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Article
LAPAROSCOPIC ENTRY: A REVIEW OF TECHNIQUES, TECHNOLOGIES, AND COMPLICATIONS

Author: Issam Merdan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2013 Volume: 19 Issue: 1 Pages: 10-23
Publisher: Basrah University جامعة البصرة

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Abstract

Laparoscopy (Gr: Laparo-abdomen, scopein-to examine) is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdomi¬nal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen’s contents with an illuminated telescope. With the advent of videocameras and other ancillary instruments, laparoscopy rapidly advanced from a being a diagnostic procedure to one used in fallopian tubal occlusion for sterilization and eventually in the performance of numerous sur¬gical procedures in all surgical disciplines for a variety of indications.

Keywords

laparoscopy --- techniques


Article
Evaluation of Clinical Parameters that Predict Difficulties During Laparoscopic Cholecystectomy

Authors: Karam Kamal Younis --- Layth Qassid Al-Harbawi --- Omar Abbas Ashoor
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 175-180
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) may be rendered ‘difficult’ by various problems encounteredduring surgery e.g accessing the peritoneal cavity, dissecting the gall bladder … etc. OBJECTIVE:To identify certain preoperative clinical parameters to predict technical difficulties during (LC) .SETTING: Surgical wards of Al-Jamhoori Teaching Hospital between October 2009 to October 2010. METHODS: A prospective analysis of150 patients who underwent (LC). Prospective analysis of differentpreoperative data including patient's age, gender, weight, height, previous abdominal surgery andprevious attack of acute cholecystitis were done. The dependent variables (outcomes) included theduration of operation, bleeding, difficult accessing, bile leak, difficult dissection of gall bladder, andconversion to open cholecystectomy. Surgeons who performed the operations had operative experienceof more than 50 (LC) RESULTS: The difficulties were met in 57(38%) patients. The mean duration of surgery was 79·83 ± 1·30 minutes.Factors contributed to difficult (LC) were; male gender, previous upper abdominal surgery and BMI >35. CONCLUSION: Preoperative clinical patient's factors including male gender, BMI > 35 and history of previous upperabdominal surgery are significant predictive preoperative parameters for difficult (LC). Knowledge ofthese parameters preoperatively can predict difficulties during (LC).


Article
Conversion Rate in Laparoscopic Cholecystectomy: A Review of 300 Cases

Authors: Abbas A. Al-Jubori --- Fadhil A. Al-Janabi --- Raad S. Al-Saffar
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.1 Issue: 6 Pages: 772-778
Publisher: Kerbala University جامعة كربلاء

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Abstract


background : Prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon to be better prepared for the intra-operative risk and the risk of conversion to open cholecystectomy. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 300 cases since September 2007 to December 2009 in a single center with respect to conversion to open cholecystectomy.
AIM: evaluation of difficult laparoscopic cholecystectomy and conversion rate in different 300 cases of cholelithiasis.
Methods: Patients who underwent laparoscopic cholecystectomy (LC) from September 2007 to December 2009 were analyzed. The cases were analyzed in relation to conversion rate to open surgery; factors affecting pulmonary disease were not included in the study.
Results: Out of 300 cases, 52 patients (17.33%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 295 patients with a completion rate of 98.33%. Laparoscopic procedure had to be converted to the open procedure in 5 patients with a conversion rate of 1.66% of the total LCs performed and 9.6% of the difficult cases. Conversion had been done due to several reasons.
Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.
Key words: conversion, laparoscopy, cholecystectomy.


Article
Role of Surgery and Laparoscopy in Management of Abdominal Tuberculosis

Authors: Bashar A. Abdul Hassan --- Anees K.Nile --- Enas Adnan Abdulrasul Al-Kazaaly --- Ahmed H. Ismael
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 261-268
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUD:Tuberculosis (TB) considered as the most communicable disease world wid. Among extra pulmonary TB the prevalence of abdominal TB shows rising tendency. Abdominal TB is defined as an infection of one or more common of two or more of the following sites; peritoneum, mesentery, gastrointestinal tract and or solid organs. Reported incidence of abdominal TB varies from country to country. The most common clinical features are abdominal pain, fever and weight loss.OBJECTIVE:To evaluate the role of surgery in the management of abdominal TB especially with the advent of minimal access surgery (laparoscopy) in the diagnosis of this disease.PATIENT AND METHODS:Prospective study was conducted in Al-Kadhymia Teaching Hospital over three years (2007-2010), fifty six patients with abdominal TB were included, the patients were managed by full surgical and or medical teams, results was analyzed by appropriate statistical measures.RESULTS:Most patients were in the 2nd, 3rd and 4th decades of life. Female to male ratio was 1.5:1. Most of the patients (82%) considered to have primary abdominal TB. Diagnostic laparoscopy was done for 21 patients and proved TB in 19 patients. Explorative laparotomy was done in 19 patients, the commonest operative finding was ascites and peritoneal tubercles.CONCLUSION:Abdominal TB should be considered in all patients who presented with unexplained abdominal symptoms and signs. Laparoscopy is an effective modality for diagnosis of abdominal TB.


Article
Laparoscopic Varicocelectomy for Bilateral Varicoceles in Infertile Males

Authors: Saad D. Farhan --- Muayed Abass Fadhel**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 317-322
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility.Despite the very long history of the disease and many records on different surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a matter of controversy. The perfect technique would be one that preserves testicular function and eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications.OBJECTIVE:To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles in infertile males.METHODS:We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic vessels between January 2009 and November 2010.RESULTS:The average operative (Bilateral Laparoscopic Varicocelectomy) time was 34 minutes. There were no intra operative complications in the study group. Hydrocele formation was seen in 3 (6%) patients recurrence was seen in one (2%) patient .The average hospital stay was 18 hours. postoperative analgesics (1-2) doses , daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients (72% )of the patients had improvement of the seminal fluid parameters During follow up period (6 months),with seminal fluid analysis, clinical and ultrasonic examination.CONCLUSION:Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling rapid return to normal activity


Article
Laparoscopic management of impalpable testes in pediatric age group

Authors: Muataz A. Al-ani معتز العاني --- Bassam K. Al Abbassi بسام العباسي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2012 Volume: 38 Issue: 2 Pages: 5-9
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTAim of the study: The purposes of our study are to evaluate the role of laparoscopy in localizing impalpable testes and the management strategy for both unilateral and bilateral impalpable testes.Patients and methods: Throughout the period between January 2005 to December 2008, 36 patients with impalpable testes were admitted to pediatric surgery centre at Al-Khanssa Teaching Hospital in Mosul, Laparoscopy done for them to assess and manage 42 impalpable testes. In all patients 10 mm canula port was inserted in surpaumbilical position using an open technique, a single 5 mm port was occasionally required in contralateral iliac fosse to manipulate bowel and testes. A further port was used for laparoscopic clipping and division of the testicular vessels. These performed as the first part of the one or two stages Fowler- Stephen orchiopexy (high division of testicular vessels), and all patients has been followed for period of about two years.Results: Twenty seven testes found to be positive, ten of them near the internal inguinal ring and nine in the iliac fossae, while two testes where found intra canalicular. Fifteen testes were absent with closed ring, 12 of them showed vas and vessels enter the internal ring (vanished testes), while three with no vas and vessels entering the ring (agenesis). Assisted laparoscopic orchiopexy using sub dartous pouch was successfully done in 16 testes. Single stage Fowler-Stephen technique was adopted in four testes. Two stages for another two testes, in one patient, fixation done near upper scrotum which was then re fixed by second operation few months later.Conclusion: Laparoscopy is a safe and reliable technique in diagnosing the presence or absence of impalpable testes, provides a valuable information about the associated anomalies and condition of the internal ring, it can direct the surgeon to chose the proper technique for orchiopexy, with no mortality and very low morbidity.

الخلاصةهدف الدراسة: إن هدف دراستنا هو لبيان دور (تنظير البطن الجراحي) في تحديد (الخصى الغير ممكن إدراكها باللمس) وتحليل ما تم إيجاده من خلال استعمال ناظور البطن لجهة واحدة أو لكلتا الجهتين. المرضى والطرق:خلال الفترة من (ك2/2005) ولغاية (ك1/2008) تم إدخال (36) طفل لديهم حالة (الخصى الغير ممكن إدراكها باللمس) إلى مركز جراحة الأطفال في مستشفى الخنساء التعليمي في الموصل. تم إجراء التنظير البطني لهم لتقييم وتدبير (42) حالة (خصية لا يمكن إدراكها باللمس). في كل هؤلاء المرضى تم إدخال كانيولا ذات فوهة قطر (10 ملم) في وضعية فوق السرة باستعمال التقنية المفتوحة. وأحيانا كان هناك حاجة لفوهة قطر (5 ملم) في الجهة الجانبية المقابلة للحفرة الحرقفية لغرض المعالجة اليدوية للمعي والخصية. وكذلك فوهة أخرى استخدمت لغرض قص الأوعية الدموية بواسطة الناظور البطني. وقد تمت متابعة كل المرضى لفترة حوالي سنتين بعد العملية.النتائج: وجد أن (27) من الخصى موجبة، وان (16) منهم كانوا قرب الحلقة المغبنية الداخلية و(9) في الحفرة الحرقفية، في حين وجد أن هناك (2) من الخصى كانتا في (وضعية التواجد داخل القناة). (15) من الخصى كانت مفقودة مع انسداد الحلقة، (12) منهم اظهر وجود قناة ووعاء دموي داخلا إلى الحلقة الداخلية (خصى زائلة) بينما كان هناك (3) من الخصى بلا قناة ولا وعاء دموي داخلا الى الحلقة (قصور في النمو). إن عملية تثبيت الخصية المساند بالناظور البطني باستخدام (الجيب تحت العقبولي) تم إجراؤه بنجاح في (16) من الخصى. مرحلة واحدة لتقنية (فاولر ستيفان) تم تطبيقها في (4) من الخصى، ومرحلتين من هذه التقنية تم تطبيقها لـ(2) من الخصى. واحد من المرضى أجري له تثبيت الخصية قرب أعلى كيس الصفن حيث تم بعدها إعادة التثبيت بعملية ثانية تلتها ببضعة أشهر.الاستنتاج: إن للناظور البطني دور فعال وآمن في تشخيص وجود (الخصى التي لايمكن إدراكها باللمس) من عدمه، وكذلك فان له فائدة في انه يوجه الجراح لاختيار التقنية الملائمة لتثبيت الخصية، كما يوفر معلومات قيمة عن التشوهات الخلقية والحالات الأخرى المرافقة للحلقة الداخلية.


Article
Complications of laparoscopic cholecystectomy

Author: Tariq E. Al-aubaidi MBChB, FICMS د. طارق ابراهيم العبيدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 4 Pages: 357-360
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:Background: cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years .laparoscopic cholecystectomy was introduced in 1980s.Patient and methods: Two hundred patients admitted to first surgical unit in Baghdad teaching hospital from first May 2007- first May 2009 with gall stone disease both symptomatic and asymptomatic, of both genders and any age were evaluated by history, examination and investigations and data was collected.Results: Two hundred patients underwent LC in the study period. 181(90.5%)were females and 19(9.5%)were males. The most common age group was between 21-40 years (55%), bleeding was the commonest complication, occurring from trocar site in 11(5.5%) cases, vascular injury in Calot's triangle in 9(4.5%) cases and liver bed in 23(11.5%) cases. Spilled gall stones occurred in 32(16%) cases, biliary leak in 7(3.5%) cases including common bile duct injury in one case. Port site infection was seen in 11(5.5%). There was no bowel injury or port site hernia and there was no mortality. Conclusion: LC is a safe and effective procedure in almost all patients with cholelithiasis. Good training and dealing with the complications makes this procedure with good results and less complication.Keywords: laparoscopy, cholecystectomy, complications.


Article
Meta- Analysis to find out an ideal treatment for Acute appendicitis

Author: Hadi Awad Hmoud
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 1 Pages: 2098-2105
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Open appendectomy (OA) was the standard procedure for inflamed appendix. First laparoscopic appendectomy (LA) was done in 1980 since then Laparoscopic Appendectomy has been gaining more popularity and approval despite the controversies that surrounding its safety and universal applicability.Aim: This is a comparative study to evaluate the safety, effectiveness and the superiority of LA vs OA in treating the acute appendicitis.Materials and methods: This retrospective study was performed by examining huge number of literatures and huge number of clinical observations regarding treatment of acute appendicitis after applying new parameters like patient selection, operating time, hospital stay, cost effectiveness, intra and postoperative complications, needs for painkillers, role of antibiotics, operative technique and cosmetic issues.Result: Large number of studies have showed that LA is highly beneficial for young age group females, it shortens the hospital stay time, minimizes the need for post- operative painkillers, and it bears good cosmetic outcome. On the other hand it carries serious complications, it is time consuming technique, and it impacts big financial burden. While antibiotics use and modifying the type of operative techniques can improve the overall outcome for both modalities.Discussion: This study has found that both laparoscopic and open appendectomy have some advantages and disadvantages, but logical evaluation of these outcomes clearly shows that, the LA impacts more serious and devastating complication, which may outweigh its benefits.Conclusion: By careful reviewing of all above parameters we can reach an important decision regarding the ideal approach for operating on acute appendicitis, such decision gives the superiority for the OA over the LA in treating acute appendicitis, especially in an attempt to avoid devastating complications.


Article
Follow Up of Women after Laparoscopy Versus Laparotomy in Emergency Gynecological Problems

Author: Enas Mahmood Yaseen
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2016 Volume: 2 Issue: 2 Pages: 193-209
Publisher: Tikrit University جامعة تكريت

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Article
A comparative study between small dose dexamethasone, tropisteron, metoclopramide and normal saline in reducing nausea and vomiting after laparoscopic cholecystectomy
دراسة مقارنة بين جرعة صغيرة من الديكساميثازون ، التروبيستيرون ، الميتوكلوبراميد والمحلول الملحي الطبيعي في الحد من الغثيان والقيء بعد استئصال المرارة بالمنظار

Authors: Tayeb S. Kareem --- Aman Abdulmawjood Taha
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2013 Volume: 17 Issue: 1 Pages: 317-321
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: Nausea and vomiting are among the most common distressing complications encountered by patients postoperatively. The aim of this study is to evaluate the prophylactic effect of small dose of dexamethasone (5 mg) on postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). Methods: A prospective double blind placebo controlled study of 160 patients who underwent elective LC at Rizgary Teaching and Hawler Private Hospitals in Erbil, Kurdistan in a period between Jan 2009 and Dec 2009. Preoperatively the patients were allocated randomly to one of the four groups (n = 40 each). 1. The dexamethasone group received dexamethasone 5mg. 2. The metoclopramide group received metoclopramide 10mg. 3. The tropisetron group received tropisetron 2mg. 4. The placebo group received normal saline 2ml. Results: Both the dexamethasone and tropisetron groups were significantly different from the placebo group in the incidence of nausea and vomiting. The differences between the dexamethasone and tropisetron groups were not significant (P = 0.799). Conclusion: : prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing LC.

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