Annals of Bariatric Surgery
Volume:3 Issue: 2, Spring 2014

Context: Laparoscopic surgery is considered to be a minimally invasive procedure with fewer complications and faster recovery. However, pain following such surgery is still a major problem.. Evidence acquisition: A multimodal approach to pain management has been suggested for optimal treatment of pain after laparoscopic surgery. Other than the parenteral and oral pain medications used, various local anesthetic techniques can provide analgesia following laparoscopic surgical procedures.. Local anesthetic can be instilled locally at the wound site in the form of incisional or intraperitoneal approach, or around the nerves as a spinal, epidural, paravertebral or transversus abdominis plane block. Lidocaine has also been studied as an intravenous infusion to provide postoperative analgesia following laparoscopic surgery.. There is still not a definitive consensus as to which technique is superior, but including one of the methods in addition to providing the patient with parenteral and enteral drugs could provide better postsurgical analgesia. The aim of this review article is to look at the effectiveness of various local anesthetic techniques available to provide analgesia following laparoscopic surgery..

Context: Different approaches are routinely applied in the treatment of concomitant cholecystocholedocholithiasis. Most patients are treated by preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy in a two-stage approach. However one-stage approach carrying out intraoperative endoscopic sphincterotomy (IOES) is emerging as a minimally invasive alternative option. Our review evaluates the outcomes and potential advantages of IOES compared to the other therapeutic options..Evidence Acquisition: An accurate enquiry for papers relating to IOES and the different available options was performed on different medical databases. Endpoints considered were: successful clearance of common bile duct stones, overall complication rate, procedure related morbidity, conversion rate, duration of hospital stay and costs.. Data were collected from 21 scientific papers including: 5 prospective randomized clinical trial, 4 Meta-analysis and 12 case series. Similar rates of successful clearance of common bile duct stones were reported between Intra Operative Endoscopic Sphincterotomy (IOES) and Pre Operative Endoscopic Sphincterotomy (POES) (96.9% versus 96.3). Overall morbidity showed no statistical significant differences between the two approaches (16.1% in two stage approach versus 19.9% in one stage approach). IOES resulted superior to two-stage approach regarding duration of hospital stay with a mean difference of 2.83 days. The shorter hospital stay ensued in a reduction of cost in most studies. No differences in conversion rate were observed between POES and IOES (3.8% versus 3.7%).. Intraoperative endoscopic retrograde cholangiography is a safe, effective and feasible treatment for patients with concomitant gallbladder stones and choledocholithiasis. This review highlighted the advantages of IOES as a minimally invasive, one-stage approach. However in order to guarantee the success of such approach a profound collaboration between surgeon and endoscopist is mandatory and an efficient logistic organization of the operating theatre is needed..

Port site complications following elective surgery are rare and port site infections remain the most common short long term complications.. The study was conducted to analyze port site complications occurring in patients undergoing Laparoscopic Cholecystectomy for symptomatic cholelithiasis..Patients and Ninety patients undergoing laparoscopic cholecystectomy were recruited to the study. Patients were followed for one year after surgery and port sites were examined for any complication.. Out of ninety patients, only three developed port site infections. No case of port site bleeding, discharge and hernia were reported in follow-up period. The results were insignificant as complication was seen in only 3 patients.. Laparoscopic cholecystectomy is a safe and effective procedure with low complication rates..

Uterus didelphys with imperforate hemivagina is a rare Müllerian anomaly occurring between the 12th and 16th weeks of gestation. Currently the excision of the vaginal septum is considered the treatment of choice for cases of obstructed hemivagina, conventionally performed using scissors and scalpel. The hysteroscopic excision of vaginal septum in those with uterus didelphyshas several advantages including feasibility, availability, effectiveness and preservation of virginity.. We aimed to report the benefits of hysteroscopic resection of vaginal septum in patients with uterus didelphys and obstructed hemivagina..Patients and This cross-sectional study was performed in Shiraz University of Medical Sciences including 11 patients with uterus didelphys and obstructed hemivagina. Hysteroscopic resection, of vaginal septum was performed for all patients and the outcomes were observed.. The mean age of the patients was 14.73 ± 2.3 (range 13-16) years. The most common symptom was cyclic dysmenorrhea. The vaginal septum was resected safely in all of the patients. The symptoms including cyclic dysmenorrhea and hematometra resolved after 3 months.. Hysteroscopic resection of the vaginal septum is an available, feasible, convenient, and effective tool in the management of uterus didelphysplus obstructed hemivagina which enables the surgeon to preserve the hymen integrity..

Dysfunctional uterine bleeding (DUB) is the most common gynecologic disorder in women of reproductive age. Medical treatments are often ineffective. Endometrial ablation is an alternative to hysterectomy for these women.. To evaluate the response to treatment rate of the Cavaterm TM plus technique for management of menorrhagia secondary to dysfunctional uterine bleeding (DUB)..Patients and In this clinical trial study 40 women aged 35-50 years with menorrhagia secondary to DUB, who had been referred to the gynecology clinic of Arash Hospital, Tehran, Iran, were recruited. They underwent endometrial ablation via Cavaterm™ plus system and were followed for one year.. The observed mean number of days of bleeding per month decreased significantly from 14.95 ± 6.7 days before treatment to 3.42 ± 3.04 days after treatment (P < 0.001). Intervals between hemorrhagia increased significantly from 16.25 ± 5.50 to 21.30 ± 11.10 days (P = 0.01). The rate of dysmenorrhea decreased significantly from 32.5% to 10% (P < 0.05). The improvement rate of dysmenorrhea was 69.5%. The overall improvement of menorrhagia was reported 92.5% (P < 0.001). After one year the rates of hypomenorrhea, amenorrhea and eumenorrhea were 47.5%, 27.5% and 17.5%, respectively..The failure to treatment rate was reported 7.5%. Patient satisfaction rate was 85%.. The Cavaterm™ plus system is a safe and effective technique and it can be an excellent alternative to hysterectomy for the treatment of menorrhagia due to DUB..

We hypothesized that Io-PTH levels would decline to normal or near normal after successful parathyroidectomy.. Evaluate efficacy and predictive factor of parathyroid hormone measurement during parathyroid resection.. Every Io-PTH level from 2001-10 at a single institution was evaluated. Charts were reviewed for preoperative diagnosis, final Io-PTH level, unilateral or bilateral exploration, calcium and parathyroid hormone levels.. 225 patients underwent 594 Io-PTH measurements. 16 patients were excluded. Final Io-PTH levels were normal (< 65 pg/mL) in 189 patients and elevated in 20 patients. 12 of 20 patients with elevated final Io-PTH levels had > 80% decrease, so that 201 patients had Io-PTH levels that were normal or dropped by > 80%. 8 patients had Io-PTH levels that dropped by < 80%, 4 of whom had < 50% decline. Normal or near-normal Io-PTH level after resection of a parathyroid adenoma allowed unilateral exploration in 146 patients. Persistent elevation of Io-PTH levels led to bilateral exploration in 22 patients.. Io-PTH levels should become normal or to drop by at least 80% during successful parathyroidectomy. Persistent elevations of Io-PTH after resection of an abnormal gland dictate the need for bilateral exploration..

Primary Amenorrhea isa condition in which a young woman has not started her menstrual periods by the age of 16-18. The principal features of polycystic ovarian syndrome (PCOS) are anovulation, resulting in irregular menstruation, amenorrhea, and ovulation-related infertility.. From January 2007 to June 2013 we conducted 2215 laparoscopies, out of which 605(27.6%) were infertile patients with PCOS who underwent Laparoscopy procedure as day surgery in the standard method under general anesthesia; among these patients one case had primary amenorrhea and infertility.. A twenty-two years obese patient referred to us with acne and Hirsutism. PCO was diagnosed by ultrasound & confirmed by laparoscopy. Laparoscopic findings showed normal uterus & patent tubes. Ovarian drilling was done after 6 months of conservative management. 3 months after the drilling the patient was conceived, delivered a full term baby and was menstruating for the first time 6 weeks after her delivery. PCOS is one of the most common female endocrine disorders. The patient underwent laparoscopy and ovarian drilling followed by clomiphene plus metformin and finally she conceived and regained her first cycle after her delivery. The reason could be that the drilling decreases the level of androgen, metformin makes the cells more sensitive to insulin and clomiphene increases the chance of ovulation as well. Clinicians in Sudan must consider PCOS as an important cause of primary amenorrhea and a common cause of primary infertility..

The benefits of laparoscopy over laparotomy include lower blood loss, decreased length of hospital stay, and decreased postoperative pain. It is unknown, however, whether patients with previous surgeries are good candidates for laparoscopic surgery.. To determine whether the location and type (laparoscopic surgery vs. laparotomy) of previous abdominal surgery is associated with increased complication rates during subsequent laparoscopic gynecologic surgery..Patients and A total of 903 consecutive patients who underwent gynecologic laparoscopy from January 2000 to January 2009. Intervention: Patients were stratified according to whether they had previous abdominal surgery or not. Patients who had undergone previous surgery were further stratified according to the location of surgery (lower abdominal surgery only, upper abdominal surgery only, or both lower and upper abdominal surgery), as well as type of surgery (laparoscopy or laparotomy). Incidence of complications during subsequent gynecologic laparoscopy was then compared between patient subgroups.. Intraoperative complications occurred in 15 (4%) of the 337 patients with no previous surgery, 1 (2%) of the 53 patients with previous upper abdominal surgery, 16 (4%) of the 422 patients with previous lower abdominal surgery, and 4 (4%) of the 91 patients with previous upper and lower abdominal surgery. Rates of complications did not differ significantly among these groups. Among patients with previous laparotomy, complication rates did not differ significantly by location of previous surgery. Similarly, among patients with prior laparoscopy, complication rates did not differ by location of previous surgery. When patients were stratified according to location of previous surgery, rates of complications did not differ among the patients with a history of laparoscopy versus laparotomy.. Our findings suggest that previous abdominal surgery, regardless of location or surgical approach, should not be a contraindication to gynecologic laparoscopy..