Background: This study is based on the access technique for the creation of pneumoperitoneum in the operative procedure of laparoscopic cholecystectomy. This technique is a crucial step in this operative procedure. Aim: The specific aim is to study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing their outcomes and complications. Materials and methods: Our study is a prospective observational study for 2 years January 2021 to January 2023 of cases done in our facility at central and southern Ondo, Nigeria. Consecutive patients with cholelithiasis who consented to laparoscopic cholecystectomy were recruited into the study using a purposive sampling method after applying the exclusion criteria. The patients demographics and comparative variables were imputed into a proforma which was analyzed using SPSS version 26 (IBM incorporated Chicago, Illinois). Results: Of the 50 patients under study there were 4 males (8%) and 46 females (92%). The mean age was 45.74 ± 6.2 years. About 28 underwent the closed method of access while 22 underwent the open method. Minor complications like gas leaks during the procedure were observed more in the open method group. Other complications such as visceral and vascular injury and conversion to open surgery after the initial access were not observed in both groups. However umbilical port-site hematoma, umbilical port-site infection, and incisional hernia were observed in the open access method during follow-up period. The time taken to close abdominal ports wound was almost the same in both groups. However, the mean operating time was significantly less in the closed-access method. In general, the length of hospital stay in both groups was not significantly different. Conclusion: Even though both access methods are safe, the closed method is more efficacious than the open method.

Aim: Work-related musculoskeletal disorders consist of group of symptoms caused by occupational risk factors. These symptoms are the main cause of loss of productive working time and increase in labor costs. This study aims at estimating the prevalence and identifying risk factors for developing work-related musculoskeletal symptoms in surgeons performing laparoscopic surgery. Materials and methods: This cross-sectional study was conducted on 50 surgeons in a tertiary care hospital of Ahmedabad. In this study, the prevalence and severity of musculoskeletal symptoms was evaluated using the Nordic Pain questionnaire and Workplace Ergonomic Risk Assessment (WERA) method in surgeons performing laparoscopic surgery. Results and conclusion: The results revealed that there's development of significant pain during laparoscopic surgeries due to various reasons like neck posture and shoulder abduction posture; various ergonomics of laparoscopy. Workplace Ergonomic Risk Assessment scoring was very effective in identifying group of surgeons having high risk of developing musculoskeletal symptoms. This study concluded that surgeons maintained a more extended posture during laparoscopic surgery that led to musculoskeletal symptoms.

Aims and background: Simulation-based training is an innovative approach to medical education that is rapidly being adopted in many medical specialties, including surgery. Simulation-based training has several advantages over traditional methods of surgical training as it provides a safe and controlled environment for the repeated practice of surgical skills, which allows residents to gain confidence and competence in a particular skill before applying it to real patients. The objective of this study is to assess the perspective of a surgical residents toward simulation-based training in polytrauma scenario. Materials and methods: A prospective observational study was conducted over a period of 1 month in September 2022 at the BMCRI Simulation and Skill Centre located at Victoria Hospital in Bengaluru. About 26 surgery residents participated in the study and at the end of the study; all residents completed a short survey to obtain their perspective about the qualities of the simulator as well as usage of the system. Results: Based on the responses from the participants, it can be inferred that the majority of them agree (38.5%) or strongly agree (38.5%) with the effectiveness of the simulation training in polytrauma scenario briefing, the superiority of simulation-based education techniques (53.8%), the use of hands-on techniques (61.5%), and the appropriateness of the polytrauma scenario and equipment choices (38.5%). Additionally, the majority of the participants (76.9%) agree that the course met their needs regarding orientation to polytrauma assessment and management and that they would highly recommend the course to their peers. Regarding debriefing, the majority disagree (46.2%) which indicates a need for further detailed debriefing regarding the scenario. Conclusion: Simulation-based training is an effective method for training surgical residents in the management of polytrauma scenarios. Clinical significance: With the rapidly evolving surgical education simulation-based education is highly appreciated by surgical residents and they would benefit from more exposure to simulation in their learning process.

Background: The laparoscopic sleeve gastrectomy (LSG) is a pure restrictive bariatric operation. Gastropexy-omentopexy was proposed to alleviate complications, such as leakage, twist, and vomiting that may occur after sleeve gastrectomy This study was aimed to compare the effect of gastropexy-omentopexy on the early postoperative complications of LSG. Methodology: This is a prospective comparative study conducted between August 2021 and January 2024. It included 376 patients who had LSG at Asyut University Hospital. They were randomly divided in two groups, group A (No = 200) with gastropexy-omentopexy and group B (176) without gastropexy-omentopexy. Results: There was no statistically significant difference in terms of age, sex, and preoperative body mass index. The overall postoperative complications of group B are higher than those of group A (p = 0.001). There was no significant difference in postoperative leak, bleeding, stricture, and twist between the two groups. Nausea and vomiting were higher in group B than in group A (p = 0.001) gastropexy-omentopexy. Conclusion: Laparoscopic sleeve gastrectomy with omentopexy had a significant effect on the overall early complications and readmission rates after LSG. More studies are required to provide a strong recommendation of omentopexy as a standard step in LSG.

Aims and background: Surgical repair of diaphragmatic hernia (DH) is indicated in all diagnosed cases. It can be done by various approaches. Traditionally, laparotomy has been preferred, but with increasing experience in laparoscopic techniques advanced laparoscopic procedures are being carried out as well. Materials and methods: We retrospectively reviewed the clinical records of confirmed cases of DH treated in our institute from April 2016 to March 2018 with a minimum follow-up of 3 years. Cases of hiatus hernias have been excluded. The diagnosis was confirmed in all cases radiologically. Surgical repair was done in all cases by laparoscopic approach. Results: Laparoscopic repair was completed successfully in all patients with none requiring conversion. All patients except one were male (Male:Female – 6:1). Median age in our series of patients was 42 years. Predominant symptoms were abdominal discomfort with one patient being asymptomatic. Eventration was present in two of the patients, both being on the left side, while Bochdalek's hernia was noted in two patients. Three patients had anterior parasternal hernia with one being Morgagni and Larry's hernia each and in one patient bilateral anterior hernia was present. Diagnosis made in all preoperatively except Larry's hernia that was detected intraoperatively. Content comprised of stomach, part of small and large bowel, omentum, appendix, spleen, tail of pancreas and left kidney. Mesh repair was done in all cases except Larry's hernia where anatomical repair of defect was done. Operative time ranged from 50 to 90 minutes. Postoperative recovery was smooth in all. Hospital stay was 2–4 days. Follow-up has ranged from 45 to 68 months that has been uneventful till date without any recurrence reported. Conclusion: Surgical repair of DH should be done in all diagnosed patients irrespective of symptoms. The laparoscopic approach is recommended, keeping in view better vision, lesser postoperative pain, shorter hospital stay, and quicker recovery with the equivalent outcome. Clinical significance: Congenital diaphragmatic hernias (CDH) are mainly present in the neonatal period and are associated with high mortality. Rarely, these hernias are present later in life in adulthood. Late-presenting CDH is often difficult to diagnose and delays in treatment are common. In this article, we share our experience of diagnosing and managing CDH in adult patients.

Background: Abnormal uterine bleeding (AUB) is one of the most common indications for hysterectomy in perimenopausal age-group patients. Due to inadequate and varied response to medical management, fear of malignancy and lack of awareness, patients prefer to opt for hysterectomy. The incidence of unwanted hysterectomies is increasing particularly in rural and tribal populations in our country. Hysteroscopy is considered the gold standard technique for diagnosing and managing pathological conditions affecting the uterine cavity. Immediate treatment of endocervical, endometrial, or submucosal pathologies is possible with advanced operative hysteroscopy and it is associated with high patient satisfaction. Major surgery like hysterectomy can be avoided in case of benign uterine pathologies. Aims and objectives: To evaluate the role of advanced hysteroscopy in perimenopausal age-group patients with chronic AUB and to study the effect of operative hysteroscopy on improvement in the quality of life of perimenopausal AUB patients. Materials and methods: It was a retrospective study conducted over a period of one and a half year. 128 patients of age-group 35–50 years with AUB who had undergone hysteroscopy were included. Any demonstrable pelvic pathologies like pelvic malignancies and active pelvic inflammatory diseases were set as an exclusion criteria. Institutional standard operating protocol for hysteroscopic surgeries was followed. As per the protocol experienced senior faculties were the operating surgeons for all the cases. Demographic characteristics, hysteroscopic findings, and histopathology reports were correlated. All the patients were followed up for 6 months after hysteroscopic surgery. Results: A significant number of patients were diagnosed with intracavitatory lesions and they were managed successfully through operative hysteroscopy. Patients were satisfied with their quality of life after hysteroscopic surgeries. Conclusion: Operative hysteroscopic surgeries have been shown to be effective in treating AUB and possibly avoiding or delaying hysterectomy in perimenopausal women.

Purpose: In the realm of laparoscopic cholecystectomy, the significance of Rouviere's Sulcus as a pivotal physiological landmark cannot be overstated. Its identification plays a crucial role in facilitating the meticulous dissection of Calot's triangle, ensuring the secure ligation of the cystic artery and duct, and ultimately preventing common bile duct injuries. Understanding the anatomical variations of Rouviere's Sulcus is paramount for surgeons aiming to enhance the precision and safety of this common surgical procedure. Materials and methods: This observational study was designed to meticulously examine 49 patients presenting with confirmed gallstones, identified through ultrasound of the abdomen, in the general surgery outpatient department. The individuals included in the study were aged 19 years and above, representing both genders. The study methodology involved a comprehensive observation during laparoscopic cholecystectomy procedures. Results: Among the 49 patients subjected to laparoscopic cholecystectomy, the visualization of Rouviere's Sulcus was achieved in 46 cases (93.9%). The observed variations in Rouviere's Sulcus were diverse, revealing distinct anatomical configurations: Open type: 23 cases (46.9%), closed type: 7 cases (14.3%), slit type: 9 cases (18.4%), scar type (oblique): 4 cases (8.2%), scar type (transverse): 3 cases (6.1%) and absent: 3 cases (6.1%). Conclusion: These findings underscore not only the high prevalence of Rouviere's Sulcus but also the diverse nature of its anatomical presentations. The recognition of such variations emphasizes the need for a nuanced and individualized surgical approach, ensuring the utmost safety and efficacy in laparoscopic cholecystectomy.

Introduction: Obesity and type 2 diabetes mellitus (T2DM) pose significant health challenges, necessitating innovative interventions. This study aims to explore the efficacy of a novel swallowable balloon process in addressing these dual burdens. Methodology: To evaluate weight loss, diabetes remission, and adverse events (AEs) in 150 patients with a body mass index of 30–40 kg/m². The swallow balloon was inserted, and outcomes were assessed over a 6-month follow-up period. Results: The swallowable balloon process demonstrated consistent and significant (p < 0.001) weight loss, with mean percentage total weight loss (%TWL) ranging from 6.8 to 14.6% and mean percentage excess weight loss (% EWL) ranging from 15.5 to 32.8% over the 6-month follow-up period. Remarkably, diabetes remission rates were notable at 30% in 3 months and an impressive 67% in 6 months post-balloon insertion. However, AEs, particularly nausea and vomiting extending beyond one week, occurred in 12% of participants, leading to hospital admission, highlighting the importance of careful monitoring and management. Additionally, nausea and vomiting occurred in 46.6% and 40.6% of participants, respectively, without major complications. Conclusion: The swallowable balloon process demonstrates promising outcomes in weight loss and diabetes remission over the end of period. AEs require careful consideration, emphasizing the need for ongoing research to optimize safety and efficacy. This intervention offers a nonsurgical approach for individuals with obesity and T2DM, marking a significant step toward addressing these interconnected health challenges.

Gallbladder (GB) stones are a very common scenario in surgical cases operated worldwide. However, large GB stones are rarely reported and operated on due to the fact of high risk of complications and technical difficulties during surgery with few successful outcomes or postoperative complications. Here we report a case series of successful laparoscopic cholecystectomies done for large GB stones, the largest measuring 7 × 6 cm with no complications and positive outcomes with no mortality or postoperative complications in the Indian and Asian subcontinent. Case presentation: Case 1: A 77-year-old female with complaints of right hypochondriac pain. Ultrasound report suggestive of contracted GB filled with echogenic shadow. Elective laparoscopic cholecystectomy was performed with the removal of 7 × 6 cm large solitary GB stone through an extended umbilical port. Case 2: A 45-year-old female presented in emergency with a complain of colicky pain in her abdomen. Radiological findings are suggestive of a large GB stone measuring 6 × 5 cm. Laparoscopic cholecystectomy was performed safely. Case 3: A 51-year-old male presented with a history of cholelithiasis and cholecystitis with pain and vomiting. Ultrasound findings reveal multiple large gall stones largest measuring 4 × 3 cm and smallest 1.5 × 1 cm with a total 5 GB stones operated laparoscopically. Case 4: A 40-year-old female with history of acute cholecystitis with intermittent right upper quadrant pain and vomiting. Ultrasound suggestive of large GB stone of size measuring 5 × 4 cm. Conclusions: Large gallstones >5 cm are rare, with a greater incidence of complications during surgical and postoperative management. It is advocated to operate even in asymptomatic cases as they have higher risks of GB cancer, biliary enteric fistula, and ileus. Laparoscopic management poses risks and challenges including grasping GB wall, calots triangle exposure, and extraction of large stones from 10 mm size ports. In cases of large GB stones, there are likelihood of conversion from laparoscopic to open cholecystectomy. However laparoscopic management is the gold standard procedure in the hands of experienced surgeons and is the procedure of choice as a laparoscopic approach has higher benefits than the traditional open method.

Robotic surgery is an innovation that has yielded a multitude of applications within the realm of surgery. This approach has allowed for the performance of more complex procedures with the promise of improved outcomes. Although the availability of this surgical operating system depends on market and financial elements within healthcare organizations, it has shown its value in clinical practice. This ranges from reduced complication rates resulting in decreased hospital stay and return to baseline activity. The ability to operate this system remotely is fascinating and can allow the involvement of experts from around the world. We aim to shed light on the value of robotic surgery, particularly when it comes to the surgical management of patients participating in missions in outer space.

The documentation of this case report about ovarian inguinal hernia is to create awareness about this rare entity. A 40-year-old female was referred to the Department of Surgery from the Department of Obstetrics and Gynaecology with complaints of pain and swelling in the left groin region and a history of secondary infertility. Physical examination revealed an inguinal hernia with irreducible contents and no features of obstruction or strangulation. Sonography confirmed the left inguinal hernia with the ovary as the content. The patient was taken up for laparoscopic repair. Ovarian inguinal hernias are commonly present in the pediatric population and are associated with congenital anomalies of the female genital tract and are rarely present in women of reproductive age-group. This study aims to create awareness of the possibility of ovarian inguinal hernia which should be kept in mind when a female patient presents with an irreducible groin swelling. Uncomplicated hernias are amenable to laparoscopic repair.

Aim: This case report aims to highlight a tailored solution in the management of femoral and inguinal concurrent recurrence by laparoscopic approach. Background: Hernia recurrence is one of the problems in this kind of surgery. Recurrence rates following primary hernia repair range from 0.5 to 15%. Hernia recurrence is more common after primary femoral hernia repair due to higher rates of emergency treatment than inguinal hernia. We present a case of complicated femoral hernia recurrence with concomitant re-recurrence of inguinal hernia that required a tailored solution to restore both hernia recurrences. Case description: A 66-year-old woman with a medical history of previous treatment for a right groin hernia, its subsequent recurrence, and an open repair for a right femoral hernia. A description of challenge in the diagnosis and treatment of coexisting inguinal and femoral ipsilateral recurrence with a tailored solution. Conclusion: Laparoscopy is widely recommended in women with a hernia in the groin area because it often presents an unsuspected femoral hernia that was not diagnosed by preoperative examination. Clinical significance: The presented case report highlights how tailored solutions can be used in complicated anatomical presentations. In particular, an unusual solution was presented to correct the recurrent double defect with the placement of plugs and mesh in a non-standard way.

A still debated issue is how to treat gallbladder diseases in patients with advanced stages of liver cirrhosis. Laparoscopic cholecystectomy has specific advantages in patients with liver cirrhosis. Complications of the wound, incisional hernia rate, operating time, and hospitalization time are significantly reduced due to the less invasiveness of laparoscopic cholecystectomy. The risk of contamination of the ascitic fluid and the exposure of the surgical team to fluids infected by hepatitis C virus (HCV) or hepatitis B virus (HBV) are reduced. The risk of bleeding is also reduced, either because of the less invasiveness of the procedure or the pneumoperitoneum pressure, which induces vascular compression. There is another important reason that can help reduce bleeding during laparoscopic cholecystectomy in cirrhotic patients. Laparoscopic surgery induces activation of coagulation and fibrinolytic pathways. This prothrombotic tendency may be a further advantage for cirrhotic patients who tend to have alterations of coagulation in a prohemorrhagic sense.

Aim: The aim of reporting this technique is to demonstrate the new surgical method and its feasibility. Background: Intraoperative bowel endoscopy (IOBE) is a salvage technique when conventional and advanced endoscopic techniques, video capsule endoscopy (VCE), and radiological imaging fail. Conventional IOBE requires the use of a flexible endoscope and the need for a skilled endoscopist, leading to the requirement of extra manpower and costs. Hence, there is a need for alternative easy-to-perform techniques. Technique: An intestinal clamp is applied distally. The bowel is opened, and a 30-degree 10 mm rigid laparoscope is inserted along with 10 French infant feeding tubes for air insufflation and irrigation. The laparoscope is maneuvered as required. Conclusion: Intraoperative bowel endoscopy by rigid laparoscope can be easily done by most surgeons due to its easy availability and easy learning curve. It plays an important role in the evaluation of the bowel for various indications. Clinical significance: Here, we have described an easy-to-do and novel technique that can be done by the operating surgeon with basic laparoscopic skills.