Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mo... more Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mortality. In recent years, a marked improvement in the safety of surgery and anesthesia in this high-risk group of patients has been witnessed; owing to the improvements in surgical and anesthetic care, greater awareness of pathophysiology of the disease, proper perioperative preparation, and attention to factors predisposing to vasoocclusive crises. However, this is not paralleled by similar improvement in countries where the disease is not prevalent. Greater population mobility in recent years makes recognition of surgical manifestations of the disease, and awareness of perioperative management of sickle cell patients undergoing surgical interventions of paramount importance. This article aims to summarize steps towards safer surgery in patients with SCD.
We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with... more We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with signs, symptoms, and radiological features of acute cholecystitis. She was initially treated conservatively, but failed to respond well. Hence, laparoscopic cholecystectomy LC was performed successfully with good materno-fetal outcome. This article discusses the feasibility and safety of LC in the third trimester of pregnancy and the special precautions that are needed to guarantee the safety of materno-fetal well-being.
Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic... more Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be re...
Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium... more Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received. A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed. Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis. For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.
Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for s... more Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for sigmoid colon and rectal cancer: a study of 10 cases and review of the literature. Int J Colorectal Dis 2012; 27:671–5” by Park et al. I would like to share my experience of two similar cases of colon ischaemia that I have encountered after minimally invasive colorectal cancer surgery (one after hand-assisted laparoscopic colectomy (HALC) and another after laparoscopic anterior resection).
Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encounter... more Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encountered in young females (mean age 26 years) and have a female predominance. It is most commonly detected incidentally, but may occasionally present with sudden pain or symptoms related to compression of adjacent organs. We report the case of a 12-year-old boy having a solid-pseudopapillary tumor of the pancreas presenting with a tender upper abdominal mass following a slight trauma. Radiological investigation showed the lesion to be a cystic mass arising from the body and the tail of the pancreas. The child underwent emergency distal pancreatectomy and has remained free of recurrence for 3 years. In the pediatric age group, solid-pseudopapillary tumors may present acutely with a tender abdominal mass following a slight trauma. Awareness of this fact will allow appropriate and prompt management to be undertaken.
Canadian journal of surgery. Journal canadien de chirurgie, 2006
I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparosco... more I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparoscopic splenectomy (Can J Surg 2005;48:352-4).1 I agree with the authors' assumption that the frequency of PVT after laparoscopic splenectomy is just as high as that after open splenectomy. I believe that the laparoscopic procedure per se has no bearing on the occurrence of PVT, which is found mainly in patients who undergo splenectomy for benign and malignant hematologic conditions. I also believe that PVT is more likely to occur after splenectomy if the postsplenectomy platelet count is greater than 1000 × 109/L, although it may occur at lower counts as the authors have indicated. In a review of 55 patients who underwent open splenectomy for various indications in our unit, only 2 (3.6%) had PVT; both had portal hypertension, and splenectomy was performed as part of an emergency devascularization procedure for bleeding esophageal varices.2 PVT should be suspected in any patient who is...
Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of un... more Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of unilateral diaphragmatic agenesis. The diagnosis of this rare condition is typically made in early infancy. However, in asymptomatic patients, the diagnosis is often delayed for months and even years. We present a case of a 27-year-old female, who was referred 48-hours after Caesarean section with suspected pulmonary embolism. Computed tomography scan revealed herniation of the liver as well as bowel loops into the right hemi-thorax. Exploration through a right thoracotomy revealed right diaphragmatic agenesis. The contents were reduced into the abdomen, and the defect was repaired using a mesh. The patient had an uneventful postoperative recovery and was discharged home 10 days later. This case highlights the acute late presentation of right diaphragmatic eventration with abdominal visceral herniation in adulthood. The condition may be triggered by the increasing size of gravid uterus.
Background/Aim:As totally laparoscopic colorectal surgery is considered challenging and technical... more Background/Aim:As totally laparoscopic colorectal surgery is considered challenging and technically demanding with a long steep learning curve, we adopted hand-assisted laparoscopic colorectal surgery as a bridge to totally laparoscopic assisted colorectal surgery. This prospective study aims to highlight the initial experience of a single surgeon with this technique.Materials and Methods:A prospective analysis of the first 25 cases of hand-assisted laparoscopic colorectal resections which were performed by a single surgeon over a 15-month period. There were 15 males and 10 females with a mean age of 55.5 (range 20-82) years.Results:The indication in majority of cases was cancer (76%). The procedures consisted of 18 (72%) various colectomies and 7 (28%) anterior resections. The operative time ranged between 110-400 (mean 180) min. There was one conversion (4%) and the mean operative blood loss was 80 (range 60-165) ml. The number of lymph nodes retrieved in the cancer cases was 5-31 (mean 15) nodes. The mean length of hospital stay was five (range 3-10) days. The total number of short-term complications was six (24%) and there was one death due to anastomatic leak and multiorgan failure. Long-term complications after a maximum follow up of 30 months were two incisional hernias at the hand port site, but none of the patients developed adhesive small bowel obstruction or late anastomotic stricture. Currently all our colorectal procedures are conducted laparoscopically.Conclusion:Hand-assisted laparoscopic colorectal procedures are easy to learn as a good bridge to master totally laparoscopic colorectal surgery.
Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mo... more Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mortality. In recent years, a marked improvement in the safety of surgery and anesthesia in this high-risk group of patients has been witnessed; owing to the improvements in surgical and anesthetic care, greater awareness of pathophysiology of the disease, proper perioperative preparation, and attention to factors predisposing to vasoocclusive crises. However, this is not paralleled by similar improvement in countries where the disease is not prevalent. Greater population mobility in recent years makes recognition of surgical manifestations of the disease, and awareness of perioperative management of sickle cell patients undergoing surgical interventions of paramount importance. This article aims to summarize steps towards safer surgery in patients with SCD.
We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with... more We report a case of a 35-year-old lady who presented in the third trimester of her pregnancy with signs, symptoms, and radiological features of acute cholecystitis. She was initially treated conservatively, but failed to respond well. Hence, laparoscopic cholecystectomy LC was performed successfully with good materno-fetal outcome. This article discusses the feasibility and safety of LC in the third trimester of pregnancy and the special precautions that are needed to guarantee the safety of materno-fetal well-being.
Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic... more Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be re...
Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium... more Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received. A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed. Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis. For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.
Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for s... more Dear Editor: I have read with great interest the article “Colon ischaemia following surgery for sigmoid colon and rectal cancer: a study of 10 cases and review of the literature. Int J Colorectal Dis 2012; 27:671–5” by Park et al. I would like to share my experience of two similar cases of colon ischaemia that I have encountered after minimally invasive colorectal cancer surgery (one after hand-assisted laparoscopic colectomy (HALC) and another after laparoscopic anterior resection).
Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encounter... more Solid-pseudopapillary tumors are exceedingly rare in males. They are almost exclusively encountered in young females (mean age 26 years) and have a female predominance. It is most commonly detected incidentally, but may occasionally present with sudden pain or symptoms related to compression of adjacent organs. We report the case of a 12-year-old boy having a solid-pseudopapillary tumor of the pancreas presenting with a tender upper abdominal mass following a slight trauma. Radiological investigation showed the lesion to be a cystic mass arising from the body and the tail of the pancreas. The child underwent emergency distal pancreatectomy and has remained free of recurrence for 3 years. In the pediatric age group, solid-pseudopapillary tumors may present acutely with a tender abdominal mass following a slight trauma. Awareness of this fact will allow appropriate and prompt management to be undertaken.
Canadian journal of surgery. Journal canadien de chirurgie, 2006
I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparosco... more I read with interest the article on the incidence of portal vein thrombosis (PVT) after laparoscopic splenectomy (Can J Surg 2005;48:352-4).1 I agree with the authors' assumption that the frequency of PVT after laparoscopic splenectomy is just as high as that after open splenectomy. I believe that the laparoscopic procedure per se has no bearing on the occurrence of PVT, which is found mainly in patients who undergo splenectomy for benign and malignant hematologic conditions. I also believe that PVT is more likely to occur after splenectomy if the postsplenectomy platelet count is greater than 1000 × 109/L, although it may occur at lower counts as the authors have indicated. In a review of 55 patients who underwent open splenectomy for various indications in our unit, only 2 (3.6%) had PVT; both had portal hypertension, and splenectomy was performed as part of an emergency devascularization procedure for bleeding esophageal varices.2 PVT should be suspected in any patient who is...
Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of un... more Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of unilateral diaphragmatic agenesis. The diagnosis of this rare condition is typically made in early infancy. However, in asymptomatic patients, the diagnosis is often delayed for months and even years. We present a case of a 27-year-old female, who was referred 48-hours after Caesarean section with suspected pulmonary embolism. Computed tomography scan revealed herniation of the liver as well as bowel loops into the right hemi-thorax. Exploration through a right thoracotomy revealed right diaphragmatic agenesis. The contents were reduced into the abdomen, and the defect was repaired using a mesh. The patient had an uneventful postoperative recovery and was discharged home 10 days later. This case highlights the acute late presentation of right diaphragmatic eventration with abdominal visceral herniation in adulthood. The condition may be triggered by the increasing size of gravid uterus.
Background/Aim:As totally laparoscopic colorectal surgery is considered challenging and technical... more Background/Aim:As totally laparoscopic colorectal surgery is considered challenging and technically demanding with a long steep learning curve, we adopted hand-assisted laparoscopic colorectal surgery as a bridge to totally laparoscopic assisted colorectal surgery. This prospective study aims to highlight the initial experience of a single surgeon with this technique.Materials and Methods:A prospective analysis of the first 25 cases of hand-assisted laparoscopic colorectal resections which were performed by a single surgeon over a 15-month period. There were 15 males and 10 females with a mean age of 55.5 (range 20-82) years.Results:The indication in majority of cases was cancer (76%). The procedures consisted of 18 (72%) various colectomies and 7 (28%) anterior resections. The operative time ranged between 110-400 (mean 180) min. There was one conversion (4%) and the mean operative blood loss was 80 (range 60-165) ml. The number of lymph nodes retrieved in the cancer cases was 5-31 (mean 15) nodes. The mean length of hospital stay was five (range 3-10) days. The total number of short-term complications was six (24%) and there was one death due to anastomatic leak and multiorgan failure. Long-term complications after a maximum follow up of 30 months were two incisional hernias at the hand port site, but none of the patients developed adhesive small bowel obstruction or late anastomotic stricture. Currently all our colorectal procedures are conducted laparoscopically.Conclusion:Hand-assisted laparoscopic colorectal procedures are easy to learn as a good bridge to master totally laparoscopic colorectal surgery.
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