BACKGROUND : Peritoneal dialysis is an alternative to hemodialysis in patients with end-stage kidney disease (ESKD). The laparoscopic technique for catheter insertion has been shown to be better than the open method. This study aimed to discuss the results of laparoscopic Tenckhoff catheter insertion by the rectus sheath tunneling (RST) procedure in adult patients with ESKD. METHODS : This retrospective investigation was conducted in an Indonesian tertiary hospital. Data were gathered from the medical records of 18-year-old or older patients with ESKD who underwent laparoscopic Tenckhoff catheter insertion between January 1, 2018 to December 31, 2022. RESULTS : Of 68 patients, 45 (66%) were male and 23 (34%) were female, with a mean age of 45.25 (standard deviation: 13.2) years. The catheter survival rates at 3 months, 1 year, 2 years, and 3 years were 97%, 91%, 82%, and 80%, respectively. The estimated blood loss was 5 (2–100) ml and the median operation time was 70 (40–150) min. The omentopexy maneuver was used in 10 (15%) patients. The most common catheter problems were malfunction (18%), peritonitis (21%), exit-site infection (7%), abdominal herniation (3%), and leakage (1%). Because of uncontrolled complications, 9 (13%) patients underwent revision surgery and 10 (15%) required catheter removal surgery. Catheter migration was not observed in any patient. CONCLUSIONS Laparoscopic Tenckhoff catheter insertion using the RST technique is a practical method for adult patients with ESKD as it has a reasonably low rate of complications.
Complications ; Laparoscopic ; Peritoneal dialysis

Laparoscopic cholecystectomy has become the standard of care in the management of gallstone disease with a slightly increased risk for bile duct injury. It is therefore essential that a standard grading system can be utilized and thus predict whether cholecystectomy can be completed laparoscopically or warrants the need for bailout procedure to prevent biliary injury. This study includes all patients who underwent laparoscopic cholecystectomy in Capitol University Medical Center and Maria Reyna Xavier University Hospital from March 2021 to January 2022. Total of 220 patients underwent laparoscopic cholecystectomy but only 173 patients were included due to incomplete data. Age, BMI, sex and G10 scoring were collected. This scoring system focuses on four components: the gallbladder’s operative appearance, whether distended or contracted, ease of access including limited access due to adhesions from prior surgery, the presence of sepsis in the peritoneal cavity, either biliary peritonitis or purulent fluid, and/or a cholecystoenteric fistula, and the degree of gallbladder adhesions. Descriptive statistics and univariate analysis were used to determine the need for bailout procedure in laparoscopic cholecystectomy. It was found that each year increase in age raises the odds of doing bailout surgery by 8.2% (OR: 1.0823, p = 0.009), while higher G10 scores nearly triple the odds (OR: 2.9227, p < 0.0001). The G10 scoring system is a practical scoring system with easy to remember assessment variables. G10 score of greater than 3 with increasing age shown to have increased chance of employing bailout procedure.

Laparoscopic management of a giant choledochal cyst (CC) in an infant is a technically demanding surgical endeavor that requires specialized training and meticulous planning. Laparoscopic CC surgery presents unique challenges due to the limited operative space, delicate anatomy, and technical demands of the procedure, being both excisional and reconstructive. These challenges are magnified when presented with an infant with a giant CC. In this report, we are going to present the challenges encountered and share the various steps that allowed our team to overcome these challenges.

Our patient is an 11-month-old female, 8.6 kg female who presented to our institution with a RUQ mass, jaundice, and a CT scan showing a large type 1 saccular choledochal cyst. After careful review, our team attempted and successfully performed a laparoscopic cholecystectomy with en bloc excision of the CC and hepaticoduodenostomy reconstruction.

The main challenge is the limited operative space. Once addressed, we felt confident we could complete the procedure laparoscopically. Operative time was 270 minutes. Feeding was resumed at postoperative day 5. Patient was discharged on postoperative day 7. There were no reported intraoperative and postoperative complications. The child remained well with no issues on postoperative reviews. Laparoscopic excision of a giant choledochal cyst in an infant is feasible, effective and safe with good outcomes. Preoperative planning, creative port placement, use of multichannel port, gauze, bipolar shears and needle cyst decompression are key in the successful performance of this elusive and challenging operation.

BACKGROUND AND OBJECTIVE

Robotic surgery for rectal malignancies in the Philippines is emerging. Evidence has shown promising results for robot-assisted (R) rectal surgery when compared to the laparoscopic (L) and open (O) approach. This study discussed the clinicopathologic outcomes of the first robotic rectal resections versus laparoscopic and open rectal resections at the Philippine General Hospital (PGH).

This was a retrospective cohort of 45 consecutive surgical resections for rectal malignancy done at the PGH from March 2019 to October 2019 that compared the outcomes of the first 15 robotic procedures done at the institution versus laparoscopic (n=15) and open (n=15) operations performed during the same time period. One-way ANOVA was done to determine significant differences among variables, while Bonferonni multiple comparison test was done to analyze differences among means.

The 45 patients in the study had a mean age of 56.04 ± 13.45 years. The patients were mostly male (60%). Most of the tumors were located in the low rectum (27/45; 60%). Most of the patients had locally-advanced (at least Stage IIIB) disease (27/45; 60%), and warranted neoadjuvant treatment (41/45; 91.11%). Most patients underwent a sphincter-saving procedure (34/45; 75.56%). All three groups had comparable baseline characteristics. The R-group had the longest operative time (438.07 ± 124.57; p value < 0.0001). Blood loss was significantly highest in the R-group (399 ± 133.07 cc; p value - 0.0020) as well, while no statistical difference was observed between the Oand L-groups (p value – 0.75). No conversion to open was noted in the R- and L-groups. Most of the patients had well-differentiated adenocarcinoma (22/45; 48.49%). All patients in the L- and O-groups had an R0 resection There were two R1 resections in the R-group. All patients who underwent an open surgery had a negative circumferential resection margin (CRM); L-group 93.99%, R-group 69.23%. All patients had adequate proximal and distal resection margins. Those who underwent an open surgery had the shortest post-operative length of stay (LOS) (p value – 0.0002). Post-operative ileus (7/45; 15.56%) was the most commonly encountered morbidity, and was seen mostly in the R-group (3/15; 20%). One patient in the R-group underwent a transanal repair of an anastomotic dehiscence and was discharged three days after reoperation. There was no reported mortality.

Our institution with a beginning robotic colorectal surgery program showed promise as its initial outcomes for rectal cancer were compared to the more often-performed open and laparoscopic procedures. The authors expect more favorable clinicopathological outcomes as our staff overcome the prescribed learning curve for robotic surgery.

OBJECTIVE: To explore the effect of auricular point pressure on anesthetic recovery in the patients undergoing laparoscopic cholecystectomy. METHODS: One hundred and forty patients undergoing laparoscopic cholecystectomy were randomized into a trial group (52 cases, 2 cases dropped out) and a control group (52 cases, 2 cases were eliminated). In the control group, the conventional anesthesia program and recovery intervention were adopted. In the trial group, on the basis of the regimen as the control group, the intervention of auricular point pressure was supplemented. The auricular points on the right side were selected, including sympathetic (AH_6a), brain (subcortex, AT₄), thalamus, exciting point, heart and sore center. One day before operation, the auricular point pressure started; and the auricular points were stimulated specially before anesthesia (T0), at the moment of operation ending (T1), when entering the recovery room, at the moment of the tube removal (T2) and in 10 min of the tube removal (T3), respectively; each auricular point was pressed for 1 min a time. The recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, and the time of exiting recovery room were compared between the two groups. The score of pain visual analogue scale (VAS) and that of Richmond agitation-sedation scale (RASS) at T2, T3 and when exiting recovery room (T4), and the relevant circulatory indexes (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and mean arterial pressure [MAP]) at T0, T1, T2 and T3 were observed in the two groups. RESULTS: In the trial group, the recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, the time of exiting recovery room were shorter than those of the control group (P<0.01, P<0.05). The pain VAS and RASS scores at T2, T3 and T4, as well as HR, SBP, DBP and MAP at T0, T1, T2 and T3 were not different statistically between the two groups (P>0.05). CONCLUSION Auricular point pressure can shorten the recovery time from anesthesia in the patients undergoing laparoscopic cholecystectomy.
Humans ; Cholecystectomy, Laparoscopic ; Male ; Female ; Middle Aged ; Adult ; Anesthesia Recovery Period ; Acupuncture Points ; Aged ; Young Adult

Introduction: Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures. Methods: Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively. Results: The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01]. Conclusion Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.
Cholecystectomy, Laparoscopic ; Shoulder Pain ; Hemodynamics ; Carbon Dioxide

Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Humans ; Mirizzi Syndrome/surgery*

Objective: This study aimed to compare the cost of hospitalization for open and laparoscopic cholecystectomy (OC and LC) among adult patients with cholelithiasis in the Philippine General Hospital. Methodology: The billing records of all patients admitted for elective cholecystectomy from February to July 2017, were reviewed. An item by item costing for room and board, laboratories, radiologic exams, surgical and anesthesia needs for each patient meeting the inclusion criteria was done. Results: From February to July 2017, a total of 391 cholecystectomies were performed; 156 cases (78 OC and 78 LC) were included in the analysis. There is no significant difference between the mean total cost for the laparoscopic group which was 20,549 +/- 4,972 pesos and 18,465 +/- 7,908 pesos (p < 0.05) for the open group. Conclusion Total cost of LC is comparable to OC. However, when the total expenses were divided into categories, the OC group incurred significantly bigger charges than the LC group in room and board, laboratories, radiology, pharmacy, and surgery needs. On the other hand, the LC group had significantly higher mean charges for the surgery needs inclusive of the laparoscopic machine and disposable instruments.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Laparoscopy

Aged ; Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; complications ; diagnosis ; surgery ; Clinical Laboratory Techniques ; Coronavirus Infections ; complications ; diagnosis ; Elective Surgical Procedures ; methods ; Follow-Up Studies ; Humans ; Infection Control ; methods ; Male ; Pandemics ; Patient Safety ; Pneumonia, Viral ; complications ; diagnosis ; Postoperative Care ; methods ; Risk Assessment ; Singapore ; Treatment Outcome

OBJECTIVE: To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy. METHODS: Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed. RESULTS: Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth II in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment. CONCLUSION Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Gastric Bypass ; Humans ; Laparoscopy ; Retrospective Studies