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Fourth AIIMS Surgical WeekInternational Minimal Access Surgery Conference,

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ENDOSURG 2010

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Friday, 26th March to Sunday, 28th March 2010

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RNI No : DELENG/2006/21302 Vol. 4, No. 1, Nov 2009

IHS- NEWSLETTER

OFFICE BEARERS OF IHS

OFFICE BEARERS OF SELSI

Editor-In-Chief

Editors

Founder President

Secretary-Treasurer

Joint Secretary

Patrons

Convenor

President

Vice Presidents

Secretary

Treasurer

Joint Secretaries

Prof M C MisraNew Delhi

Dr Virinder Kumar BansalNew Delhi

Dr Subodh KumarNew Delhi

Prof M C Misra

Dr Virinder Kumar Bansal

Dr Subodh Kumar

Prof H S Asopa

Prof B M L Kapoor

Prof I K Dhawan

Prof M C Misra

Dr S D Maurya

Dr Muneer Khan

Dr Sandeep Guleria

Dr G S Moiriangthem

Dr Devendra Sortey

Dr M S Senthil Kumar

Dr Virinder Kumar Bansal

Dr Subodh Kumar

Dr H L Rajput

Dr Sandeep Agarwal

Dr Amit Gupta

Dr Amit Srivastava

www.hernia.inwww.selsi.in

Members are requested to share their experiences in the field of laparoscopic surgery for the benefit of readership of this news letter.

Appeal

Editor and Publisher: Prof. M C Misra

Room No.: 5031, Department of Surgical Disciplines, Teaching Block,

All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029

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Laparoscopic surgery has been established for more than two decades. It is being used in almost every field of surgery as people are gaining more and more experience. But still the most commonly performed surgery is laparoscopic cholecystectomy. Conventionally it is performed using four ports (two 10mm and two 5 mm ports). With the advancement, the size of the ports were reduced to two 5mm and two 3mm. As the surgeons gained experience in laparoscopy, they reduced the number of ports to three and then to two ports to remove the gall bladder with varied but acceptable results. Now the focus is on single port or more appropriately known as single incision laparoscopic cholecystectomy (SILC). Data published in English literature suggest that SILC may be an alternative to traditional three- or four-port cholecystectomy for the ideal candidate with a lower body mass index (BMI), early disease, and no previous abdominal surgery. However, it can be performed using existing instrumentation or with specially designed instruments by a reproducible technique that can be adopted by practicing general surgeons, who would have to learn this technique. It is relevant to point out that there is still limited data published in literature on early experiences with SILC cholecystectomy. There is no comparative data published in literature suggesting advantages of SILC cholecystectomy over conventional laparoscopic cholecystectomy.

The recently concluded 2nd National Conference cum Live International Laparoscopic Workshop of SELSI – SELSICON 2009 under the dynamic leadership of Prof S D Maurya from 24th-25th October 2009 at Agra was a grand success.

About 90 eminent international and national faculty shared their experiences with the delegates. More than 800 delegates participated in the conference. About 35 laparoscopic procedures (Gen & G I Surgery, Gynaecology & Infertility, Surgical Oncology, Urology and Paediatric Surgery) were demonstrated over two days.

Editors

National Executive Committee of IHS & SELSI

SELSIIHSFounder President

Secretary - Treasurer

Joint Secretary

Founder Members

North Zone

East & North East Zone

West & Central Zone

South Zone

Prof M C Misra

Dr Virinder Kumar Bansal

Dr Subodh K Garg

Prof G R Verma

Prof Sandeep Kumar

Prof Muneer Khan

Prof R K Sharma

Prof Narottam Dewan

Prof M S Griwan

Dr D S Negi

Dr P Dorji Phempu

Prof Muneer Khan

Dr Arshad Bhat

Dr GS Moirangthem

Dr Devendra Sortey

Dr J B Aggarwal

Dr A Ramamoorthy

Dr John A C Thanakumar

Zonal Members

Patrons

Convenor

President

Vice Presidents

Secretary

Treasurer

Joint Secretaries

Founder Members

International Founder Members

Executive Members

Editorial Secretaries

Academic Committee

Training Cell

Prof H S Asopa Prof B M L Kapoor Prof I K Dhawan

Prof M C Misra

Dr S D Maurya

Dr Muneer Khan Dr Sandeep Guleria Dr G S MoiriangthemDr Devendra Sortey Dr M S Senthil Kumar

Dr Virinder Kumar Bansal

Dr Subodh Kumar

Dr H L RajputDr Sandeep AgarwalDr Amit GuptaDr Amit Srivastava

Dr M C Misra Dr S D Maurya Dr Virinder K. BansalDr G S Moirnagthem Dr Dinesh Jindal Dr Shravan Kumar MalviDr P K Sachan Dr Vishal Kalia Dr Bholla Singh Sidhu Dr Rasik Shah Dr Nature Bakshi Dr P S V RaoDr Surinder Singh Dr Muneer Khan Dr Saroj C Gopal Dr S L Toplani Dr Namarta Manav Dr Narottam DewanDr Maneesh Mehta Dr S K Mishra Dr Devendra Sortey Dr M S Senthil Kumar

Dr G F Buess Dr R Bittner Dr Subhash GautatmDr Ashutosh Kaul Dr Ajay Sharma Dr Subhash Kini

Dr Narottam Dewan

Dr Shaliesh Puntambekar

Dr Renu Misra

Dr Pramod Garg/Dr D U Pathak

Dr Madhusudan Aggarwal

Dr Kishore Panjawani

Dr Sunil Chumber Dr Rajinder Prasad Dr Ch Arun Kumar Singh Dr Anita Dhar Dr Gyan Prakash Dr Siddharth DharDr Senthil Kumar Dr Surendra Pathak

Dr Subodh Garg Dr Prashant Bhowate

Dr Anurag Srivastava Dr Renu Misra Dr Madhusudan AggarwalDr Sidharth Dhar

Dr MC Misra Dr SD Maurya Dr Virinder K. BansalDr Hemanga K Bhattacharjee

General Surgery

Surgical Oncology

Gynaecology

Endoscopy

Urology

Paediatric Surgery

www.hernia.in / www.selsi.in

Laparoscopic management of refractory hypertension in a child

www.hernia.in / www.selsi.in

Virinder K Bansal *, Mahesh C Misra*, Prashant Bhowate*, KB Hemanga*, AP Bhalla **

Department of Surgical Disciplines* and Anaesthesiology**, All India institute of Medical Sciences, Ansari Nagar, New Delhi-110029

Childhood hypertension is an uncommon entity. Phaeochromocytoma accounts for about 1% of all pediatric 1hypertensive population .For diagnosis of phaeochromocytoma estimation of the metabolites are done in urine

& plasma, substantiated with radiological investigations for localization. We here present a case of a young child detected to have refractory childhood hypertension after the hospitalization for his persistent urological complains. He required six anti-hypertensive drugs but his hypertension was refractory. The biochemical investigation for urinary VMA & plasma catecholamine was negative. MIBG considered a hallmark for tumor

2localization was false negative but CT & MRI localized the tumor in right adrenal. For this hypertensive emergency a successful laparoscopic removal of phaeochromocytoma was done.

3To best of your knowledge, literature reports only three cases of MIBG with false negative report for benign phaeochromocytoma. Laparoscopic removal has an added advantage of minimal fluctuations in blood pressure on tumor handling, thus the modality of choice in surgical removal.

Hypertension, Phaeochromocytoma, negative MIBG, Laparoscopic resection, Childhood.

1Phaeochromocytoma are responsible for approximately 1% of non essential hypertension in children . Usually children with phaeochromocytoma have sustained hypertension as compared with adults, where the

4hypertension is usually intermittent . Laparoscopic adrenal surgery for phaeochromocytomas, including large 5lesions, has become the standard of care in adults . As the instrumentation and techniques in laparoscopy have

improved, there are various case reports and small series of successful laparoscopic management of phaeochromocytoma in children also. We are presenting a case of 8 year old male child with phaeochromocytoma, presented with paroxysm of sustained hypertension and the hypertension was refractory to medical treatment. A successful laparoscopic resection of the tumor could be done in this case.

A 8 years old male child developed a posterior urethral stricture following a road traffic accident. While undergoing supra pubic cystostomy he developed a sudden episode of sustained hypertension, requiring nitroglycerin drip for control. He had an episode of generalized tonic clonic convulsion in the post operative period, requiring anti-convulsant therapy. For control of this hypertension he required 3 drugs Amlodepine 5mg b.d, Captopril 5mg b.d & Clonidine 300 mg/ day. Again during a Cystoscopy examination he developed a paroxysm of hypertension. On investigation his renal function were within normal limits. An USG abdomen showed a SOL in liver, kidneys and adrenal were reported to be normal. A renal scan done showed normal uptake of tracer by the kidneys. A suspicion of phaeochromocytoma was made and Urinary VMA levels were done which were in the normal range (13.47mg/24hr- 0.6-52.8mg/24 hr). A MIBG scan was also done, which showed no radiotracer uptake in adrenal or extra adrenal region.

CECT abdomen showed a well circumscribed mass lesion of 4x5cm in the right adrenal region splaying and displacing IVC anteromedially. The left adrenal was normal.

MRI showed a hyper intense lesion on T2 wt. image in right adrenal area.

Abstract

Keywords:

Introduction

Case Report