Introduction: To study the efficacy of visual impression of the peritoneal cavity by laparoscopy in the diagnosis of abdominal tuberculosis (TB). Materials and methods: Fifty patients with suspected abdominal Kochs underwent diagnostic laparoscopy, and the visual impression was compared with other tests like acid-fast bacillus (AFB) stain, AFB culture, histopathology, TB PCR and Gene Xpert. Observations: Out of 50 patients, 42 (84%) had positive visual findings on laparoscopy characterized by enlarged lymphadenopathy, ascites, peritoneal tubercles, and interbowel adhesions. Thirty-eight (76%) patients had positive histopathological findings and TB PCR, while thirty-nine (78%) patients had positive Gene Xpert. So, laparoscopic visualization of abdominal cavity is 100% sensitive for the diagnosis of abdominal tuberculosis. Conclusion: Laparoscopy is a safe and rapid method for the diagnosis of abdominal TB.

Background: Acute cholecystitis is a very common gastrosurgical emergency. The timing of laparoscopic cholecystectomy (LC) in cases of acute cholecystitis is still a matter of debate. In general, delayed LC is preferred because of higher morbidity and conversion rate when LC is performed in acute cholecystitis. Aim and objective: To compare the various parameters and outcomes between early and delayed laparoscopic cholecystectomies with safety and feasibility evaluation. Materials and methods: A prospective, randomized controlled, interventional study was conducted from October 2017 to February 2019. Patients with a diagnosis of acute cholecystitis post-randomization were assigned into the early group (n = 50; LC within 72 hours of admission) and the delayed group (n = 50; initial conservative treatment followed by delayed LC 6–12 weeks later). The primary outcome measures were intraoperative and postoperative complications (bile duct injuries, bile leak, and wound infection), morbidity, mortality conversion, and length of hospital stay. The secondary outcome measures were the mean duration of surgery, the mean blood loss, other complications (subhepatic collection, postoperative pneumonia), and unsuccessful nonoperative management. Results: In our study, the conversion rate in early laparoscopic cholecystectomy (ELC) group was 5 (10%) and delayed laparoscopic cholecystectomy (DLC) group was 7 (14%), respectively. The mean operative time was 77.30 ± 20.078 vs 66.94 ± 29.501 minutes; p <0.001 in ELC and DLC groups, respectively; the mean blood loss was 82.60 ± 59.67 vs 65.40 ± 74.21; p <0.007 in ELC and DLC groups, respectively. Postoperative complication was 4 (8%) vs 7 (14%) for ELC and DLC groups, respectively. However, the patients in the ELC group had a significantly shorter hospital stay (4.46 ± 1.32 vs 6.0 ± 2.54 days; p <0.002). Conclusion: Early cholecystectomy is safe and feasible in patients with acute cholecystitis. Early cholecystectomy offers definitive treatment as it eliminates risks of failed conservative management and repeated episodes of acute cholecystitis with the advantage of shorten mean hospital stay without increased morbidity and mortality.

Background: Cryptorchidism is the commonest genitourinary anomaly in boys. Laparoscopy has been the mainstay for the management of nonpalpable testis. Aim and objective: This study has been done to assess the role of laparoscopy in diagnosing and treating nonpalpable testes. Materials and methods: Medical records of 160 patients of laparoscopic testicular exploration, during a 10-year period, were retrospectively analyzed. All 160 boys with 320 testicular units were examined prior to surgery—118 of the 320 testicular units were normally descended (37%), 9 had palpable undescended testicular units (3%), and 193 testicular units (60%) were nonpalpable. Results: After laparoscopy, 111 of the 193 nonpalpable testicular units were found to be intra-abdominal, 32 were atrophic testes, 22 were peeping testes, 19 were intracanalicular, and 9 were vanishing testes. Of the 111 intra-abdominal testicular units according to the location in relation to the deep inguinal ring, 51 of the testicular units were located within 2 cm from the deep inguinal ring. Among these, 49 cases underwent single-stage laparoscopic orchidopexy and 2 patients required laparoscopic mobilization followed by open orchidopexy due to long loop vas. Sixty testicular units were found greater than 2 cm from the deep inguinal ring and were managed by two-stage Fowler–Stephens laparoscopic orchidopexy. Conclusion and clinical significance: Laparoscopy is safe and effective in managing nonpalpable testis. Single-stage orchidopexy is the treatment of choice for intra-abdominal testis located within 2 cm from the deep inguinal ring with pliable testicular vessels and two-stage surgery is required for intra-abdominal testis located more than 2 cm from the deep inguinal ring and with nonpliable testicular vessels.

Aim and objective: This paper was conducted to examine the results of laparoscopic intersphincteric resection and colon shaping for low rectal cancer treatment in adults. Materials and methods: Data were collected, including general characteristics, preoperative and postoperative characteristics, and long-term treatment outcomes. The Kaplan–Meier survival analysis was performed to assess the survival rate of 48 months after surgery. Results: Of 43 patients with low rectal cancer, subtotal intersphincteric resection was the primary surgical method at 37.2%. The colon was mainly shaped “J” at 51.2% of the patients. According to Kirwan classification, there were 83.7% of the patients at grade I; and this rate decreased to 62.9% after surgery (p <0.05). According to Wexner score, before surgery, 62.8% of the patients had a score <5, which reduced to 48.8% after surgery (p >0.05). The mean survival time was 41.53 ± 2.37 months, with a cumulative survival probability of 48 months of 78.8%. There was no difference in survival rate between patients with different stages of cancer and colon shaping. Conclusion: Laparoscopic intersphincteric resection and colon shaping were effective in low rectal cancer treatment. Colon shaping was an effective method of improving bowel function in cases of subtotal or total intersphincteric resection.

Introduction: Nowadays laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease (GSD). Prediction of “difficult laparoscopic cholecystectomy” (DLC) may decrease morbidity and mortality as well as reduce the average cost of therapy. At present, very few scoring systems are available to predict the degree of difficulty during surgery. Aim and objective: To compare the outcome of intraoperative findings with preoperating scoring to predict DLC. Materials and methods: Two-hundred and nine patients were having GSD, operated by a single experienced surgeon in 2-year duration. Various preoperative predictors and intraoperative parameters of DLC were used for scoring and categorizing the difficulties, into (0–5), (6–10), and (10–15) as early, difficult, and very difficult surgical procedures, respectively. Result: History of hospitalization for acute cholecystitis, overweight with BMI ≥27.5 kg/m², palpable gallbladder, wall thickness >4 mm, and impacted stone were the most accurate preoperative predictors of DLC in the age-group of above 50 years. Statistically, a significant association was determined by comparing preoperative evaluation with the intraoperative outcome. Conclusion: The preoperative and intraoperative scoring system can be helpful for assessment, experience, and decision-making. These scoring systems deserve a large-scale prospective study for validation.

Laparoscopic surgery is a highly specialized and rapidly evolving field in veterinary science. Since laparoscopic surgery has an enormously broad scope and a high impact on welfare of animals, competence in this field should urgently be promoted and provided in India. At present, we are lacking a well-designed training course having dedicated facilities with all the instruments to maximize hands on experience for better learning of this highly sophisticated technique. We need to inculcate this technique in the veterinary education from the undergraduate program for effective learning. Initially some foundational program for learning this minimally invasive technique should be planned followed by advanced courses/trainings depending upon the specialization of veterinarians. Nowadays veterinarians across the world have started using this technique but in India, there exists no specific training programs for laparoscopy surgery, so there is urgent need to explore and implement laparoscopic training program for the veterinarians for getting them exposed in the field of laparoscopic surgery. In this article, we will discuss about the current scenario of veterinary laparoscopy, laparoscopy education and training programs availabilities, and the future perspective of implementing veterinary laparoscopy in India.

Background: An ureteropelvic junction (UPJ) obstruction is a blockage of urine passage from the renal pelvis to the upper ureter. Back pressure inside the renal pelvis can cause renal damage and function deterioration. In children, the adynamic segment, crossing vessel, ureteral valves, and sticky bands are the most common causes of UPJ obstruction. The surgical rebuilding of the UPJ to drain and decompress the kidney is known as pyeloplasty. The process, benefits, limits, and post-operative results of open and laparoscopic pyeloplasty are examined in this research. Materials and methods: The study included children diagnosed with pelviureteric junction obstruction in the Urology Department at our institute between January 2016 and December 2019. Ultrasound, micturating cystourethrogram, and diethylenetriamine pentaacetate (DTPA) were used to evaluate them. Results: Around 45 of the 70 instances involved boys. Twenty-one were discovered prenatally and confirmed postnatally using ultrasonography. The most prevalent kind of presentation was abdominal mass in 44 (42.8%) of the youngsters. There were 35 open and 35 laparoscopic pyeloplasties performed. The laparoscopic pyeloplasty group had a mean total operating time of 99.2 minutes with stent implantation, compared to 80.5 minutes in the open group. The mean glomerular filtration rate (GFR) and differential renal function improved in both groups; however, the difference was not statistically significant (p >0.05). The postoperative analgesic need was much reduced in the laparoscopic group as compared to open pyeloplasty. Conclusion: The major drawback of laparoscopic pyeloplasty is the length of time it takes to complete the procedure. It necessitates exceptional intracorporeal suturing skills, and the benefit is that it has a lower rate of morbidity, shorter hospital stays, and better aesthetic results than the open technique.

Background and objectives: Due to the late detection of primary carcinoma of gallbladder (CaGB), the overall prognosis has remained poor with a 5-year survival of 5–10%. In practice, after elective cholecystectomy for presumably benign gallbladder disease, primary CaGB is an unexpected histopathological finding in resected specimens. Current study aims to determine the incidence of incidental CaGB and to determine factors predictive of CaGB in patients operated for chronic cholecystitis. Materials and methods: In this single center, prospective observational study, analysis of incidence and various biological characteristics of 200 consecutive patients with chronic cholecystitis was done who underwent cholecystectomy and were subsequently histologically diagnosed as incidental CaGB. Results of the study were compiled, tabulated, and analyzed using statistical methods, and inference was drawn. Results: In the study, five patients were diagnosed with incidental CaGB histologically after cholecystectomy for chronic cholecystitis, and the incidence of incidental CaGB was 2.5%. Sociodemographic parameters and pathophysiological observations are additionally drawn to determine factors predictive of primary CaGB. Conclusions: In view of the study findings, it may be inferred that chronic cholecystitis is a significant surgical disease in our population. This is significant because laparoscopic cholecystectomy is being more commonly used for the treatment of chronic cholecystitis in which there are considerable chances of perioperative spillage of biliary contents because of which there are possibilities for the very early gallbladder carcinoma becoming a disseminated disease. The operating surgeon should have high index of suspicion regarding this incidental but fatal gastrointestinal malignancy.

Aim and objective: Spasmo-proxyvon addiction-induced gastric complication has been sparsely discussed in the literature. This study highlights the laparoscopic management of gastric outlet obstruction secondary to spasmo-proxyvon abuse. Materials and methods: From January 2015 to May 2020, 16 patients presenting with gastric outlet obstruction due to spasmo-proxyvon addiction were managed with laparoscopic truncal vagotomy and gastrojejunostomy. Preoperative data, immediate outcome, and long-term results were analyzed. Results: All the 16 patients managed with laparoscopic truncal vagotomy and antecolic posterior gastrojejunostomy were male patients. Median age was 36.5 years and median duration of addiction was 25.5 months. The mean operative time was 139.30 minutes. There was no conversion to laparotomy. There was no intra and immediate postoperative mortality. Two patients had delayed gastric emptying in the immediate postoperative period. Median follow-up was 37.30 months. All the patients had significant improvement in oral intake and weight gain. One patient died due to severe anorexia, malnutrition, and generalized anasarca secondary to resumption of drug abuse one year after surgery. Conclusion: Laparoscopic truncal vagotomy and gastrojejunostomy is a useful mean to manage gastric outlet obstruction secondary to spasmo-proxyvon addiction. This method results in satisfactory perioperative and optimal long-term outcome.

Aim and objective: The rapid and large-scale spread of coronavirus disease-2019 (COVID-19) pandemic has become a major cause of concern for healthcare professionals. The purpose of this study was to determine the preparedness of surgical specialty personals in managing surgery during COVID-19 pandemic. Materials and methods: The present study was conducted online from May 5, 2020, to June 5, 2020, through a predesigned and pretested questionnaire-based proforma on the preparedness of surgical practice related to COVID-19 infection circulated through Google Forms. The participants selected were serving in Punjab and holding allopathic degrees in any of the surgical specialties. Exclusion criteria were responses by nonsurgical specialists and incompletely filled proforma. A total of 412 responses were received, out of which 318 were valid responses in terms of completeness of proforma. The data so collected were compiled and statistically analyzed by SPSS v.21 (IBM). Results: Three-hundred and eighteen received responses were analyzed. Mean age was 42.3 ± 10 years. Male-to-female ratio was 2.38:1. Majority of the respondents were from general surgery specialty 130 (40.8%). Two-hundred and thirty-eight respondents were from private sector and 80 from public sector. One-hundred and sixty-six (52.2%) respondents reported existence of standard protocols and triage for COVID-19 at their workplace. Two-hundred and fourteen (67.2%) respondents stated that they usually get patients tested for COVID-19 before elective surgery. Two-hundred and seventeen (68.2%) of the respondents reported checking out the correct sequence of donning and doffing the personal protective equipment (PPE). Of the 170 respondents who had consumed hydrochloroquine as recommended by the Indian Council of Medical Research (ICMR), 114 (67%) were private practitioners and 56 (32.9%) were public healthcare sector professionals. Conclusion: Surgical community need guidelines on how to deliver surgical services safely and successfully during COVID-19 pandemic.

Background: The most feared complication of laparoscopic cholecystectomy is injury to bile duct. Different strategies have been proposed to avoid this serious complication. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) “Culture of Safe Cholecystectomy” is one such strategy. Aim: This study was done to evaluate and validate SAGES “Culture of Safe Cholecystectomy” components modified and tailored to the setting of a rural hospital with emphasis on a bystander surgeon. Materials and methods: This was a prospective study of 382 patients with gallstone disease who underwent surgery at District Hospital, Anantnag, a rural hospital from September 2016 to September 2018. Results: Mean age of patients was 43 years. Two-hundred and ninety-eight (78%) patients were females, and 84 (22%) were male with male female ratio of 1:3.54. Most common indication was chronic cholecystitis in 213 patients (55.7%). Bystander surgeon was present in all cases. Critical view of safety (CVS) was achieved in 256 patients (67%). Rouviere's sulcus was present in 242 patients (63.3%). Bailout option was adopted in 19 patients (4.97%). Conversation to open cholecystectomy was done in 11 of the 382 patients (2.87%). Most common indication for conversion was inability to achieve CVS. Mean duration of surgery was 45 minutes. None of the patients in our study had bile duct injury. Conclusion: SAGES culture of safe cholecystectomy can be modified to make it applicable to rural hospitals in developing countries where more reliance can be put on a detached bystander surgeon who is likely available in the vicinity.

Aim: This study is aimed to examine the effectiveness of laparoscopic totally extraperitoneal (TEP) repair using three-dimension (3D) mesh to treat bilateral inguinal hernia in adults. Materials and methods: We conducted case series on 50 patients with bilateral inguinal hernias undergoing laparoscopic TEP surgery using 3D mesh at Thanh Nhan Hospital from January 2017 to June 2019. Results: Of 50 patients, 66.0% of patients had a direct inguinal hernia and 34.0% of patients had an indirect inguinal hernia. The diameter of the herniated hole was mainly from 1.5 to 3 cm in 84.0% of patients. There were 82% of patients using small 3D mesh (8.5 × 13.7 cm) and one case required mesh fixation (2.0%). Seven patients (14.0%) had complications during surgery. The average postoperative pain time was 2.2 ± 1.5 days (1–15 days). Pain degree decreased gradually from day 1 to day 3. By day 3 after surgery, 94% of patients had only slight pain, two patients (4.0%) had mild pain, and one patient (2.0%) had moderate pain. All patients were followed for a mean of 21.4 ± 11.8 months (minimum 1 month, maximum 40 months). At 1 month postoperative, there was one patient with chronic pain in the groin (2.1%). After 6, 12, and 24 months, no recurrence was recorded. Conclusion: TEP laparoscopic surgery using 3D mesh is a safe, feasible, and effective method in bilateral inguinal hernia in adults, with low rates of complications and recurrence.

Laparoscopic cholecystectomy is the gold standard for the surgical treatment of symptomatic cholecystolithiasis. A skin incision is made above the umbilicus, an area that is infrequently exposed to UV light, soaps, and contains a large amount of bacteria. The purpose of this study is to examine the effect of the use of topical prophylactic antibiotic to prevent post-videolaparo-cholecystectomy infection at the umbilical port site. Our outcomes display that in patients treated with topical antibiotics, umbilical port site infections occurred less often than in the patients not treated. Further studies are required to determine what other procedures should be engaged to decrease the high rate of infections.

Appendicitis is a surgical emergency that is encountered by surgeons all over the world. Today, laparoscopic appendicectomy is the ideal procedure that is done for a case of appendicitis. Aim: The aim of the study is to show the benefits of laparoscopic appendicectomy and to determine the advantages of laparoscopic appendicectomy over the conventional open method of appendicectomy. Materials and methods: This was a prospective study that was carried out from March 2016 to February 2019. The study was conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. Investigations, such as complete blood count (CBC), X-ray of the abdomen, ultrasound abdomen, and CT scan of the abdomen, were done. A total of 101 patients were studied, and the results obtained were tabulated. The statistics were analyzed using SPSS package 16.0. Ethical clearance was obtained from the institutional ethics committee. Results: From our study, it was found that for most of the patients who presented with appendicitis, laparoscopic appendicectomy was the procedure of choice (66.33%). The duration of surgery for most of our patients was 60 minutes or less. Moreover, 82.35% of patients who underwent open appendicectomy and 89.55% of patients who underwent laparoscopic appendicectomy stayed in the hospital for only 3 days or less after surgery. Conclusion: Our study shows the benefits of laparoscopic appendicectomy and the reason that it is the procedure of choice in cases of appendicitis.

Introduction: Hiatus hernia is axial type of hernia occurring at the esophageal opening of diaphragm. Large hiatal hernias have increased risk for severe complications that can include gastric strangulation, bleeding, and perforation. This study presents our technique and results of laparoscopic management of hiatus hernia. Materials and methods: This study was done retrospectively on 42 patients from data over a period of last 10 years (April 2010–March 2020) in a tertiary care hospital. Results: Total number of patients included in our study were 42. The range of age and the mean age of patients were 22–60 years and 38.36 (SD 8.018), respectively. Heartburn (32, 76.19%) was the most common symptom. Nissen's fundoplication was our primary choice performed in 37 (88.1%) patients. Few of our patients were comorbid and frail to whom Toupet's repair (4, 9.52%) and gastropexy (1, 2.3%) were performed, optimum to their conditions. Out of 42, mesh was placed in 17 (40.48%) patients including all the type IV and few of the type III patients. The mean operative time, mean blood loss, and hospital stay were126.90 (SD 12.781 minutes), 62.14 (SD 17.605 mL), and 4.60 (SD 1.127 days), respectively. Two patients were converted to open procedure. Recurrence occurred in three (7.1%) patients of type III hernia in whom only fundoplication was done without mesh placement. Conclusion: This study concluded that laparoscopic management of hiatus hernia is a feasible and safe option, with a very low morbidity and mortality rate.

Background: Gallstone disease represents a significant burden for healthcare systems making laparoscopic cholecystectomy one of the most common surgical procedures performed in the world. Aims and objectives: Numerous studies have shown intraperitoneal ropivacaine instillation to have good analgesic effect thus enhancing postoperative recovery. In this study, we aim to evaluate the effect of intraperitoneal instillation of ropivacaine on postoperative bowel movements. Methods: A prospective study was conducted on 28 patients undergoing laparoscopic cholecystectomy in the Victoria Hospital, affiliated to Bengaluru Medical College and Research Institute, Bengaluru, from October 2019 to December 2019. Laparoscopic cholecystectomy was performed electively on patients diagnosed with symptomatic cholelithiasis. Group A were instilled with ropivacaine intraperitoneally (40 mg of ropivacaine in 100 mL of normal saline) during laparoscopic cholecystectomy, after the removal of the gallbladder but prior to the removal of the ports into the gallbladder bed and over the liver surface. Group B were not instilled with any drug. Patients were then monitored postoperatively, treated with intravenous analgesics, and other supportive care was given. Postoperative bowel movements were then recorded in terms of mean time for appearance of bowel sounds, passage of flatus, and passage of stools. Patients were then discharged after being deemed fit for discharge. Results: There was no significant improvement in the return of bowel sounds or in the time to passage of flatus/stools as a result of intraperitoneal ropivacaine instillation. Further, it did not seem to have a positive effect on the early discharge of patients. Conclusion: Early recovery from surgery has been a major concern. In this regard, the effect of intraperitoneal instillation of ropivacaine on postoperative analgesia has been well documented. However, its effect on postoperative bowel movements does not seem to be significant.

Background: Laparoscopic-assisted surgical approach performing either extended right or left hemicolectomy or performing only conservative approach by transverse colectomy could be considered as various management approaches of cancer of the transverse colon but a consensus of which technique is the best is still lacking. So the choice of surgical approach depends on the preference and experience of the operating surgeon. Aim: The aim of this study was to compare performing laparoscopic extended right or left hemicolectomy and performing transverse colectomy for management of transverse colon cancer located in the middle part of the transverse colon regarding surgical and oncological findings and patients’ outcomes to prove which surgical approach is the best. Patients and methods: We analyzed collected data of 120 patients with mid-transverse colon cancer. We divided them into two groups: the first group included 80 patients who were managed by right or left hemicolectomy and the second group included 40 patients who were managed by transverse colectomy. We evaluated operative, postoperative, and follow-up data of all included patients. Results: The length of specimens was longer in the hemicolectomy group than that in the transverse colectomy group (p = 0.007). The numbers of dissected lymph nodes were significantly higher in the hemicolectomy group than in the transverse colectomy group (p <0.001). The duration of operative time was longer in the hemicolectomy group than in the transverse colectomy group (p = 0.014). The group of patients in the hemicolectomy group experienced a higher rate of recovery findings than the transverse colectomy group. The group of patients in the hemicolectomy group experienced lower rates of intraoperative and perioperative complications than the transverse colectomy group (p = 0.002). Five years of overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates were slightly longer in the hemicolectomy groups than those in the transverse colectomy group, but results were not statistically significant. Conclusion: We concluded that hemicolectomy is a better surgical approach of management of cancer located in the mid-transverse colon regarding operative and short-term outcomes than transverse colectomy, but regarding oncological outcomes, both techniques are considered safe and feasible.

Background: Laparoscopic surgery is widely accepted as a reliable alternative to the open approach across surgical disciplines. Benefits of single-incision laparoscopic surgery (SILS), as exemplified here by single-port laparoscopic cholecystectomy (SPLC), have yet to be formally proved. However, the hypothesized benefits of SILS would include those of standard traditional laparoscopic surgery plus improved esthetic outcomes, with surgery being performed through a single hidden incision. Methods: All patients who had chronic calcular cholecystitis at the General Surgery Department at Mansoura University Hospital between May 2014 and May 2018 were eligible for this study to compare SPLC with multiport laparoscopic cholecystectomy (MPLC). Operative and perioperative outcomes, including cosmesis, were analyzed. Results: SPLC had been performed in Group A (40 patients), mean age was 37.35 ± 10.72, 80% were females, and mean BMI was 30.15 ± 4.53. MPLC was performed in Group B (40 patients), mean age was 40.70 ± 9.71, 75% were females, and mean BMI was 28.35 ± 2.83. The average duration of postoperative hospital stay in SPLC cases was 24 hours and in MPLC group was 25.20 hours, with p = 0.330, which was insignificant. In the SPLC group, the mean operative time was 95.75 minutes whereas in the MPLC group the mean operative time was 42.10 minutes. Therefore, the mean operative time in the SPLC group was significantly higher than in the MPLC group (p <0.01). Esthetic results were better in the SPLC group than in the MPLC group. Conclusion: Based on the current findings, SPLC seems to be a safe procedure in uncomplicated cholecystitis with rapid recovery, less postoperative pain, less wound infection, and better cosmesis. The operative time was long. However, patients should be aware of the risks of port-site incisional hernia and instructed to avoid heavy work and exercises during the first three postoperative months.

Sleeve gastrectomy is a commonly performed bariatric procedure that is complicated by stricture formation in approximately 0.5% of cases. Gastric sleeve surgery adverse events, which can result in strictures and leaks, are increasingly managed through a minimally invasive endoscopic approach. Endoscopic treatment with pneumatic balloon dilation and stent insertion has repeatedly proven to be effective and safe as the first line of management for this complication as in our case with two sites of stenosis and twisting because of severe adhesions due to previous scar tissue and acute pancreatitis. Surgical intervention should be considered only after the failure of endoscopic treatment.