Browsing by Author "Vishnu Kumar Bhartia"

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Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults
(Hindawi Publishing Corporation, 2016) Sanjay Kumar Saroj; Satendra Kumar; Yusuf Afaque; Abhishek Kumar Bhartia; Vishnu Kumar Bhartia
Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n=13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands. © 2016 Sanjay Kumar Saroj et al.
The laparoscopic re-exploration in the management of the gallbladder remnant and the cystic duct stump calculi
(Journal of Clinical and Diagnostic Research, 2016) Sanjay Kumar Saroj; Satendra Kumar; Yusuf Afaque; Abhishek Bhartia; Vishnu Kumar Bhartia
Introduction: The gallbladder remnant and the cystic duct stump calculi are uncommon causes of post-cholecystectomy syndrome. Re-exploration usually needed in the cases where symptom persists. Very few case series and reports are available regarding laparoscopic re-exploration. Aim: To assess the safety and feasibility of Laparoscopic reexploration in the cases of gallbladder remnant and cystic duct stump calculi leading to post cholecystectomy syndromes. Materials and Methods: In this study, laparoscopic reexplorations was done in 22 patients in which 17 patients had gallbladder remnant calculi and 5 had cystic duct stump calculi. The study considered parameters the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 15 years and the data was retrospectively reviewed. Results: The median operating time was 83 minutes (range 51 to 134 minutes). Only one patient had conversion to open surgery. In postoperative period two patients had bile leak. They were managed conservatively and leak subsided in 8 and 11 days respectively. One patient had postoperative bleeding not requiring blood transfusion. There was no major complication requiring further intervention and no mortality. Patients were discharged on median day 4 (range 2-11) after the surgery. Patients were followed up every 3 months for one year. However, out of these three patients did not turn up for follow-up. Conclusion: In expert hands laparoscopic re-exploration of the gallbladder remnant/cystic duct stump calculi can be performed within a reasonable operating time. The conversion to conventional re–exploration rate was very low with minimal post-operative complications and shorter hospital stay. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.