37843135 DOI: 10.4103/1319-2442.385957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Laparoscopic donor nephrectomy (LDN) has advantages over open donor nephrectomy (ODN), with less bleeding and pain, and earlier discharge. However, the quality of life (QOL) has not been compared between these techniques. All consecutive donors undergoing left LDN or ODN from 2013 to 2015 at our center were included. The donors' QOL was measured with the brief World Health Organization QOL (WHOQOL-BREF) and the Hospital Anxiety and Depression Scale (HADS) questionnaires preoperatively and at 3 and 6 months postoperatively. Cosmesis was measured by the body image questionnaire, and patient satisfaction was scored on a verbal rating scale at 3 and 6 months. Of the 264 donors, 228 met the inclusion criteria (100 - LDN and 128 - ODN). The LDN group showed no difference in WHOQOL-BREF scores at 3 months, and significant improvements in the psychological and social domains at 6 months versus the baseline. The ODN group showed a significant decrease in the physical, psychological, and environmental domains at 3 and 6 months versus the baseline. Compared with the ODN group, the LDN group had better QOL scores at 3 and 6 months in all domains. The responses to the HADS questionnaire were similar between the groups at all time points. The mean body image, cosmesis, and satisfaction scores were significantly better in the LDN group. LDN minimized the negative effects of surgery on the donors' QOL, with improvements in the long-term psychological and social aspects versus the baseline. LDN was more cosmetic and was associated with higher satisfaction than ODN.
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Affiliation(s)
- Devanshu Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Jain M, Krishna A, Prakash O, Kumar S, Sagar R, Ramachandran R, Bansal VK. Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial. Surg Endosc 2022; 36:7494-7502. [PMID: 35277771 DOI: 10.1007/s00464-022-09180-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are no randomized controlled trials comparing the eTEP with IPOM repair and this randomized study was designed to compare the two techniques in terms of early pain, cost effectiveness, and quality of life. METHOD This was a prospective randomized trial with intention to treat analysis. The primary outcome was immediate post-operative pain scores. Operative time, conversions, peri operative morbidity, hospital stay, return to daily activities, incremental cost effectiveness ratio and quality of life (WHO-QOL BREF) were secondary outcomes. RESULTS Sixty patients were randomized equally. Early post-operative pain scores and seroma rates were significantly lower and with a significantly earlier return to activity in eTEP group (p value < 0.05). With negative costs and positive effects, eTEP group was 2.4 times more cost effective. CONCLUSION eTEP repair is better in terms of lesser early post-operative pain, earlier return to activities and cost effectiveness in small and medium size defects.
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Affiliation(s)
- Mayank Jain
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.
| | - Om Prakash
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.
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Singh A, Ramachandran R, Chandralekha C, Trikha A, Ray BR, Bansal VK, Mahajan S, Asuri K, Rewari V. Timing of intraoperative crystalloid infusion may decrease total volume of infusate without affecting early graft function in live related renal transplant surgery: A randomized, surgeon-blinded clinical study. Indian J Urol 2022; 38:53-61. [PMID: 35136296 PMCID: PMC8796753 DOI: 10.4103/iju.iju_239_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Early graft function is crucial for successful kidney transplantation. Intravascular volume maintenance is paramount in ensuring reperfusion of transplanted kidney. This study was planned to compare whether the timing of fluid infusion can help to decrease amount of fluid given without altering early graft function during renal transplantation. MATERIALS AND METHODS The present study included forty recipients, randomized into standard (Group-S) or targeted fluid therapy (Group-T). Group S received fluid according to conventional fasting deficit while Group T received at 1 ml/kg/h from the start of surgery till start of vascular anastomosis after which fluid infusion rate in both group was increased to maintain a central venous pressure of 13-15 mm of Hg till reperfusion. Primary outcome measured was serum creatinine level on first postoperative day while secondary outcomes were IV fluid given, perioperative hemodynamics, onset of diuresis, graft turgidity, urine output, and renal function during first 6 postoperative days. RESULTS The study showed Group T postoperatively had early fall in serum creatinine (day 3) than S (day 6) although this difference was not statistically significant. Group T had received significantly less fluid per kg of dry weight (T-42.7 ± 9.7 ml/kg, S-61.1 ± 11.1 ml/kg, P < 0.001), had early diuresis, better graft turgidity and urine output than Group S. CONCLUSION Targeted hydration significantly decreases the total amount of fluid infused during the intraoperative period without altering early graft function. Targeted hydration during vascular anastomosis produced stable hemodynamics and early diuresis without any side-effects pertaining to hypo or hyper-volemia.Clinical trial identifier number-CTRI/2016/07/007111.
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Affiliation(s)
- Abhishek Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India,E-mail:
| | - C. Chandralekha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Asuri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Krishna A, Maqbool U, Bansal VK, Prakash O, Kumar S. Spontaneous renal allograft rupture of unknown etiology - A case report. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_69_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Goyal A, Hemachandran N, Kumar A, Sharma R, Shamim SA, Bansal VK, Das CJ, Kandasamy D, Agarwal SK, Dinda AK, Seenu V. Evaluation of the Graft Kidney in the Early Postoperative Period: Performance of Contrast-Enhanced Ultrasound and Additional Ultrasound Parameters. J Ultrasound Med 2021; 40:1771-1783. [PMID: 33184930 DOI: 10.1002/jum.15557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the various quantitative parameters of Doppler ultrasound, contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) of graft kidneys in the early postoperative period and to explore their utility in the diagnosis of parenchymal causes of graft dysfunction. METHODS In this ethically approved study, consecutive patients who underwent renal transplantation from March 2017 to August 2018 were recruited, and those with urologic or vascular complications and those who denied consent were excluded. All patients underwent ultrasound with Doppler, SWE, CEUS (using sulfur hexafluoride), and renal scintigraphic examinations 3 to 10 days after transplantation. A composite reference standard was used, including the clinical course, renal function test results, urine output, and histopathologic results for graft dysfunction. Cortical SWE values, quantitative CEUS parameters (generated from a time-intensity curve), and their ratios were analyzed to identify graft dysfunction and differentiate acute tubular necrosis (ATN) from acute rejection (AR). RESULTS Of the 105 patients included, 19 developed graft dysfunction (18.1%; 12 ATN, 5 AR, and 2 drug toxicity) in the early postoperative period. The peak systolic velocity in the interpolar artery showed a significant difference between control and graft dysfunction groups (P < .001) as well as between ATN and AR (P = .019). Resistive indices and SWE did not show significant differences. Ratios of the time to peak showed a significant difference between control and graft dysfunction groups (P < .05). The rise time and fall time of the large subcapsular region of interest and the rise time ratio were significantly different between ATN and AR (P = .03). CONCLUSIONS Contrast-enhanced ultrasound can be used to diagnose parenchymal causes of early graft dysfunction with reasonable diagnostic accuracy.
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Affiliation(s)
- Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Naren Hemachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V Seenu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Bansal VK, Misra MC, Agarwal AK, Agrawal JB, Agarwal PN, Aggarwal S, Aslam M, Krishna A, Baksi A, Behari A, Bhattacharjee HK, Bhojwani R, Chander J, Chattopadhyay TK, Chintamani, Chowbey P, Dalvi A, Dash NR, Dhawan IK, Gamangatti S, Garg PK, Gupta NM, Gupta R, Gupta SK, Gupta V, Kaman L, Kapur BML, Kataria K, Khan M, Khanna AK, Khullar R, Kumar A, Kumar A, Kumar S, Kumar S, Lal P, Maurya SD, Moirangthem GS, Pal S, Panwar R, Parshad R, Pottakkat B, Prajapati OP, Puntambekar S, Ranjan P, Rathore YS, Sahni P, Sarangi R, Seenu V, Sharma R, Shukla VK, Singh DP, Singh J, Singh R, Sinha R, Sikora SS, Srivastava A, Srivastava A, Srivastava KN, Thomas S, Verma GR, Wig JD, Kapoor VK. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bansal VK, Prakash O, Krishna A, Jain M, Kumar S, Mishra MC. Comparison of Polypropylene Mesh with Covered Meshes in Patients Undergoing Intraperitoneal Onlay Mesh Repair of Incisional and Ventral Hernia—Our Experience and Review of Literature. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Alam S, Goyal A, Kandasamy D, Bansal VK, Asuri K, Agarwal S, Khadgawat R. Resistant Hypertension Due to Familial Hyperaldosteronism Type III: First Report From Indian Sub-Continent. J Endocr Soc 2021. [PMCID: PMC8089238 DOI: 10.1210/jendso/bvab048.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Familial hyperaldosteronism type III (FH-III) is caused by germline mutations in KCNJ5 gene. FH-III presents with phenotypic variability from spironolactone-responsive hypertension to massive adrenal hyperplasia requiring bilateral adrenalectomy. Till date, seven different pathogenic mutations in KCNJ5 gene have been identified. Here we describe a sporadic FH-III case, due to a Gly151Arg mutation, first from Indian subcontinent, presenting with extremely high plasma aldosterone concentration (PAC) values, further expanding our knowledge of this rare condition. Clinical Case: A 24-year-old female, symptomatic since age of 5 years with periodic limb weakness and gradual increase in frequency of episodes over the years. Her blood pressure (BP) was recorded for first time at 9 years of age, and it was 170/110 mm Hg. On evaluation at this time, PAC was highly elevated at 1007 ng/dL and plasma renin activity (PRA) was suppressed at 0.04 ng/ml/h with aldosterone renin ratio (ARR) of 25,175 ng/dL per ng/mL/h (>20 suggestive of primary aldosteronism). CT scan demonstrated mild enlargement of bilateral adrenal glands. A presumptive diagnosis of Glucocorticoid-remediable aldosteronism was made. She was started on dexamethasone, spironolactone and nifedipine but was not improved. Dexamethasone was stopped after 1 year of initiation. Before presenting to our referral center in 2018, she was having uncontrolled hypertension with recurrent episodes of hypokalemic paralysis. She was on maximal doses on four antihypertensive agents, further increased to six agents (including spironolactone 100 mg BD), and potassium chloride supplementation (120 mEq/day). Despite this, she had a serum potassium of 2.6 mEq/L. Her biochemical investigations demonstrated that PAC was 2070 ng/dL, direct renin concentration (DRC) was 2.35 µIU/mL (PRA 0.2 ng/ml/h) and ARR was 880.9 ng/dL per µIU/mL. CT scan revealed massive bilateral adrenal hyperplasia. Genetic analysis by whole exome sequencing detected KCNJ5 (p.Gly151Arg) mutation, confirming the diagnosis of FH-III. She was subjected to bilateral adrenalectomy and she became normokalemic. Dramatic reduction in antihypertensives with BP control achieved only on amlodipine post-operatively. Genetic testing of family members was not done but they were normotensive and normokalemic. Histopathological examination revealed bilateral adrenal hyperplasia. PAC levels up to 297 ng/dL have been described previously in FH-III but our patient had exceedingly high-level of 2070 ng/dL. Conclusion: This case demonstrates florid clinical and biochemical manifestations of FH-III and gradual worsening of symptoms, consistent with progression of disease with age. It illustrates that proper investigations and treatment can lead to remission of symptoms. Further studies are warranted to elucidate the full clinical and biochemical spectrum of FH-III.
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Affiliation(s)
- Sarah Alam
- All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Krishna Asuri
- All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- All India Institute of Medical Sciences, New Delhi, India
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Ghosh NK, Bhattacharjee HK, Prajapati O, Krishna A, Kumar A, Mahajan S, Bansal VK. Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients. J Vasc Access 2021; 23:508-514. [PMID: 33719712 DOI: 10.1177/11297298211001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND About 18%-65% of Arterio-Venous fistula (AVF) made to facilitate haemodialysis in end stage renal disease patient fail to mature. This study was designed to evaluate the impact of clinical parameters and vascular haemodynamics on maturation of AVF on Indian patients. MATERIAL AND METHODS This was a prospective observational study. Eligible patients' clinical profiles and vascular haemodynamics by Doppler ultrasonography were noted. All patients underwent radio-cephalic AVF on the non-dominant arm under local anaesthesia. Clinical definition was used to assess success rate of AVFs which is defined as successful six settings of satisfactory dialysis. Data were analysed using Stata/12.0 software. Independent t-test, chi-square test, logistic regression analysis and multivariate analysis were used. The p-value of <0.05 was considered significant. RESULTS A total of 205 patients were enrolled and analysed. Among clinical factors, age, sex, serum creatinine, hypertension had no significant association with failure (p = 0.5, 0.08, 0.76 and 0.74). Patient's BMI and presence of diabetes had significant impact on outcome (p < 0.001 and 0.02 respectively). Among vascular haemodynamics, radial vein diameter of >2.5 mm and radial artery flow rate >40 ml/min had no significant association with failure (p = 0.12 and 0.28). Diameter of radial artery (>2 mm) and intra-operatively immediate thrill were independent predictor of success (p = 0.002 and <0.001). CONCLUSION In the present study rate of fistula, maturation was 73.2% without any post-operative radiological intervention. Radial artery diameter >2 mm and presence of immediate thrill post-operatively were significantly associated with successful cannulation.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | | | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Khatiwada S, Agarwal S, Kandasamy D, Jyotsna VP, Kumar R, Kumar Bansal V, Pandey RM, Gupta N, Tandon N. Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission. Diabetes Metab Syndr 2020; 14:2169-2175. [PMID: 33395777 DOI: 10.1016/j.dsx.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Pheochromocytoma and paraganglioma (PPGL) are associated with dysglycemia and diabetes mellitus (DM) much of which improves post operatively. In this study, we set out to ascertain pre and post-operative prevalence of DM in patients with PPGL based on oral glucose tolerance test (OGTT) and HbA1c and to evaluate effect of insulin secretion and sensitivity indices on DM pre-operatively. METHODS Clinical and anthropometric data collection, HbA1c, 75 g OGTT with serum insulin estimation were done pre-operatively (n = 34) and at follow-up after successful surgery (n = 24) in patients with PPGL. RESULTS Pre and post-operative prevalence of DM were 48%(18/37) and 17% (4/24) respectively. Comparison of patients with highest (Q4) and lowest (Q1) quartiles of insulinogenic index (IGI),a parameter of insulin secretion, revealed trends towards higher prevalence of DM in patients with lower IGI (Q4 to Q1: 29% versus 71%,n = 28, p = 0.24)but no association was observed with HOMA-IR (Q4 to Q1:50% versus 57%, n = 28, p = 1.00), an insulin sensitivity index. DM remitted in 77% patients post-operatively, predicted by duration of DM of<3 years. CONCLUSION There is high prevalence of DM in PPGL, with marked remission post-operatively, especially predicted by shorter duration of DM. Impaired insulin secretion is more strongly associated with pre-operative DM than increased insulin resistance.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | | | | | - V P Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India.
| | | | | | - R M Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
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14
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Firoz Khan W, Kumar Bansal V, Asuri K, Prakash O. Ergonomic Analysis of Muscle Activity during Laparoscopy and Influence of Training. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Qin R, Kendrick ML, Wolfgang CL, Edil BH, Palanivelu C, Parks RW, Yang Y, He J, Zhang T, Mou Y, Yu X, Peng B, Senthilnathan P, Han HS, Lee JH, Unno M, Damink SWMO, Bansal VK, Chow P, Cheung TT, Choi N, Tien YW, Wang C, Fok M, Cai X, Zou S, Peng S, Zhao Y. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr 2020; 9:464-483. [PMID: 32832497 PMCID: PMC7423539 DOI: 10.21037/hbsn-20-446] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023]
Abstract
IMPORTANCE While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD. OBJECTIVE The aim of this consensus statement is to guide the continued safe progression and adoption of LPD. EVIDENCE REVIEW An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China. FINDINGS Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument. CONCLUSIONS AND RELEVANCE The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.
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Affiliation(s)
- Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Christopher L. Wolfgang
- Division of Surgical Oncology, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barish H. Edil
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Chinnusamy Palanivelu
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rowan W. Parks
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Jin He
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiping Mou
- Department of Gastroenterology and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Palanisamy Senthilnathan
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven W. M. Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Pierce Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Nim Choi
- Department of General Surgery, Hospital Conde S. Januário, Macau, China
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Manson Fok
- Department of Surgery, University Hospital, Macau University of Science and Technology, Macau, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Shengquan Zou
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyou Peng
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Asuri K, Mohammad A, Prajapati OP, Sagar R, Kumar A, Sharma M, Chaturvedi PK, Gupta SV, Rai SK, Misra MC, Bansal VK. A prospective randomized comparison of sexual function and semen analysis following laparoscopic totally extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) inguinal hernia repair. Surg Endosc 2020; 35:2936-2941. [PMID: 32556764 DOI: 10.1007/s00464-020-07733-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With standardization of laparoscopic technique of groin hernia repair, the focus of surgical outcome has shifted to lesser studied parameters like sexual function and fertility. METHODS This prospective randomized study was conducted in a single surgical unit at a tertiary care hospital. A sample size of 144 was calculated with 72 in each group (Group 1 TEP and Group 2 TAPP). Primary outcomes measured included comparison of sexual function using BMFSI, qualitative semen analysis and ASA levels between patients undergoing TEP or TAPP repair. Semen analysis and ASA was measured pre-operatively and 3 months post-operatively. RESULTS A total of 145 patients were randomized into two groups, TAPP (73) and TEP (72) patients. Both the groups were comparable in terms of demographic profile and hernia characteristics with majority of the patients in both the groups having unilateral inguinal hernia (89.0% in TAPP group and 79.2% in TEP group). Both the groups showed statistically significant improvement in overall sexual function score (BMFSI) at 3 months; however, there was no inter group difference. Both the groups were also comparable in terms of ASA and qualitative semen analysis. CONCLUSION Both TEP and TAPP repair are comparable in terms of sexual function and effect on semen analysis. Laparoscopic repair improves the overall sexual functions in patients with groin hernia.
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Affiliation(s)
- Krishna Asuri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
| | - Aamir Mohammad
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Om Prakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radio Diagnosis, All India Institute of Medical Sciences, India, New Delhi
| | - Mona Sharma
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shardool Vikram Gupta
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeet Kumar Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | | | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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17
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Kumar N, Goyal A, Manchanda S, Sharma R, Kumar A, Bansal VK. Aggressive pelvic angiomyxoma and its mimics: can imaging be the guiding light? Br J Radiol 2020; 93:20200255. [PMID: 32401545 DOI: 10.1259/bjr.20200255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the imaging characteristics of aggressive angiomyxoma (AA) and identify features which would help to differentiate it from similar appearing lesions. METHODS A retrospective review of departmental records was done and cases where AA was suspected on CT or MRI were included. With histopathology as gold-standard, the cases were grouped into AA or mimics and differentiating features were identified on USG, CT and MRI. Fischer's exact test was applied for the statistical significance of the differentiating features. RESULTS 18 patients were identified of which 2 were excluded for lack of histopathology records. 10 were AA and 6 mimics which included 2 fibromatoses, 2 neurogenic tumors, and 1 each of germ cell tumor and inflammatory myofibroblastic tumor. On MRI, all AA showed T2 hyperintensity and intense contrast enhancement with characteristic laminated pattern in 7/9 cases. Diffusion restriction was seen in 2/3 cases, cystic component in 4/10 and hemorrhage in 1/10 cases. Pelvic fibromatosis was the closest imaging differential showing laminated pattern in one of the cases. CONCLUSION Large pelvic mass with abdominal/perineal extension in reproductive age female patient should lead to suspicion of AA. Laminated pattern on T2 weighted images and intense homogeneous contrast enhancement further add to the diagnostic confidence. ADVANCES IN KNOWLEDGE This study for the first time describes radiological mimics of AA. Large cystic component, diffusion restriction, hemorrhage and organ infiltration have not been previously described in AA.
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Affiliation(s)
- Niraj Kumar
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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18
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Krishna A, Bansal VK, Gupta S, Misra MC. Prospective Randomized Controlled Study to Compare the Outcome of Standard 4-Port Laparoscopic Cholecystectomy with Single-Incision Laparoscopic Cholecystectomy in Patients with Gallstone Disease. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Srivastava A, Nasta AM, Pathania BS, Sundaram E, Jani KV, Manickavasagam K, Asuri K, Lal P, Goel RG, Chaudhari T, Bansal VK. Surgical practice recommendations for minimal access surgeons during COVID 19 pandemic - Indian inter-society directives. J Minim Access Surg 2020; 16:195-200. [PMID: 32503958 PMCID: PMC7440016 DOI: 10.4103/jmas.jmas_93_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
These are inter-society guidelines for performance of laparoscopic surgery during COVID-19 pandemic that has affected the way of surgical practice. The safety of healthcare workers and patients is being challenged. It is prudent that our surgical practice should adapt to this rapidly changing health environment. The guidance issued is based on global practices and national governmental directives. The Inter-Society Group urges you to be updated with the developing situation and evolving changes.
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Affiliation(s)
- Amit Srivastava
- Department of Minimal Access Surgery, Srivastava Hospital, Agra, Uttar Pradesh, India
| | - Amrit Manik Nasta
- Center of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | | | | | - Kalpesh V Jani
- Department of Minimal Access Surgery, VIGOS Hospital, Vadodara, Gujarat, India
| | - Kanagavel Manickavasagam
- Department of General, Gastrointestinal and Minimal Access Surgery, St. Isabel's Hospital, Chennai, Tamil Nadu, India
| | - Krishna Asuri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Pawanindra Lal
- Department of Surgery, Maulana Azad Medical College, University of Delhi; Departement of General Surgery, Lok Nayak Hospital, New Delhi, India
| | - Ramen G Goel
- Center of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Tamonas Chaudhari
- Department of Surgery, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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20
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Krishna A, Bansal VK, Kumar S, Garg P, Kapoor BML, Misra MC. Pancreaticogastrostomy After Whipple’s Surgery Avoids Pancreatic Fistula—a Large Case Series Analysis. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01991-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Manoharan D, Kumar A, Krishna A, Bansal VK. Unusual pseudocyst in a wandering spleen. BMJ Case Rep 2019; 12:12/9/e229948. [PMID: 31492728 DOI: 10.1136/bcr-2019-229948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudocysts of the spleen are rare, generally asymptomatic lesions developing secondary to trauma, infection or infarction. When symptomatic, they typically present as non-specific pain in the left hypochondrium, with or without a palpable lump on clinical examination. However, these conventions fail when they occur in a wandering spleen, making imaging critically important. This report describes an unusual case of a 50-year-old who presented with a large cystic mass in a pelvic spleen; imaging facilitated a successful splenectomy and subsequent histopathology revealed a pseudocyst in a wandering spleen.
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Affiliation(s)
- Dinesh Manoharan
- Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Atin Kumar
- Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Asuri Krishna
- General Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 2019; 33:3069-3139. [PMID: 31250243 PMCID: PMC6722153 DOI: 10.1007/s00464-019-06907-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
Abstract In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
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Affiliation(s)
- R Bittner
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia. .,Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
| | - K Bain
- Department of Surgery, New York University, New York, USA
| | - V K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - F Berrevoet
- Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - J Bingener-Casey
- Division of Breast, Endocrine, Metabolic & Gastrointestinal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Chen
- Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Los Angeles, USA
| | - J Chen
- Department of Hernia and Abdominal Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Fengtai, China
| | - P Chowbey
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - U A Dietz
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - A de Beaux
- Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - G Ferzli
- Department of Surgery, New York University, New York, USA
| | - R Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, 1160, Vienna, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - M Iskander
- Department of Surgery, Mount Sinai Hospital, 1010 5th Avenue, New York, NY, 10028, USA
| | - Z Ji
- Department of Surgery, Southeast University School of Medicine, Main Add. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, China
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen NV, Denmark
| | - R Khullar
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - P Kirchhoff
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Germany
| | - J Kukleta
- Klinik im Park, Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - K LeBlanc
- Our Lady of the Lake Physician Group, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA
| | - J Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - D Lomanto
- Department of Surgery, YLL School of Medicine, National University Hospital, Level 2, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - F Mayer
- Paracelsus Medizinische Universität Salzburg (PMU), Universitätsklinik für Chirurgie, Salzburg, Austria
| | - V Meytes
- Department of Surgery, New York University, New York, USA
| | - M Misra
- Mahatma Gandhi University of Medical Sciences & Technology, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, 302 022, India
| | - S Morales-Conde
- Centro de Cirugía Mayor Ambulatoria Ave María, Avda. de la Palmera, 53, 41013, Seville, Spain
| | - H Niebuhr
- HANSECHIRURGIE, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Radvinsky
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - B Ramshaw
- Department of Surgery, University Surgeons Associates, 1930 Alcoa Highway, Bldg A, Ste 285, Knoxville, TN, 37920, USA
| | - D Ranev
- Lenox Hill Hospital-Northwell Health, New York, USA
| | - W Reinpold
- Abteilung für Chirurgie, Wilhelmsburger Krankenhaus, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Sharma
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - R Schrittwieser
- Abteilung für Chirurgie, LKH Hochsteiermark, Standort Bruck an der Mur Tragösser Str. 1, 8600, Bruck an der Mur, Austria
| | - B Stechemesser
- Hernienzentrum Köln, Zeppelinstraße 1, 50667, Cologne, Germany
| | - B Sutedja
- Gading Pluit Hospital, Jl. Boulevard Timur Raya Kelapa Gading, Jakarta, 14250, Indonesia
| | - J Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - J Warren
- Minimally Invasive Surgery, Greenville Health System, Department of Surgery, University of South Carolina School of Medicine, Greenville, USA
| | - D Weyhe
- Pius-Hospital Oldenburg, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Georgstraße 12, 26121, Oldenburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - G Woeste
- AGAPLESION ELISABETHENSTIFT gemeinnützige GmbH, Akademisches Lehrkrankenhaus, Landgraf-Georg-Strasse 100, 64287, Darmstadt, Germany
| | - Q Yao
- Department of Hernia and Abdominal Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Garg PK, Meena D, Babu D, Padhan RK, Dhingra R, Krishna A, Kumar S, Misra MC, Bansal VK. Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. Surg Endosc 2019; 34:1157-1166. [PMID: 31140002 DOI: 10.1007/s00464-019-06866-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP. PATIENTS AND METHODS Patients with symptomatic pseudocysts or walled-off necrosis suitable for laparoscopic and endoscopic transmural internal drainage were randomized to either modality in a randomized controlled trial. Endoscopic drainage comprised of per-oral transluminal cystogastrostomy. Additionally, endoscopic lavage and necrosectomy were done following a step-up approach for infected collections. Surgical laparoscopic cystogastrostomy was done for drainage, lavage, and necrosectomy. Primary outcome was resolution of PFCs by the intended modality and secondary outcome was complications. RESULTS Sixty patients were randomized, 30 each to laparoscopic and endoscopic drainage. Both groups were comparable for baseline characteristics. The initial success rate was 83.3% in the laparoscopic and 76.6% in the endoscopic group (p = 0.7) after the index intervention. The overall success rate of 93.3% (28/30) and 90% (27/30) in the laparoscopic and endoscopic groups respectively was also similar (p = 1.0). Two patients in the laparoscopic group required endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention. CONCLUSIONS Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend on available expertise and patient preference.
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Affiliation(s)
- Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
| | - Danishwar Meena
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Babu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Padhan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Dhingra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Chandra Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
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Narayanan R, Kumar S, Gupta A, Bansal VK, Sagar S, Singhal M, Mishra B, Bhoi S, Gupta B, Gamangatti S, Kumar A, Misra MC. An Analysis of Presentation, Pattern and Outcome of Chest Trauma Patients at an Urban Level 1 Trauma Center. Indian J Surg 2018; 80:36-41. [PMID: 29581683 PMCID: PMC5866799 DOI: 10.1007/s12262-016-1554-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022] Open
Abstract
Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25 % of deaths due to trauma. Therefore, this study was conducted to analyze the presentation, patterns, and outcome of chest trauma in a level-1 urban trauma center. It was a prospective observational study of all patients presented with chest trauma to an urban level 1-trauma center over a period of 3 years. Demographic profile, mechanism of injury, injury severity scores (ISS), associated injuries, hospital stay, etc. were recorded. Morbidity and mortality rates were analyzed and compared with the published literature. Chest injuries comprised 30.9 % of all trauma admissions and the mechanism was blunt in majority (83.5 %) of the cases. Vehicular crashes (59.7 %) followed by assault were the most common modes of injury. Rib fracture was the most common chest injury seen in 724 of the 1258 patients while abdominal visceral injuries were the commonest associated injuries in polytrauma cases. Majority of the patients were managed non-operatively. Inter costal tube drainage (ICD) was the main stay of treatment in 75 % of the cases, whereas, thoracotomy was required only in 5.56 % of the patients. Overall mortality was 11 % and it was found to be significantly higher following blunt chest trauma. We observed that associated extra thoracic injuries resulted in higher mortality as compared to isolated chest injuries. Thoracic injuries can be readily diagnosed in the emergency department by meticulous and repeated clinical evaluation and majority require simple surgical procedures to prevent immediate mortality and long-term morbidity.
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Affiliation(s)
- Rajasekhar Narayanan
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Subodh Kumar
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Amit Gupta
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Virinder Kumar Bansal
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sushma Sagar
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Maneesh Singhal
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Biplab Mishra
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Babita Gupta
- Department of Anesthesia, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Shivanand Gamangatti
- Department of Radiodiagnosis, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Adarsh Kumar
- Department of Forensic Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Mahesh Chandra Misra
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 110029 India
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Bansal VK, Krishna A, Rajan K, Prajapati O, Kumar S, Rajeshwari S, Garg P, Misra MC. Outcomes of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography in Patients with Concomitant Gall Stones and Common Bile Duct Stones: A Prospective Study. J Laparoendosc Adv Surg Tech A 2016; 26:985-991. [DOI: 10.1089/lap.2016.0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Rajan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subramaniam Rajeshwari
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C. Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Garg PK, Bansal VK. Intraoperative on-table endoscopic retrograde cholangiopancreatography (ERCP) is better than laparoscopic bile duct exploration for concomitant bile duct stones during emergency laparoscopic cholecystectomy. Evid Based Med 2016; 22:27. [PMID: 27836920 DOI: 10.1136/ebmed-2016-110549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Bansal VK, Krishna A, Manek P, Kumar S, Prajapati O, Subramaniam R, Kumar A, Kumar A, Sagar R, Misra MC. A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs. Surg Endosc 2016; 31:1478-1486. [PMID: 27495344 DOI: 10.1007/s00464-016-5142-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is very scant literature on the impact of inguinal hernia mesh repair on testicular functions and sexual functions following open and laparoscopic repair. The present randomized study compares TAPP and TEP repairs in terms of testicular functions, sexual functions, quality of life and chronic groin pain. METHODS This study was conducted from April 2012 to October 2014. A total of 160 patients with uncomplicated groin hernia were randomized to either trans-abdominal pre-peritoneal (TAPP) repair or totally extra-peritoneal (TEP) repair. Testicular functions were assessed by measuring testicular volume, testicular hormone levels preoperatively and at 3 months postoperatively. Sexual functions were assessed using BMSFI, and quality of life was assessed using WHO-QOL BREF scale preoperatively and at 3 and 6 months postoperatively. Chronic groin pain was evaluated using the VAS scale at 3 months, 6 months and at 1 year. RESULTS The median duration of follow-up was 13 months (range 6-18 months). The mean preoperative pain scores (p value 0.35) as well as the chronic groin pain were similar between TEP and TAPP repairs at 3 months (p value 0.06) and 6 months (p value 0.86). The testicular resistive index and testicular volume did not show any significant change at follow-up of 3 months (p value 0.9) in the study population. No significant difference was observed in testicular resistive index and testicular volume when comparing TEP and TAPP groups at at follow-up of 3 months (p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over the follow-up period following laparoscopic inguinal hernia repair. However, sexual function improvement was similar in patients undergoing both TEP and TAPP repairs. All the domains of quality of life in the study population showed a significant improvement at a follow-up of 3 and 6 months. Subgroup analysis of all the domains of quality of life in both TAPP and TEP groups showed a similar increment as in the study population (p value <0.001); however, the mean scores of all the domains were comparable between the two subgroups (p value >0.05), preoperatively and 3 and 6 months follow-up. CONCLUSIONS Laparoscopic groin hernia repair improves the testicular functions, sexual functions and quality of life, but TEP and TAPP repairs are comparable in terms of these long-term outcomes.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Pratik Manek
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Kumar
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - M C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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28
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Prakash P, Bansal VK, Misra MC, Babu D, Sagar R, Krishna A, Kumar S, Rewari V, Subramaniam R. A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair. J Minim Access Surg 2016; 12:154-61. [PMID: 27073309 PMCID: PMC4810950 DOI: 10.4103/0972-9941.170018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of our study was to compare chronic groin pain and quality of life (QOL) after laparoscopic lightweight (LW) and heavyweight (HW) mesh repair for groin hernia. MATERIALS AND METHODS One hundred and forty adult patients with uncomplicated inguinal hernia were randomised into HW mesh group or LW mesh group. Return to activity, chronic groin pain and recurrence rates were assessed. Short form-36 v2 health survey was used for QOL analysis. RESULTS One hundred and thirty-one completed follow-up of 3 months, 66 in HW mesh group and 65 in LW mesh group. Early post-operative convalescence was better in LW mesh group in terms of early return to walking (P = 0.01) and driving (P = 0.05). The incidence of early post-operative pain, chronic groin pain and QOL and recurrences were comparable. CONCLUSION Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term.
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Affiliation(s)
- Pradeep Prakash
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Delhi, India
| | - Mahesh Chandra Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Delhi, India
| | - Divya Babu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Asuri Krishna
- Department of Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, All India Institute of Medical Sciences, Delhi, India
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29
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Bava EP, Ramachandran R, Rewari V, Chandralekha, Bansal VK, Trikha A. Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial. Anesth Essays Res 2016; 10:561-567. [PMID: 27746552 PMCID: PMC5062234 DOI: 10.4103/0259-1162.186620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored. Aims: The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC. Settings and Design: This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital. Materials and Methods: Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively. Statistical Analysis: The data were analyzed using t-test, Mann–Whitney test or Chi-square test. Results: The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group (P = 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 (P = 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period (P = 0.034 and P = 0.007, respectively). Conclusion: USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.
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Affiliation(s)
- Ejas P Bava
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Chandralekha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anjan Trikha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Vassiliadis A, Zanoni A, Di Leo A, Zanella S, Lauro E, Moscatelli P, Ricci F, Huang H, Wada N, Furukawa T, Kitagawa Y, Hirukawa H, Takesue Y, Saito K, Sato H, Tada T, Choua O, Fu XJ, Yao QY, Yang S, Wang MG, Zhu YL, Cao JX, Shen YM, Togbe JO, Gbessi DG, Dossou FM, Iawani I, Cijan V, Gencic M, Scepanovic M, Bojovic P, Brankovic M, Agresta F, Verza LA, Prando D, Roveran MA, Azabdaftari A, Rubinato L, Vacca U, Lubrano T, Vidotto C, Falcone A, Grasso L, Ghiglione F, Morino M, Nácul M, Cavazzola L, Loureiro M, Bonin E, Ferreira P, Misra MC, Bansal VK, Subodh K, Krisha A, Bansal D, Ray S, Rajeshwari S, Wang P, Jia Z, Zhang FJ, Yan JJ, Zhu YH, Jiang K, Altinli E, Eroglu E, Sertel HI, Hizli F, Jacob B, Bresnaham E, Reiner M, Bates A. Inguinal Hernia: Lap vs Open. Hernia 2015; 19 Suppl 1:S57-62. [PMID: 26518862 DOI: 10.1007/bf03355327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Vassiliadis
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - A Zanoni
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - A Di Leo
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - S Zanella
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - E Lauro
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - P Moscatelli
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - F Ricci
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - H Huang
- Union Hospital, Fujian Medical University, Fuzhou, China
| | - N Wada
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - T Furukawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - H Hirukawa
- Tachikawa General Hospital, Nagaoka, Japan
| | - Y Takesue
- Tachikawa General Hospital, Nagaoka, Japan
| | - K Saito
- Tachikawa General Hospital, Nagaoka, Japan
| | - H Sato
- Tachikawa General Hospital, Nagaoka, Japan
| | - T Tada
- Tachikawa General Hospital, Nagaoka, Japan
| | - O Choua
- N'Djaména School of Medecine, N'Djaména, Chad
| | | | - Q Y Yao
- Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - M G Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | - V Cijan
- Surgery department, Clinical Hospital Center Zvezdara, Belgrade, Serbia
| | | | | | | | | | - F Agresta
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - L A Verza
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - D Prando
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - M A Roveran
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - A Azabdaftari
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - L Rubinato
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - U Vacca
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - T Lubrano
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - C Vidotto
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - A Falcone
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - L Grasso
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - F Ghiglione
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - M Morino
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - M Nácul
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L Cavazzola
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - E Bonin
- Universidade Positivo, Curitiba, Brazil
| | | | - M C Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - V K Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - P Wang
- Center of Hernia Surgery Department of Nanjing Medical, University associated HangZhou Hospital, Hangzhou, China
| | | | | | | | | | | | - E Altinli
- Dept. of General Surgery, TC Istanbul Bilim University, Istanbul, Turkey
| | - E Eroglu
- Dept. of General Surgery, TC Istanbul Bilim University, Istanbul, Turkey
| | - H I Sertel
- Florence Nightingale Kadikoy Hospital, Istanbul, Turkey
| | - F Hizli
- Florence Nightingale Kadikoy Hospital, Istanbul, Turkey
| | - B Jacob
- Mount Sinai Medical Center, New York, USA
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LeBlanc K, Jensen K, Krarup PM, Jorgensen L, Mynster T, Zappa B, Begolli L, Quazi S, Bhargava A, Luque JB, Suarez Gráu JM, Menchero JG, Moreno JG, Juraro JG, Ferreras ID, Nardi M, Millo P, Usai A, Lorusso R, Grivon M, Persico F, Allieta R, Christoffersen M, Brandt E, Helgstrand F, Westen M, Rosenberg J, Kehlet H, Strandfeit P, Bisgaard T, Vanini P, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Katsumoto F, Ahlqvist S, Björk D, Jänes A, Weisby-Enbom L, Israelsson L, Cengiz Y, Ndungu B, Kiragu P, Odende K, Jovanovic S, Pejcic V, Filipovic N, Trenkic M, Pavlovic A, Jovanovc B, Tatic M, Jovanovic A, Misra MC, Bansal VK, Subodh H, Krishna A, Bansal D, Ray S, Rajeshwari S, Björklund I, Burman A, Riccio PA, Vetrone G, Linguerri R, Liotta S, Antor M, Scottá M, Khalil H, Ichihara K, Takuo H, Ogawa M, Hidaka S, Hara K, Taki T, Ohashi S, Yoshida K, Galimov O, Shkundin A, Khanov V, Sarik J, Basta M, Bauder A, Kovach S, Fischer J, Tang L, Fei X, Xu M. Incisional Hernia: Daily Cases. Hernia 2015; 19 Suppl 1:S85-92. [PMID: 26518867 DOI: 10.1007/bf03355332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K LeBlanc
- Our Lady of the Lake Physician Group, Baton Rouge, Louisiana, USA.,Department of Surgery, Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - L Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - T Mynster
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - B Zappa
- King George Hospital, London, UK
| | | | - S Quazi
- King George Hospital, London, UK
| | | | | | | | | | | | | | | | - M Nardi
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - P Millo
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - A Usai
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Lorusso
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Grivon
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - F Persico
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Allieta
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Christoffersen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - E Brandt
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - F Helgstrand
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - M Westen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - J Rosenberg
- Gastro Unit, Surgical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Strandfeit
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - T Bisgaard
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - F Katsumoto
- Katsumoto Day Surgery Clinic, Kitakyusyu, Japan
| | - S Ahlqvist
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - D Björk
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L Weisby-Enbom
- Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden
| | - L Israelsson
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - Y Cengiz
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - B Ndungu
- The University of Nairobi, Nairobi, Kenya
| | - P Kiragu
- Maralal County Hospital, Maralal, Kenya
| | - K Odende
- Kenyatta National Hospital, Nairobi, Kenya
| | - S Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - V Pejcic
- Center for minimally invasive surgery, Nis, Serbia
| | - N Filipovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M Trenkic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Pavlovic
- Center for minimally invasive surgery, Nis, Serbia
| | - B Jovanovc
- Center for minimally invasive surgery, Nis, Serbia
| | - M Tatic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M C Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - V K Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - H Subodh
- All India Institute of Medical Sciences, New Delhi, India
| | - A Krishna
- All India Institute of Medical Sciences, New Delhi, India
| | - D Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - S Ray
- All India Institute of Medical Sciences, New Delhi, India
| | - S Rajeshwari
- All India Institute of Medical Sciences, New Delhi, India
| | | | - A Burman
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | | | | | | | | | - M Antor
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | | | | | - H Takuo
- Katsusika Medical Center, Tokyo, Japan
| | - M Ogawa
- Katsusika Medical Center, Tokyo, Japan
| | - S Hidaka
- Katsusika Medical Center, Tokyo, Japan
| | - K Hara
- Katsusika Medical Center, Tokyo, Japan
| | - T Taki
- Katsusika Medical Center, Tokyo, Japan
| | - S Ohashi
- Katsusika Medical Center, Tokyo, Japan
| | - K Yoshida
- Katsusika Medical Center, Tokyo, Japan
| | - O Galimov
- Bashkir State Medical University, Ufa, Russia
| | - A Shkundin
- Bashkir State Medical University, Ufa, Russia
| | - V Khanov
- Bashkir State Medical University, Ufa, Russia
| | - J Sarik
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - M Basta
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - A Bauder
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - S Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - L Tang
- Shaoxing people' hospital, Shaoxing, China
| | - X Fei
- Shaoxing people' hospital, Shaoxing, China
| | - M Xu
- Shaoxing people' hospital, Shaoxing, China
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Bansal VK, Rajan K, Sharma A, Paliwal P, Chaubal G, Jindal V, Misra MC, Kucheria K. Prospective Case-Control Study to Evaluate the Role of Glutathione S Transferases (GSTT1 and GSTM1) Gene Deletion in Breast Carcinoma and Its Prognostic Significance. Indian J Surg 2014; 77:1067-72. [PMID: 27011512 DOI: 10.1007/s12262-014-1152-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
Breast cancer is the most common cause of cancer death in women with the incidence rising in young women. GST gene polymorphisms are significant because of their role in the detoxification of both environmental carcinogens and also cytotoxic drugs used in therapy for breast cancer. The present study has been designed to identify the role of polymorphisms in GSTT1 and GSTM1 genes in the risk of development of breast cancer, in the prognostication of breast cancer, and in the prediction of response towards chemotherapy. Ninety-nine patients with breast cancer and 100 healthy controls with no history of cancer were taken from blood donors after informed consent. Epidemiological and clinical data was collected from participants and 5 ml of peripheral venous blood was collected for genotype analysis. Null genotype of GSTT1 was detected in 51.04 % of the controls in comparison to 20.2 % of patients with carcinoma breast, which was found to be statistically significant (OR 4.18; 95 % CI 2.01-8.75; P = 0.0001). GSTM1 gene deletion was also significantly more common among controls (60 %) than in patients with breast cancer (33 %) (OR 4.57; 95 % CI 2.20-9.51; P = 0.0001). Tumors more than 5 cm in size had greater tendency for GSTM1 gene expression (P value = 0.019), but other clinicopathological parameters did not show any correlation. GSTT1 and GSTM1 genes status did not show any association with response to chemotherapy. The results indicated the null genotype of both GSTT1 and GSTM1 to be protective for the development of carcinoma breast. None of the known etiological factors have any correlation with GSTT1 and GSTM1 gene deletion. Patients with small tumor size expressed GSTM1 gene deletion. Other tumor characteristics and clinicopathological parameters did not have any correlation with gene deletion.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Karthik Rajan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Arundhati Sharma
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Preeti Paliwal
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Chaubal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Vikas Jindal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Kiran Kucheria
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.
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Affiliation(s)
| | | | - Sandeep Guleria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Mallick S, Dinda AK, Rajan K, Bansal VK, Sharma MC, Singh L. Malignant melanoma of soft parts with osteoclast-rich giant cells: A rare tumor of the jejunum. Australas Med J 2014. [DOI: 10.21767/amj.2014.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krishna A, Bansal VK, Kumar S, Sridhar P, Kapoor S, Misra MC, Garg P. Preventing Delayed Gastric Emptying After Whipple's Procedure-Isolated Roux Loop Reconstruction With Pancreaticogastrostomy. Indian J Surg 2013; 77:703-7. [PMID: 26730093 DOI: 10.1007/s12262-013-0992-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022] Open
Abstract
Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life-threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2012 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. A total of 52 patients were operated using this technique from January 2009 to October 2012. The mean operative time was 260.8 ± 50.3, and the mean operative blood loss was 1,068.0 ± 606.1 ml. Mean gastric emptying time 106.0 ± 6.1 min (89-258 min). Three out of the 52(5.7 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE.
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Affiliation(s)
- Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - P Sridhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Sameer Kapoor
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Pramod Garg
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
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Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 2013; 28:875-85. [PMID: 24162138 DOI: 10.1007/s00464-013-3237-4] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 09/21/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ideal method for managing concomitant gallbladder stones and common bile duct (CBD) stones is debatable. The currently preferred method is two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). This prospective randomized trial compared the success and cost effectiveness of single- and two-stage management of patients with concomitant gallbladder and CBD stones. METHODS Consecutive patients with concomitant gallbladder and CBD stones were randomized to either single-stage laparoscopic CBD exploration and cholecystectomy (group 1) or endoscopic retrograde cholangiopancreatography (ERCP) for endoscopic extraction of CBD stones followed by LC (group 2). Success was defined as complete clearance of CBD and cholecystectomy by the intended method. Cost effectiveness was measured using the incremental cost-effectiveness ratio. Intention-to-treat analysis was performed to compare outcomes. RESULTS From February 2009 to October 2012, 168 patients were randomized: 84 to the single-stage procedure (group 1) and 84 to the two-stage procedure (group 2). Both groups were matched with regard to demographic and clinical parameters. The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (91.7 vs. 88.1 %). The overall success rate also was comparable: 88.1 % in group 1 and 79.8 % in group 2 (p = 0.20). Direct choledochotomy was performed in 83 of the 84 patients. The mean operative time was significantly longer in group 1 (135.7 ± 36.6 vs. 72.4 ± 27.6 min; p ≤ 0.001), but the overall hospital stay was significantly shorter (4.6 ± 2.4 vs. 5.3 ± 6.2 days; p = 0.03). Group 2 had a significantly greater number of procedures per patient (p < 0.001) and a higher cost (p = 0.002). The two groups did not differ significantly in terms of postoperative wound infection rates or major complications. CONCLUSIONS Single- and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single-stage strategy was better in terms of shorter hospital stay, need for fewer procedures, and cost effectiveness.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India,
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Bansal VK, Tamang T, Misra MC, Prakash P, Rajan K, Bhattacharjee HK, Kumar S, Goswami A. Laparoscopic suturing skills acquisition: a comparison between laparoscopy-exposed and laparoscopy-naive surgeons. JSLS 2013; 16:623-31. [PMID: 23484575 PMCID: PMC3558903 DOI: 10.4293/108680812x13462882737375] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study suggests that training improves laparoscopic suturing skills in experienced as well as inexperienced laparoscopic surgeons. Background: Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room. This study was done with the primary aim of assessing whether prior exposure to laparoscopic surgery helped trainees in acquiring laparoscopic suturing skills more quickly than trainees with no prior exposure to laparoscopic surgery. Materials and Methods: Twenty laparoscopy-exposed and 20 laparoscopy-naïve surgeons performed 5 laparoscopic gastrojejunostomies each on a phantom porcine model. The performance was evaluated for operation time, overall anastomotic score (calculated by adding scores of anastomotic leak, size of the anastomosis, suture placement, and mucosal approximation), and the level of difficulty. The performance at the beginning of training (baseline) was compared to the performance at the end of training. Results: All participants showed statistically significant improvement in operation time, overall anastomotic score, and difficulty level. Laparoscopy-exposed surgeons had a significantly better operation time than laparoscopy-naïve surgeons at the beginning of training; however, the difference became insignificant by the end of training. The difference in overall anastomotic score was not significant between laparoscopy-exposed and naïve-surgeons. Laparoscopy-exposed surgeons showed significant improvements in anastomotic leak rate and size of the anastomosis, whereas laparoscopy naïve surgeons showed improvements in all the parameters, although these were not significant statistically. Conclusion: Training improves the laparoscopic suturing skills of laparoscopy-exposed as well as laparoscopy-naïve surgeons. Prior experience in laparoscopic surgery does not seem to influence the acquisition of laparoscopic suturing skills as laparoscopic-naïve surgeons manage to catch up with the skills of the laparoscopy-exposed surgeons.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
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Kumar S, Bansal VK, Muduly DK, Sharma P, Misra MC, Chumber S, Singh S, Bhardwaj DN. Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Blunt Trauma Abdomen-A Prospective Study. Indian J Surg 2013; 77:393-7. [PMID: 26730032 DOI: 10.1007/s12262-013-0851-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022] Open
Abstract
Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination, primarily aimed at the identification of the presence of free intraperitoneal or pericardial fluid. In the context of blunt trauma abdomen (BTA), free fluid is usually due to hemorrhage, bowel contents, or both; contributes towards the timely diagnosis of potentially life-threatening hemorrhage; and is a decision-making tool to help determine the need for further evaluation or operative intervention. Fifty patients with blunt trauma abdomen were evaluated prospectively with FAST. The findings of FAST were compared with contrast-enhanced computed tomography (CECT), laparotomy, and autopsy. Any free fluid in the abdomen was presumed to be hemoperitoneum. Sonographic findings of intra-abdominal free fluid were confirmed by CECT, laparotomy, or autopsy wherever indicated. In comparing with CECT scan, FAST had a sensitivity, specificity, and accuracy of 77.27, 100, and 79.16 %, respectively, in the detection of free fluid. When compared with surgical findings, it had a sensitivity, specificity, and accuracy of 94.44, 50, and 90 %, respectively. The sensitivity of FAST was 75 % in determining free fluid in patients who died when compared with autopsy findings. Overall sensitivity, specificity, and accuracy of FAST were 80.43, 75 and 80 %, respectively, for the detection of free fluid in the abdomen. From this study, we can safely conclude that FAST is a rapid, reliable, and feasible investigation in patients with BTA, and it can be performed easily, safely, and quickly in the emergency room with a reasonable sensitivity, specificity, and accuracy. It helps in the initial triage of patients for assessing the need for urgent surgery.
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Affiliation(s)
- Subodh Kumar
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India ; Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
| | - Dillip Kumar Muduly
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Sharma
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Saraman Singh
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - D N Bhardwaj
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
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Mayerhofer R, Good AG, Bansal VK, Thiagarajah MR, Stringam GR. Molecular mapping of resistance to Leptosphaeria maculans in Australian cultivars of Brassica napus. Genome 2012; 40:294-301. [PMID: 18464830 DOI: 10.1139/g97-041] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Doubled haploid (DH) lines together with a cotyledon bioassay were employed for the molecular analysis of resistance to the blackleg fungus Leptosphaeria maculans in the Australian Brassica napus cultivars Shiralee and Maluka. We used bulked segregant analysis to identify 13 RAPD and two RFLP markers linked to the resistance phenotype and mapped these markers in the segregating DH population. Our data suggest the presence of a single major locus controlling resistance in the cultivar Shiralee, confirming our previous results obtained from Mendelian genetic analyses. In addition, preliminary mapping data for the cultivar Maluka also support a single locus model for resistance and indicate that the resistance genes from 'Shiralee' and 'Maluka' are either linked or possibly identical. The molecular markers identified in this study should be a useful tool for breeding blackleg resistant varieties using marker-assisted selection, and are the essential first step towards the map-based cloning of this resistance gene.
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Bansal VK, Misra MC, Sharma A, Chabbra A, Murmu LR. Giant retroperitoneal liposarcoma- renal salvage by autotransplantation. Indian J Surg 2012; 75:159-61. [PMID: 24426418 DOI: 10.1007/s12262-012-0474-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/18/2010] [Indexed: 11/24/2022] Open
Abstract
Liposarcomas are the most common retroperitoneal soft tissue tumors. We here in report a case of giant retroperitoneal sarcoma which weighed 24 kgs. Renal autotransplant of right kidney was done for organ preservation. The patient has done well after a follow up of 63 months. Complete surgical resection with organ preservation is the goal of treatment in patients with retroperitoneal liposarcomas.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India institute of Medical Sciences, Room No.5045, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
| | - Mahesh C Misra
- Department of Surgical Disciplines, JPNA Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Ajay Sharma
- Department of Surgery, Royal Liverpool Hospital, Liverpool, UK
| | - Anjolie Chabbra
- Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - L R Murmu
- Department of Surgical Disciplines, All India institute of Medical Sciences, Room No.5045, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India
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Bansal VK, Misra MC, Chaubal G, Datta Gupta S, Das B, Ahuja V, Sagar S. Helicobacter pylori in gallbladder mucosa in patients with gallbladder disease. Indian J Gastroenterol 2012; 31:57-60. [PMID: 22350820 DOI: 10.1007/s12664-012-0162-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 01/09/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Helicobacter species have been found to be associated with biliary tract diseases. This prospective study was done to determine the prevalence of H. pylori in the biliary tract of patients suffering from gallbladder disease. METHODS Forty-nine patients undergoing laparoscopic/open cholecystectomy for benign biliary tract diseases were investigated with urea breath test for H. pylori infection of gastric antrum. Bile and gallbladder tissues were studied for presence of H. pylori by rapid urease test, histopathological examination, culture and PCR analysis. Gallbladder specimens from two patients who underwent Whipple's operation and from 10 cadavers were studied as controls. RESULTS The mean (SD) age of patients was 42.4 (11.1) years. Urea breath test was positive in 17 (34.6%) cases. Rapid urease test was negative in all the cases. There was no evidence of H. pylori infection of gallbladder on histopathological examination using H&E, Giemsa and Warthin Starry stains. H. pylori DNA were detected in 16 patients (32.6%) and none of the 12 controls by PCR analysis (p = 0.025). The presence of H. pylori DNA in bile and/or gallbladder was associated with positive urea breath test, (p < 0.0001). Other factors like age, gender, jaundice and cholestasis were not associated with H. pylori infection of bile and gallbladder. CONCLUSIONS Nearly three quarters of patients with positive urea breath test have detectable H. pylori DNA in gallbladder tissue. The significance of these findings needs to be further evaluated.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, Room No. 5021, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
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Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 2011; 26:639-49. [PMID: 21959688 DOI: 10.1007/s00464-011-1931-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/31/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. METHODS The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. RESULTS One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05). CONCLUSIONS In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.
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Affiliation(s)
- Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
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Kilambi R, Bansal VK, Misra MC. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc 2010; 25:2050; author reply 2051. [PMID: 20976475 DOI: 10.1007/s00464-010-1438-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Bansal VK, Misra MC, Kumar S, Rao YK, Singhal P, Goswami A, Guleria S, Arora MK, Chabra A. A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc 2010; 25:1431-8. [PMID: 20976495 DOI: 10.1007/s00464-010-1410-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 09/03/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone. MATERIALS AND METHODS 68 patients admitted for LIVHR repair (defect size less than 25 cm2) were randomized in two groups: group I, tacker fixation (36 patients) and group II, suture fixation (32 patients). Various intraoperative variables and postoperative outcomes were recorded and analyzed. RESULTS The patients in the two groups were well matched in terms of age, sex, body mass index (BMI), and hernia characteristics. Mean BMI was 29.0 kg/m2. Operative time was found to be significantly higher in group II (77.5 versus 52.6 min, p=0.000). Patients in group I were found to have significantly higher pain scores at 1 h, 6 h, 24 h, 1 week, 1 month, and 3 months postoperatively. At follow-up, incidence of seromas was higher in group II but the difference was not significant (7 versus 4, p=0.219). During long-term follow-up, patients in group II were satisfied cosmetically. CONCLUSION Suture fixation is a cost-effective alternative to tacker fixation, for small and medium-sized defects in anatomically accessible areas. However, suture fixation requires significantly longer operation time, but patients have statistically significantly less postoperative pain.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, Room No. 5021, 5th Floor, Teaching Block, New Delhi, India.
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Bansal VK, Misra MC, Krishna A, Kumar S, Garg P, Khan RN, Loli A, Jindal V. Pancreatic hydatid cyst masquerading as cystic neoplasm of pancreas. Trop Gastroenterol 2010; 31:335-337. [PMID: 21568157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Bansal VK, Krishna A, Misra MC, Khan RN, Noba AL, Kishore N. Spontaneous splenic rupture in complicated malaria: non-operative management. Trop Gastroenterol 2010; 31:233-235. [PMID: 21560536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Khan RN, Jindal V, Kapoor S, Panwar R, Bansal VK, Kumar S, Misra MC. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse (Br J Surg 2010; 97: 167-176). Br J Surg 2010; 97:961; author reply 961-2. [PMID: 20474014 DOI: 10.1002/bjs.7144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jindal V, Khan RN, Panwar R, Bansal VK, Misra MC. Nationwide study of early outcomes after incisional hernia repair (Br J Surg 2009; 96: 1452-1457). Br J Surg 2010; 97:617-8; author reply 618. [PMID: 20205221 DOI: 10.1002/bjs.7054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bansal VK, Misra MC, Krishna A, Buess GF. Transanal excision of anorectal lesions. Trop Gastroenterol 2010; 31:1-4. [PMID: 20860220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Khan RN, Bansal VK, Kumar S, Jindal V, Misra MC, Bhatia V. Duodenal gastrinoma: a diagnostic dilemma. Am J Surg 2009; 197:e48-50. [PMID: 19233342 DOI: 10.1016/j.amjsurg.2008.06.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 06/25/2008] [Accepted: 06/25/2008] [Indexed: 11/26/2022]
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