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Combined Procedures in Laparoscopic Surgery

Wadhwa, Atul MS; Chowbey, Pradeep K MS, MNAMS, FIMSA, FAIS, FICS; Sharma, Anil MS, FICS, FRCS; Khullar, Rajesh MS, FICS; Soni, Vandana MS; Baijal, Manish DNB, MNAMS

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: December 2003 - Volume 13 - Issue 6 - p 382-386
Original Article

With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30–280 minutes.). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1–21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different coexisting pathologies without significant addition in postoperative morbidity and hospital stay.

From the Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, 11060 (India)

The following is the winning paper from Surgical Laparoscopy, Endoscopy & Percutaneous Techniques' 2002–2003 Resident/Fellow paper competition. The Editors-in-Chief and the Editorial Board extend their congratulations to the authors. Deadlines for the 2003–2004 competition appear in the beginning of this issue.

Received for publication July 1, 2003; accepted August 4, 2003.

Reprints: Dr. Atul Wadhwa, c/o Dr. P. K. Chowbey, Ayushman, 13, D.S. Market, R-Block, New Rajinder Nagar, New Delhi-110060 (India) (e-mail:,,

© 2003 Lippincott Williams & Wilkins, Inc.