::NEWSLETTER::





Dear Colleagues, We are pleased to write to thank you for the support you have provided over the past 6 months. I thank you for the appreciation you had shown following our last activity report. Your well wishes and guidance have helped us to grow and carry out newer and more difficult procedures, some of which have been outlined below. Our work in the field of retroperitoneoscopy along with ortho surgeon Dr Sugavanam for sacro iliac disease has been accepted as a original article for publication for pioneering work in the journal of bone and joints. We have been fortunate to have been invited to Malaysia to take part in live workshop to perform 11 laparoscopic operations including Endoscopic Axillary Thyroidectomy for the first time in Malaysia in April 2007.Scientific papers in Dubai and Hernia workshop in Singapore formed some of the international activities.We have been able to share and exchange our experience in pancreatic work and advanced gastro intestinal minimal access surgery in meetings in Bangalore, Chennai and Hyderabad.Future academic sessions include the invitation to deliver the presitigious Dr Das Mahopatra Oration at ASI Conference in Bhubaneswar in Dec 2007, convening scientific committe for IAGES meeting in Jaipur 2008 and invitation to operate as faculty in Dhaka in the Surgical Society in Dec 2007.We thank you for the support and guidance you have provided for us to serve the needy.I do hope that we will be able to meet in Delhi FIAGES meet, Hernia meet of Indian Society of Hernia and later on in IAGES Congress ,Jaipur in Feb 2008 . We wish you all the best in the festive season and all prosperity and happiness in 2008.
With kind personal regards, John AC Thanakumar, Director of Minimal Access Surgery, KMCH.

Editorial Committee: Dr Naveen Alexander Dr Sheik Afzal Rubby Dr Satish Kumar Dr Chakravarthy Photos Mrs Jeyamani Mr Ramesh Topography Mrs Usha
		HELP course helps to train in Basic and Advanced Laparscopic Surgery. For details, case of the week, evidence based surgery, visit www.lapsurgeon.org

	Kovai Medical Center& Hospital Ltd,Avinashi Road, Coimbatore,TN. Tel:0422-2627572,4323618,0984302143,09443709158. www.lapsurgeon.org Email: drjact@gmail.com

Laparoscopic Splenectomy

Splenectomy

Splenectomy is done as an emergency or elective operation. Whether the approach is open or minimal access depends on the indication and the condition of the patient. We present 2 cases of splenectomy in different clinicla scenerio. A 38 year old lady presents with thrombocytopenia and is found to have idiopathic thrombocytopenic purpura with no response to earlier medical treatment. She underwent laparoscopic splenectomy. The second patient was 50 year old man who had a road traffic accident and sustained multiple rib fracture and splenic rupture with moderate hemo peritoneum. He underwent open splenectomy in view of falling BP and rupture.

Splenic artery

Splenic Vein

Laparotomy for Rupture

Laparotomy

Rupture

Left Hemipancreatectomy in 12 year old girl

12 year old girl presented with mass in the upper abdomen with discomfort. CT revealed a mass in the pancreatic body and tail. Tumor markers were borderline. We carried out left hemipancreatectomy . Histologically this was a pseudocyst of the body of pancreas presenting as a tumor of the pancreas. She is well after surgery.Cysts of the pancreas are well known entity and tumor should not be missed out on an assumption of innocuous diagnosis.

Appendigitis Epiploicitis

This is an abnormal inflammation of the fatty appendices epiploiacea of large bowel which results in sudden onset of pain not unlike appendicitis on the right side and sigmoid colitis on the left side. 24 year old young man presented with mass in the left iliac fossa of 3 day duration. US revealed a mass and CT confirmed the diagnosis. This is a self limiting condition and is treated with anti inflammatory drugs. There is no need for laparoscopy if diagnosis is made with confidence.

CT pictures reveal appendigitis epiplicitis

Appendicitis with perforation of caecum

Appendicitis is the commonest surgical emergency. Most patients prefer laparoscopy. We present a case of appendicitis in 40 year old male with a history of right iliac pain of 5 day duration with increasing pain and mild fever.He had a tender mass in the right iliac fossa. At laparoscopy it was appendicitis with mass formation and minimal pus. The base of the appendix had much inflammation and gangrenous with perforation extending from appendicular base to caecal wall. Laparoscopic appendectomy was done with harmonic scalpel . The perforation of the caecal wall sutured with interrupted silk sutures in single layer. After leaving a drain, laparoscopy was completed. He made an uneventful recovery. Good suturing skills obviate the need for conversion to open surgery.

www.lapsurgeon.org Dr John AC Thanakumar

Idiopathic Perforation of Gall Bladder:

Gallbladder perforation is an infrequent but potentially fatal disease. It is usually a complication of acute cholecystitis with or without gallstones and has rarely been reported in association with trauma, neoplasia, chemotherapy, vascular disease or pregnancy.However, idiopathic perforation of the gallbladder without any demonstrable cause is an extremely rare occurrence.

Our 55 male nondiabetic patient presented with acute abdomen of right upper abdomen.He was tender in right upper abdomen. US showed no perforation. Laparoscopy revealed localized perforation of gall bladder with biliary peritonitis. Following lapaposcopic cholecystectomy, he made uneventful recovery.

Bile Peritonitis

Perforation

Hernia surgery

Laparoscopy for hernia has revolutionized the management. For uncomplicated bilateral and recurrent hernia, laparoscopy is the treatment of choice. Complications such as perforation and obstruction were contraindications for laparoscopy before, but no longer. We present 2 cases of complicated herniae by laparoscopy. First is 70 year female who presented with vomiting and abdominal distension. Except for visible peristalsis and normal hernial orifices, she was not tender. CT revealed an obstructed and locally perforated obturator hernia. She underwent laparoscopic repair of the same. Second is female hysterectomised patient with an obvious irreducible and tender large incisional hernia. She had obstruction on xray and she responded to laparoscopic reduction of the bowel after enlarging the obstructing ring and a mesh repair.

Visible peristalsis Perfed Obt Hernia Exteriorize,Resect Closure of ring

Incisional Hernia Gut in ring Contents reduced Defect for repair

Liver Resection for Giant Hemangioma

Giant hemangiomas of liver measure more than 5 cm by definition. We present a symptomatic giant hemangioma of left lobe measuring 18X15 cm in 25 year old male. He underwent left hemiliver resection. Blood loss was 250 ml and he required no transfusion for surgery and was

married one month later before return to Dubai