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Biomedical subjects

Neena Agarwala

Publications and source records attributed to Neena Agarwala.

3 recordsLinked to original sources

Laparoscopic appendectomy.

STUDY OBJECTIVE: To evaluate the effectiveness of laparoscopic appendectomy in women with chronic pelvic pain and to identify histopathology of the appendix. DESIGN: Retrospective review over 6.5 years (Canadian Task Force classification II-3). SETTING: Laparoscopic center and community hospital. PATIENTS: Three hundred seventeen women. INTERVENTION: Laparoscopic appendectomy in conjunction with other procedures. MEASUREMENTS AND MAIN RESULTS: Of 317 patients who underwent appendectomy, 14 (4.4%) had involvement of the appendix with endometriosis, 12 (3.78%) had early acute appendicitis, 4 (1.26%) had carcinoid tumors of the appendix, 2 (0.63%) had a large mucocele, and 1 (0.9%) each had Enterobius vermicularis infection, benign neuroma, and mucinous cystadenoma. Seventy-eight women (24.6%) had obliteration of the appendiceal lumen and 22 (6.93%) had entrapping fibrous adhesions. Thirty-two patients (10%) reported relief of chronic pelvic pain in the absence of other pathology just by having diagnostic laparoscopy with appendectomy. CONCLUSION: The appendix is a key organ in the evaluation of undiagnosed chronic pelvic pain.

Adult↗

Minimally invasive management of urinary incontinence.

Stress urinary incontinence is defined as the loss of urine at the time of an increase in abdominal pressure in the absence of a detrusor contraction. A nearly 50% prevalence of urinary incontinence in women and estimated treatment costs of more than 10 billion US dollars annually in the United States warrant an effective, successful and minimally invasive treatment. Nearly 200 different operations have been described in the literature, with cure rates reported ranging from 40% to 95%, clearly suggesting that the optimal surgical procedure has yet to be developed. Genuine stress urinary incontinence can result from either hypermobility of the bladder neck and proximal urethra or intrinsic sphincteric deficiency, which may occur alone or in combination with anatomic defects. In reviewing the recent literature and surgical modalities we present our opinion on minimally invasive surgical management of urinary incontinence.

Female↗

Safe entry techniques during laparoscopy: left upper quadrant entry using the ninth intercostal space--a review of 918 procedures.

Surgeons performing sophisticated endoscopic operations must be well versed in alternate laparoscopic access methods to address evolving patient expectations and safety requirements. The safety of left upper quadrant laparoscopic entry in patients with prior surgeries and abdominal adhesions was evaluated. Laparoscopic surgery was performed for various indications on patients with prior surgical scars and anticipated risk of adhesions at the primary umbilical port site. All laparoscopies performed from July 1998 through June 2004 were analyzed. Of the 918 laparoscopies, 504 patients (54.9%) were found to have involvement of their umbilicus with adhesions that could have affected the traditional umbilical primary port entry. Left ninth intercostal space was used for Veres needle entry, and the primary trocar was placed in the left upper quadrant space. Of the 504 potentially risky entries, there were two (0.39%) Veres-needle related and zero trocar-related injuries. All surgical procedures were accomplished laparoscopically, and all entries were accomplished by the left upper quadrant entry technique. Therefore left upper quadrant entry technique is a safe and easily learned alternate access technique.

Abdominal Wall↗