Practical application of using local anaesthetics: surgical perspectives

With reduction in surgical training, surgical trainees may find it difficult deal with local anaesthetic agents because of lack of exposure and knowledge. We have summarised the common usage of local anaesthetics in various situation. The trainees need to gain competence by understanding the basics and practising them under supervision.

Laparoscopic retroperitoneal/mesenteric lymph node sampling: a safe and effective technique

INTRODUCTION

Needle aspiration and core biopsies are commonly used to assess retroperitoneal lymph nodes. However, the tissue obtained by this method is insufficient to define and type the tumour. This article demonstrates the feasibility and safety of the laparoscopic approach in obtaining an adequate volume of lymph node tissue for typing.

METHODS

Laparoscopic retroperitoneal lymph node biopsy was performed on 12 patients over a period of five years. A pneumoperitoneum was induced with a Veress needle, and an initial 10-mm trocar was inserted in the sub-umbilical region in order to carry a 30-degree telescope. Two or more 5-mm ports were inserted into the targeted areas under laparoscopic guidance to achieve optimal triangulation in order to access the nodal tissue.

RESULTS

The procedure was successful in 11 out of the 12 patients. An average volume of 1.7 cm3 of tissue was harvested for each patient. In one patient with preoperatively undiagnosed portal hypertension, laparoscopy was converted to an open procedure due to bleeding. In all patients, the histology was adequate and contributed to the diagnosis, allowing rapid institution of treatment. The diagnosis was reactive lymphadenopathy in three patients and sarcoidosis in one patient. Seven others suffered from various conditions, including lymphoma, leukaemia, secondary from unknown origin and Castleman's disease.

CONCLUSION

Laparoscopy allows access to perihepatic and perisplenic areas, and is a procedure of choice when needle biopsy is not possible or fails to provide an adequate sample.

Simple technique of selecting the correct feeding gastrostomy button

Feeding gastrostomy is often performed in children with neurological conditions e.g. cerebral palsy or cystic fibrosis. A feeding button is often used to replace the gastrostomy tube for convenience. The button often leaks and the correct size and length is difficult to choose. The authors describe an easy and perfect way of choosing the correct size and length button by using Foley catheters.

Outcome of laparoscopy-assisted feeding tube insertion in elderly stroke victims

BACKGROUND

When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J).

METHOD

During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months.

RESULTS

The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration.

DISCUSSION

Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.

Perirectal abscess following procedure for prolapsed haemorrhoids successfully managed with a combination of VAC sponge and Redivac systems

Active drains, which work from negative pressure effect, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum assisted wound closure (VAC) (usually -125 mmHg) dressings and in Redivac system (usually -300 mmHg). As far as we know, combinations of Redivac and VAC have not been used. The authors describe a novel combination using the sponge of the VAC dressing and sealed Redivac system to drain an open rectal wound, consequence of a perforation after stapled haemorrhoidopexy.

Bridge vacuum-assisted closure: a novel technique of using a single vacuum machine for multiple adjacent wounds

AIMS

To describe a simple method of applying the VAC dressing to multiple wounds.

METHODS

Applying a VAC dressing using a sponge bridge to allow the simultaneous treatment of multiple wounds.

RESULTS

Successful healing was achieved using this simple method.

CONCLUSION

The use of a simple sponge bridge allowed the simultaneous treatment of two adjacent wounds.

Two port laparoscopic-assisted removal of a migrating rectal foreign body

A variety of rectal foreign bodies have been documented in the English literature. They are inserted for various reasons including social pleasure. Most of them can be removed manually per ano. Here, we report a case of a big soft foreign body in the recto-sigmoid, which required the assistance of laparoscopy to enable retrieval.

Portal vein thrombosis following laparoscopic surgery in a patient with sickle cell disease

We report a case of portal vein thrombosis following prolonged laparoscopic intervention in a patient with Sickle cell disease. The operation combined a laparoscopic splenectomy, cholecystectomy, appendectomy. Presentation was insidious with vague abdominal pain and persistent postoperative pyrexia. The literature is reviewed, possible pathogeneses are discussed in the light of currently available data, and a strategy is suggested to recognize, avoid, and prevent this rare but potentially lethal complication.