European Journal of Molecular & Clinical Medicine

The development of laparoscopic surgery has widened up the horizon as approach to abdominal surgery conforms and today provides an option to consider even in abdominal surgical emergencies. In this paper, we would like to highlight our experience of laparoscopic approach to treat early duodenal ulcer perforation emergencies.
Aims and objectives: To highlight the results of laparoscopic primary repair of 12 cases of duodenal ulcer perforation.
Methods: A hospital-based prospective observational study carried out on 12 patients presenting with duodenal ulcer perforation in the emergency department. The decision to choose between laparoscopic and open approach was based on the discretion of the supervising surgeon, and 12 cases were randomly selected from a spectrum of patients presenting with clinically and radiologically established hollow viscus perforation.
Conclusion: . As most of the laparoscopic surgeons are well-acquainted with laparoscopic cholecystectomy, duodenal ulcer perforation repair by laparoscopy can be feasible with intracorporeal suturing skills.

Background:  Laparoscopy has been used as a therapeutic as well as a diagnostic tool in pelvic and abdominal surgeries. Present study was aimed at to study correlation of acid base and blood gas changes during laparoscopy and effects of various insufflating agents comparing Carbon Dioxide with Nitrous Oxide at a tertiary care hospital. Material and Methods: Present study was hospital based, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. Results: We compared effects of pneumoperitoneal insufflating agents among 2 groups of 35 patients each as Group N (Nitrous oxide as the insufflating agent) versus Group C (carbon dioxide as the insufflating agent). The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet the increase in the tissue oxygen demand, it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in both the groups, with numerically high values in Group C. The PeCO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂. Though the rises of the PaCO2 and fall in pH were statistically significant, they did not reach hazardous level. Group N (14.28 %) had more incidences of nausea and vomiting as compared to Group C (5.71 %).
Conclusion: Nitrous oxide appears to be the most suitable insufflating agent, used to produce pneumoperitoneum as compared to carbon dioxide, with general anaesthesia for laparoscopic surgeries.

The burden of dysmenorrhea is greater than any other gynecological complaint. The effects extend beyond individual women to society, resulting in an important loss of productivity annually. Thus, World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain. Adenomyosis and endometriosis are the most frequent causes of secondary dysmenorrhea in young women. Aim: The aim of this study was to evaluate the causes of secondary dysmenorrhea by diagnostic laparoscopy and find out the prevalence of endometriosis as a cause of secondary dysmenorrhea. Methodology: A total of 35 women with persistent dysmenorrhea and negative imaging findings were subjected to diagnostic laparoscopy after proper investigations and informed consent. Results: In all 35 cases that underwent laparoscopy, 26 women had endometriosis (74.2%). There were 6 women diagnosed with PID (17.14%), one woman with adenomyosis, and two women with ovarian cysts. Among women with endometriosis, 53.8% had ovarian endometriomas, 76.9% had endometriotic lesions, and 34.6% had adhesions. Endometriosis was found maximum (42.9%) in the ovaries followed by POD (40%), uterosacral ligaments (17.1%), fallopian tubes (11.4%), bladder, and pelvic peritoneum 2.9% each. Histopathology was sent for 30 cases and only 24 cases reported back with biopsy reports. Biopsy-proven endometriosis and laparoscopically diagnosed endometriosis were analyzed and compared. The sensitivity of laparoscopy was found to be 77.78%, and the specificity 33.33%. Conclusion: Endometriosis should be suspected in women of the reproductive age group with secondary dysmenorrhea. Laparoscopy is the most reliable technique for the diagnosis of endometriosis. Laparoscopy should be combined with histopathological examination since endometriosis is likely to be overdiagnosed or underdiagnosed if only visual diagnosis is used

The burden of dysmenorrhea is greater than any other gynecological complaint. The effects extend beyond individual women to society, resulting in an important loss of productivity annually. Thus, World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain. Adenomyosis and endometriosis are the most frequent causes of secondary dysmenorrhea in young women.
Aim: The aim of this study was to evaluate the causes of secondary dysmenorrhea by diagnostic laparoscopy and find out the prevalence of endometriosis as a cause of secondary dysmenorrhea.
Methodology: A total of 35 women with persistent dysmenorrhea and negative imaging findings were subjected to diagnostic laparoscopy after proper investigations and informed consent.
Results: In all 35 cases that underwent laparoscopy, 26 women had endometriosis (74.2%). There were 6 women diagnosed with PID (17.14%), one woman with adenomyosis, and two women with ovarian cysts. Among women with endometriosis, 53.8% had ovarian endometriomas, 76.9% had endometriotic lesions, and 34.6% had adhesions. Endometriosis was found maximum (42.9%) in the ovaries followed by POD (40%), uterosacral ligaments (17.1%), fallopian tubes (11.4%), bladder, and pelvic peritoneum 2.9% each. Histopathology was sent for 30 cases and only 24 cases reported back with biopsy reports. Biopsy-proven endometriosis and laparoscopically diagnosed endometriosis were analyzed and compared. The sensitivity of laparoscopy was found to be 77.78%, and the specificity 33.33%.
Conclusion: Endometriosis should be suspected in women of the reproductive age group with secondary dysmenorrhea. Laparoscopy is the most reliable technique for the diagnosis of endometriosis.
Laparoscopy should be combined with histopathological examination since endometriosis is likely to be overdiagnosed or underdiagnosed if only visual diagnosis is used.

Repairing a hernia in the groin is a routine surgical treatment, and for the vast majority of patients, the healing process after surgery is straightforward. Some patients, however, continue to complain of chronic groin pain or discomfort (CGP) (or months or even years after hernia treatment. This is a complication that is becoming recognized as a substantial source of morbidity following groin hernia surgery and is growing more common.
Aims and objective: To evaluate the chronic pain after laparoscopic and open mesh repair of groin hernia
Material and methods: This research included all of the patients who voluntarily chose to have a repair of their groin hernia performed with a prosthetic mesh. These patients were asked about any pain or discomfort they experienced as a result of the groin hernia repair, as well as whether or not it prevented them from participating in daily physical or sporting activities like walking, lifting a bag of groceries, playing golf, or more strenuous sports like jogging and football. The questionnaire was given out between 6-12 months after the procedure was performed. Laparoscopic TEP repair was conducted under general anaesthesia without securing the Prolene mesh in the preperitoneal area. The procedure was performed via the transperitoneal access port (TEP). The Lichtenstein procedure was used to accomplish open mesh repair under general anaesthesia, with the exception of patients who had substantial cardiorespiratory illness or those who wanted to undergo local anaesthesia.
Results: From the group of 200 patients, 160 (80%) provided a response, 20 (10%) passed away due to factors unrelated to hernia repair, and 10 (10%) did not provide any information at all. Out of the total of 160 patients, 80 (or 50%) had laparoscopic TEP, while the remaining 80 (or 50%) underwent open mesh repair. Three-fifths of the 160 patients, on average, complained of having persistent pain or discomfort in the groin area. Nine of these individuals (5.62%) claimed experiencing pain, whereas 47 (29.37%) just reported feeling uncomfortable. CGP was seen at a considerably higher frequency after open mesh repair in comparison to laparoscopic TEP repair. CGP prevented 38 patients, or 23.75 percent of the total, from participating in daily physical or sports activity.
Conclusion: After groin hernia surgery, patients reported having chronic pain or discomfort in 35% of cases. This occurrence was substantially more likely after open mesh repair than after laparoscopic TEP repair. In 23.75 percent of the patients, it had a negative impact on their ability to participate in active or sports activities, and this was exacerbated following open mesh repair.

The female genital TB is a persistent infectious illness that has been linked to serious morbidity in the reproductive health of women. To prevent unwanted laparotomies, diagnostic laparoscopy may help in the early identification and safe management of genital TB.
Objectives: This study was planned to evaluate the role of laparoscopy in the diagnosis of genital tuberculosis in women.
Methodology: Total 80 women who underwent laparoscopy and were suspected to have genital tuberculosis in last two years were included.
Results: When comparing the diagnostic accuracy, all of the 80 patients with suspected diagnosis of genital TB on laparoscopy were included. As compared to laparoscopy, histopathology was able to diagnose only 10 (12.5%) cases of genital TB and CBNAAT was able to diagnoseonly 6 (7.5%) patients of genital TB.
Conclusion: Laparoscopy was found to be an excellent choice to diagnose genital TB over the HPE and CBNAAT. It is recommended that further studies should be conducted to establish laparoscopy as a standard method to diagnose genital TB

Aim: To study the conversion rate of laparoscopic cholecystectomy into open cholecystectomy in study conducted among 50 patients in our hospital.
Materials and Methods: This study was conducted in the department of General Surgery at Maharishi Markandeshwar University Solan. Patients were admitted from OPD.  History of the patient, general physical examination and clinical examination was done, ultrasound abdomen was done in 50 patients and sonographic findings were noted and posted for laparoscopic cholecystectomy. Patient with ultrasound proved symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, empyema gall bladder, mucocele gall bladder, gall stone pancreatitis were included in this study.  Patients with gall bladder carcinoma, CBD calculus, dilated CBD with deranged LFT, history of bleeding diathesis, having severe cardiopulmonary compromise were excluded from the study.

Aim: Acute nonspecific abdominal pain (NSAP) is frequently encountered in the daily medical practice. This prospective study was performed to elucidate the role of early laparoscopy in the management of NSAP and to compare it with active clinical observation in such cases.
Methodology: A total of 100 cases with acute NSAP were randomly divided into two groups: early diagnostic laparoscopy (EDL) group included 50 cases who underwent EDL, and observational group included the remaining 50 cases who were closely observed. Outcome measures included the definitive diagnosis, operative time, duration of hospitalization, and postoperative morbidity.
Results: No statistically significant difference was noticed between the study groups regarding demographics. However, the duration of symptoms showed significant prolongation in the observation group. Regarding the final definitive diagnosis, no significant difference was noticed between the two groups (P <0.001). No definite diagnosis was reached in 12 and 52% of cases in the EDL and observation groups, respectively. In the observation group, 18 cases underwent laparoscopic assessment after admission (36%). The duration of hospitalization was significantly prolonged in the observational group. In addition, both recurrence and readmission were more reported in the same group during 15-day and 6-month follow-up visits.
Conclusion: Diagnostic laparoscopy appears to be a reliable tool to reach a definite diagnosis in patients with NSAP because of its superior diagnostic ability, better visualization, low complications, and the ability to manage the pathology in the same setting.

Background: Laparoscopy involves the visualization of abdominal and pelvic organs after creating an artificial pneumoperitoneum. Present study was aimed at to study effects of various insufflating agents during general anaesthesia and correlation of acid base and blood gas changes during laparoscopy to determine ideal insufflating agent amongst CO₂, O₂ and N₂O at a tertiary hospital. Material and Methods:  Present study was single-center, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/ II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. 105 patients were divided in three groups of 35 patients each as Group- I (oxygen as the insufflating agent), Group II (Nitrous oxide as the insufflating agent) & Group III (carbon dioxide as the insufflating agent).Results: Mean age, body weight & types of procedures were comparable among all groups & no significant statistical difference was noted. The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet in increased the tissue oxygen demand it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in all the three groups, with a numerically high value in Group III. The PECO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂.  Though the rise of the PaCO₂& fall in pH was statistically significant, they did not reach hazardous level. The Group I had the highest incidence of nausea and vomiting (88.57 %) followed by Group II (14.28 %). Conclusion:         Nitrous oxide appears to be the most suitable amongst the three gases; Oxygen, Nitrous oxide and carbon dioxide, with general anaesthesia.

There has been an increase in prevalence of obesity over last few decades. Obesity is multifactorial disease associated with numerous co-morbidities and complications which is mainly classified based on individuals body mass index. This is a challenge for the anesthesiologist to manage the patient perioperatively because of various cardiovascular and respiratory complications that are associated with it. The compromised airway and change in respiratory physiology in obese patients and the intra-operative factors like positioning, choice of surgical methods like laparoscopy further poses a challenge in management of airway, ventilation, fluid management. The peri operative risk of deep vein thrombosis, myocardial infraction, early ambulation and discharge are other concerns that are to be addressed and managed effectively. Hence, it becomes essential for the anesthesiologist to be aware of techniques for effective management of morbid obese patients posted for laparoscopic surgery for better outcomes post operatively.

Background:Inguinal Hernias are among the most common clinical entities requiring surgical intervention in general surgery. Aim: To analyse the different surgical approaches chosen for the inguinal hernia repair in the rural areas of the third world country, the complications thereof and the hospital stay retrospectively. Methods: 365 patients presenting to the hospital between November 2017 to November 2019 were analysed for the surgical intervention in inguinal hernias. Results: 349 patients out of 365 underwent the open surgical intervention and 16 were dealt laparoscopically. Average duration of 45 minutes to 1 hr and 1 hr 45 minutes to 2 hrs was noted in open and laparoscopic method respectively. Recurrence was seen in 2 cases which had undergone open method. : 4 cases of wound infection were noted, out of which mesh removal was done in 1 case. Conclusion: Open surgery is the preferred method of surgical intervention in socially backward area

Background: This research aimed to determine, prior to surgery, what factors, if any, could help a surgeon anticipate a "difficult cholecystectomy" using either laparoscopic or open surgery. Consecutive patients undergoing cholecystectomies (both open and laparoscopic) for gallstone-related disorders are analysed to see which factors best predict the presence or absence of surgical complications. The goal of this study is to determine which clinical, laboratory, and radiographic criteria are most indicative of difficult dissection during cholecystectomy. To develop a scoring system prior to surgery that can accurately predict the result during the procedure.
Results: A cholecystectomy is a common surgical procedure. Those who experience symptoms from gallstone disease are increasingly likely to opt for laparoscopic cholecystectomy. The incidence of both complications and conversions are higher in patients who are already at high risk, as well as in complex cases that provide technical challenges. The current study included 123 individuals with confirmed cases of cholelithiasis who were scheduled to have surgery. The results and discoveries were recorded and scored intraoperatively. The range of possible grades was 0–15. In this case, a score of 5 or below indicated an easy task, 6–10 indicated a moderately difficult task, and 11–15 indicated a very challenging task. Two categories, "Easy" (scores of 5) and "Difficult" (scores of >6), were made for the purpose of statistical analysis. Demographic, clinical, laboratory, and imaging parameters were collected before to surgery and compared to the two intra-operative groups to identify any possible correlations.
Conclusion: 123 patients with cholelithiasis were the subjects of a prospective study. Data from these patients' demographics, imaging, and metabolic profiles, as well as their intra-operative outcomes, were compared. All 123 patients used in the study underwent laparoscopic procedures. Of the 123 cholecystectomies performed laparoscopically, 113 were successful without having to resort to open surgery. In this analysis, we find a conversion rate of 8%. It is 33.3% greater in cases of acute cholecystitis.

Aim: To study the efficacy of laparoscopic appendectomy as well as conversion rate of laparoscopic appendectomy to open appendectomy.

Aim: To establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery.

Background: Most demanding and challenging conditions to manage across the globe in
subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements
have been made, pain in these subjects still presents a challenge for all available diagnostic
and management methods.
Objectives: The present study was conducted to assess the efficacy and role of diagnostic
laparoscopy in the identification of the etiology of chronic abdominal pain which is not
diagnosed.
Materials and methods: In 30 subjects with chronic abdominal painwith unknown etiology
or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was
done for all the subjects. The collected data were subjected to statistical evaluation and the
results were formulated.

Background: Most demanding and challenging conditions to manage across the globe in
subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements
have been made, pain in these subjects still presents a challenge for all available diagnostic
and management methods.
Objectives: The present study was conducted to assess the efficacy and role of diagnostic
laparoscopy in the identification of the etiology of chronic abdominal pain which is not
diagnosed.
Materials and methods: In 30 subjects with chronic abdominal painwith unknown etiology
or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was
done for all the subjects. The collected data were subjected to statistical evaluation and the
results were formulated.

Introduction: Laparoscopic cholecystectomy (LC) has been proved to be the benchmark
treatment for symptomatic cholelithiasis. The overall morbidity and mortality rate is 5–
10% and 0.1% respectively, and an open conversion rate of 5–10% is commonly
reported in the literature. Over a century, classical cholecystectomy (Open method) has
been the method of choice in the surgical management of gall bladder diseases. One of
the risk factors for cholelithiasis is obesity, the incidence of which is increasing
worldwide due to the change in lifestyle habitat. Therefore, surgeons are likely to
encounter increasing number of obese patients who require a cholecystectomy for
symptomatic cholelithiasis. Conventionally obesity has been considered as a relative
contraindication to LC, as the technical difficulties associated with this procedure in
these patients were thought to be associated with higher morbidity and mortality as well
as increased open conversion rates. The aim of this study was to investigate the safety
[peri-operative morbidity and mortality and the incidence of bile duct injuries (BDI)]
and efficacy (duration of surgery, LOS and open conversion rates) of an elective LC in
the morbid/ super obese patients (BMI > 40) compared to patients with a BMI < 26 and
a BMI 26–40.

Background: Most demanding and challenging conditions to manage across the globe in
subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements
have been made, pain in these subjects still presents a challenge for all available diagnostic
and management methods.
Objectives: The present study was conducted to assess the efficacy and role of diagnostic
laparoscopy in the identification of the etiology of chronic abdominal pain which is not
diagnosed.
Materials and methods: In 30 subjects with chronic abdominal painwith unknown etiology
or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was
done for all the subjects. The collected data were subjected to statistical evaluation and the
results were formulated.

Adhesive disease of the abdominal cavity, complicated by acute intestinal obstruction, is one of the most difficult diseases of the abdominal cavity in terms of treatment and diagnosis. The urgency of the problem is determined by the complexity of prevention and treatment of the studied complication, the widespread increase in surgical activity, the expansion of indications for performing operations of extended volume and combined interventions for diseases of the abdominal cavity and retroperitoneal space. Analysis of the literature shows that acute intestinal obstruction occupies one of the first places among urgent pathology of the abdominal cavity in terms of the frequency of complications and fatal outcomes. An increase in the number of patients, the severity and recurrent nature of the disease, difficulties in diagnosis, unsatisfactory immediate and long-term results of treatment of patients with adhesive small bowel obstruction, as well as a high percentage of disability determines the relevance of the chosen topic.

To explore the possibilities of different methods
of surgical treatment of severe acute pancreatitis , two groups of surgical
patients were selected depending on the method of surgical treatment,
which were produced by different types
of " open " and laparoscopic operations. To assess the effectiveness of
the applied methods of treatment, in the postoperative period, we used
the following laboratory and physiological parameters: progression
or regression systemic inflammatory response syndrome (SIRS ), neutro
phil-lymphocyte ratio ( NLR), as well as integral scales for assessing
severity Ranson , APACHE - II and SAPS . The results obtained
demonstrate the advantages of laparoscopic surgical methods