Background: Untreated gastroesophageal reflux disease (GERD) and the associated reflux esophagitis have been negatively impacting the quality of life to a great extent. Data about the normal size of the hiatus opening seems to be prophylactic against the possible anti-reflux surgery postoperative wrap herniation into the thorax that occurs as a result of inadequate crural closure or its disrupted closure. This study aimed at determination of normal size of esophageal hiatus in adults, in an attempt to improve the outcome of anti-reflux surgeries. Patients and methods: This is a prospective study that was conducted on adult patients consecutively scheduled for abdominal surgery, either open or laparoscopic. Intraoperatively, a calibrated 36-French bougie with a balloon was introduced to the stomach through the mouth. The diameter of the balloon was measured when it was insufflated with the maximum volume that could pass through the hiatus. Results: Esophageal hiatus area ranged from 2 cm to 6.6 cm² with a mean value of 3.8 cm². No significant difference was found between males and females in the measured parameters (p >0.05). No significant correlation was found between the hiatus surface area and the patient's age, height, weight, BMI, chest circumference, or the esophageal parameters (p >0.05). Conclusion: This study reported a new mean value of the normal hiatus surface area in order to give a hand in improving the anti-reflux surgery outcome. Further studies on a large cohort are needed to estimate normal variations in regard to age and sex to help in improvement of anti-reflux surgery outcome.

Background: Performing a laparoscopic cholecystectomy (LC) surgery requires a high level of experience, and complementary training methods are demanded. In this study, we evaluated the efficacy of serious game LC training compared to the traditional LC training in laparoscopic cholecystectomy skills of junior residents. Materials and methods: Forty-four junior residents with no history of LC performance were assigned to either the serious game training group (case group, n = 22) or the traditional (Zollinger's Atlas of Surgical Operations) training group (control group, n = 22). Participants were allowed to perform the operation only when they achieved a score of more than 80% in the theory checklist. Results: The mean LC skills score based on the pre-surgery theory checklist was 84.5 ± 11.1% in the case group and 68.2 ± 17.6% in the control group (p = 0.021). The total number of attempts needed to reach an 80% score in the theory checklist was 2.97 ± 1.40 in the case and 4.17 ± 2.03 in the control group (p = 0.001). The mean operation time and the number of attempts needed to complete the operation without complications were significantly lower in the case group (p = 0.028 and p = 0.041, respectively). The final skills score was 90.8 ± 9.2% in the case group and 80.1 ± 14.2% in the control group (p = 0.012). Conclusion: Serious game training was more effective than traditional training in all aspects of LC performance. Therefore, broader usage of the serious game for LC training is recommended.

A ventral hernia does occur on the anterior abdominal wall, and a substantial number are iatrogenic from surgical incisions. Surgical treatment has progressed over the decades using mesh to correct the laxity in the anterior abdominal wall. The Intraperitoneal Onlay Mesh (IPOM) method uses a mesh inserted into the peritoneal space to repair the abdominal defect. The best mesh is the ideal mesh, least associated with complications of mesh implantation such as hematoma formation, mesh failure, and discomfort to the patient. Materials and methods: We evaluated patients who had IPOM in our center from January 2013 to January 2020 prospectively. Polypropylene polyvinylidene fluoride (PPV) mesh and the composite mesh were put under study. Other biological meshes have been used but not assessed. Factors assessed included intestinal obstruction, recurrence rates, and incidence of seroma. Both laparoscopic and open techniques were the procedures adopted in placing the meshes. Results: We had 100 patients under study. Seventy patients presented with primary hernia, while 30 patients presented with incisional hernia. All the patients were followed up for 48 months (2 years). Forty (80%) patients in the PPV group had intestinal obstruction secondary to adhesion, while no patient in the composite group had intestinal obstruction (p = 0.0001). No patient in the PPV group had seroma/hematoma, while 12 (24%) patients in the composite group had seroma/hematoma (p = 0.0001). Five (10%) of patients in the PPV group had recurrence, while 15% of patients in the composite group had recurrence (p = 0012). Conclusion: Mesh hernioplasty by IPOM is currently a procedure of choice and more preferable than ordinary suture closure of hernia. None of the mesh types are free from possible postoperative complications. A significant drawback in the use of PPV was intestinal obstruction from adhesion formation, but there was no incidence of seroma/hematoma and a much lower incidence of recurrence compared with the composite mesh. Therefore, none can be said to be superior to the other on the mesh type of choice in IPOM hernioplasty for ventral hernias.

Introduction: Bariatric surgery is one of the most effective treatments for patients with morbid obesity. Rapid weight loss can accelerate the process of fibrosis, and weight loss alone can improve the process of steatohepatitis. The conflict has confused the effect of these surgeries on the severity of the fatty liver disease. This retrospective study aimed to compare the effects of different types of bariatric surgery on the grading and severity of the nonalcoholic fatty liver disease (NAFLD). Materials and methods: Using the National Obesity Surgery Database, data were extracted from 900 patients with a body mass index (BMI) above 35 who underwent sleeve, classic bypass, or mini-bypass surgery or who did not undergo surgery for any reason. Body mass index, aspartate transaminase (AST), alanine transaminase (ALT), NAFLD fibrosis score, and liver ultrasound were evaluated before and after surgery in four different groups. Results: All three surgical procedures effectively reduced BMI. Among the various surgical procedures, the rate of BMI reduction was significantly higher in the mini-gastric bypass procedure than in the other two methods. The reduction of AST and ALT was significant in all three surgical methods compared to the nonsurgical group, with the highest reduction in sleeve surgery. Fatty liver based on ultrasound in the nonsurgical group in the second time got worse but improved significantly in all the operated groups, and all these changes including the development of fatty liver in the nonsurgical group and its improvement in the operated groups were significant (p <0.05) and NAFLD fibrosis score (NFS) decreased in all groups. This reduction was small and insignificant for the nonsurgical group while it was significant in the three operated groups.

Introduction: Diagnosing and treating subfertility is a most rapidly evolving area in modern medicine. Advances in endoscopic surgery have revolutionized the diagnostic and management approach to an infertile couple. Unlike USG and HSG, hysterolaparoscopy single-handedly provides information regarding uterine, ovarian, tubal, as well as pelvic pathology. Materials and methods: A prospective analysis was performed at BEST Institute and Research Centre, AV hospital, Bengaluru, over a period of 2 years. Couples presenting to the infertility clinic were subjected for thorough history taking, general examination, and gynecological examination. All necessary investigations were performed. Women who approached with fertility issues as a complaint and who could be potentially benefited from hysterolaparoscopy were included in the study. Results: A total of 102 patients were evaluated in the study, out of which 67 (65.7%) women had primary infertility and the rest (34.3%) had secondary infertility. Ovarian pathologies such as ovarian cysts, endometriosis of the ovary, and PCOS were the most common abnormality detected on laparoscopy followed by uterine pathologies. The most common hysteroscopic pathology was a polyp. Conclusion: Combined hysterolaparoscopy is a safe, effective, and reliable tool in comprehensive evaluation of subfertility. It should be considered as a definitive day-care procedure for evaluation and treatment of female subfertility.

Objective: The present study is to evaluate the risk involved, difficulties encountered, as well as the safeness of laparoscopic sterilization in cases of previous pelvic or abdominal surgery. Design: A retrospective study was carried out between January 2017 and January 2019 at Dr Shankarrao Chavan Government Medical College and Hospital, Nanded, Maharashtra. Setting: Tertiary Care Hospital, Nanded, Maharashtra. Materials and method: Laparoscopic tubal ligation (LTL) was performed using Falope ring in all the cases. Results: Mean age of the study population was 26.67 years, and mean parity being 3. The most common previous pelvic or abdominal surgery was cesarean section 96% followed by open appendicectomy 3%. About 14% of them had pregnancy termination (less than 12 weeks of gestation) with LTL and 86% of them had undergone interval LTL. Omental adhesions up to the anterior abdominal wall and in the pelvis were seen in 19.5% of cases, and adhesiolysis was required in 3.5% of them to complete the procedure. Minimal peritubal adhesions were noted in 3% of them, and ligation was successfully completed in all by adhesiolysis. No major intraoperative or postoperative complications were documented. Conclusion: Laparoscopic sterilization is associated with low morbidity and hence it is safe in women with previous pelvic or abdominal surgery.

Introduction and discussion: Appendicitis is one of the most common causes of acute abdomen presenting in the pediatric age-group. Surgical management is still the gold standard management for this condition. The introduction of the minimally invasive laparoscopic approach vis-à-vis the conventional laparoscopic and open approaches has overhauled the surgical management of this condition. The first laparoscopic appendectomy was performed by Semm in 1983 in an adult patient; however, it was not until 1992 when the first laparoscopic appendectomy was done in the pediatric age-group by Ure et al. Objective: Our goal with this study was to analyze if laparoscopic surgery can be used as the standard of care for appendectomies, regardless of the type of appendicitis, complicated or uncomplicated. Results: The results of our study suggest that in the pediatric age-group, males presented with appendicitis more commonly than females. We also found that the most patients had an average length of stay (ALOS) between 48 and 72 hours, regardless of the type of appendicitis, complicated or uncomplicated. Conclusion: This study only reaffirms the fact that a pediatric laparoscopic appendectomy is a safe approach in all types of appendicitis, complicated or uncomplicated, but it does have a learning curve.

Aim: To report our experience in managing retrocaval ureter and ipsilateral renal stone disease. Materials and methods: Till now we have managed five such cases. Physical examination and laboratory investigations were unremarkable in all patients. Ultrasonography revealed right moderate hydronephrosis and a single upper calyceal stone in two, inferior calyceal calculus in two, and a pelvic calculus in one patient. A CT urography and Tc-99m diethylene-triamine-penta-acetic acid (DTPA) scan were done in all patients. In all patients, the renal scan was suggestive of reduced function with a right obstructed drainage pattern. Results: All patients were managed successfully by a combined laparoscopic and endourological approach. No intraoperative or major postoperative complications were noted. On follow-up renal scan done at 1 year, all patients had unobstructed drainage and improved or stable split function. Conclusion: Combined laparoscopic and endourologic approach is the adequate modality of treatment of patients with obstructed retrocaval ureter with ipsilateral renal calculi.

Background: Laparoscopic cholecystectomy (LC) is considered as the most common laparoscopic procedure in the world and is now the Gold standard treatment for cholelithiasis. Gallstone disease (cholelithiasis) has increasingly become one of the major causes of abdominal pain and discomfort in the developing world. Its occurrence has been found to be high (7.4%) in the adult population in the cities of Chandigarh and New Delhi in North India, which is one of the highest in the world. Gallstones are more common in the female population (61%) as compared to males (39%). The most common age-group affected is 45–60 years (38.5%) among females and above 60 years in males (20.8%). A relatively higher prevalence of 39% among males when compared to reports from past studies indicates a significant shift in the pattern of prevalence of gallstone disease. Many risk factors for cholelithiasis cannot be modifiable, such as ethnic background, advancing age, female gender, family history or genetics. The modifiable risks for cholelithiasis are obesity, quick weight loss, an idle lifestyle. A rising epidemic of obesity and the metabolic syndrome predicts an escalation in gallstones. Frequent risk factors for biliary sludge include pregnancy, drugs like ceftriaxone, octreotide, and thiazide diuretics, total parenteral nutrition, and fasting. Diseases like cirrhosis, chronic hemolysis, and Crohn's disease are a few risk factors for black pigment stones. In our hospital setup (RL Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka), in the Department of Surgery, a total of 166 cholecystectomies were performed in the period between October 2015 and September 2018. In total, 134 of these cases were elective laparoscopic cholecystectomy and twenty five of them were elective open cholecystectomies. There were a total of 7 cases that had to be changed from laparoscopic to open procedure due to intraoperative difficulty involved. That gives us a conversion rate of 4.96% over the past 3 years in our hospital setup. Preoperative prediction for the likelihood of conversion to open or difficulty of operation is an important aspect of planning laparoscopic surgery as the prevalence of gallbladder disease is increasing in India, and laparoscopic surgery is becoming more accessible. Arogya Karnataka Scheme, which can be used in our hospital setup, has laparoscopic cholecystectomy as one of its schemes for impoverished patients bringing the chance of laparoscopic surgery to the public. As a result, the number of laparoscopic cholecystectomies as a whole as well as the risk of conversion increases, making the need for study all the more important. Aims and objectives: (1) To validate that a scoring system based on history, physical examination, and ultrasonographic findings is a reliable predictor of the difficulty of laparoscopic cholecystectomy. (2) To help in choosing a favorable treatment modality depending on the score. (3) To help predict the duration of hospital stay and postoperative complications with the help of this system. Methods: A prospective and comparative study, considering 70 patients admitted and undergoing laparoscopic cholecystectomy at RL Jalappa Hospital and Research Center attached to Sri Devaraj Urs Academy of Higher Education Tamaka, Kolar, during the period of November 2018 and 10th October 2020. Results: The preoperative scoring system devised is excellent at predicting the intraoperative difficulties encountered by surgeons while performing laparoscopic cholecystectomy with a sensitivity of 88.9% and a specificity of 92.3%. The scoring system also predicted intraoperative complications with a specificity of 94.2% when the score is >7. There was also a very strong correlation between the preoperative score and the duration of surgery (r = 0.752, p <0.001) and also between the preoperative score and the duration of hospital stay (r = 0.788, p <0.001). Conclusion: Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. I would conclude that the scoring system evaluated in our study can be used to predict difficult cases.

Purpose: Nissen fundoplication is still assumed as the perfect lifelong management for gastroesophageal reflux disease (GERD). Despite the marked progress in performing the operation laparoscopically, dysphagia remains the most common postoperative morbidity. The use of an intraesophageal bougie during fundoplication to decrease the risk of postoperative persistent dysphagia (PD) by a forming proper tension-free wrap has been reported before in the literature. However, the aim of our study was to highlight the role of using a bougie in allowing a more guided way to repair the crura and avoiding blinded posterior repair, and the effect of that in reducing the incidence of postoperative PD in laparoscopic Nissen fundoplication. Materials and methods: A prospective study including 40 patients undergoing laparoscopic Nissen fundoplication for repairing hiatal hernia with refractory GERD. The crural repair was guided by 50 Fr bougie. Postoperative collection of GERD–health-related quality of life (GERD–HRQL) questionnaire was done at 1 and 6 months for all the patients. The postoperative dysphagia was assessed regarding both severity and frequency. Results: The GERD symptoms significantly improved in all patients, with marked postoperative satisfaction. No patients required dilation for postoperative dysphagia. Ten patients (25%) had mild dysphagia that resolved with conservative management, but no recurrence of GERD symptoms was observed. Conclusion: Laparoscopic Nissen fundoplication is more efficient on using a bougie, allowing proper identification of the direction of esophageal descent through the hiatus, resulting in proper crural repair and the formation of an ideal wrap with a low-risk of prolonged dysphagia.

Background: SARS-CoV-2 virus infection was detected and discovered in Wuhan, China, in December 2019, and it was declared a pandemic by WHO in March 2020. Since then a lot of changes were noticed in surgical practice. Various recommendations were released by eminent surgical associations all over the world. This study was designed to study and analyze the findings and experience after resuming elective minimal invasive surgery during the pandemic. Materials and methods: This observational study was conducted at St Joseph's Hospital, Ghaziabad, from May 2020 to May 2021. Various preoperative and postoperative findings were noticed and analyzed. The presence of SARS-CoV-2 virus was also analyzed in endotracheal aspirate and surgical smoke. Observation and results: A total of 287 cases underwent surgery. Most commonly performed surgery was laparoscopic cholecystectomy. The positivity rate for SARS-CoV-2 during preoperative work-up was 2.87%. Slightly more than 5% of cases in postoperative period had COVID-19-like symptoms. None of those patients were found positive on RT-PCR, and X-ray/CT findings were also suggestive of early postoperative changes only. Presence of SARS-CoV-2 virus was not detected in either endotracheal aspirate or surgical smoke. Neither surgery team nor OT staff had infection during this period. There was no mortality, and only 1 patient was found to be infected 2 weeks after discharge. Conclusion: Minimal invasive surgery for elective cases can be safely performed by taking precautions like PPE and smoke evacuation system during the COVID-19 pandemic. There is no evidence of transmission of infection through endotracheal aspirate or surgical smoke.

Background: Ventral hernia repair has changed over the past years by the introduction of laparoscopy and prosthetic materials. The laparoscopic approach is now broadly done because it offers its advantages for the patients. The broad acceptance of laparoscopic surgery has afforded an alternative to open repair of incisional hernia. Objective: To compare the intraperitoneal onlay mesh (IPOM) repair vs the transabdominal retromuscular (TARM) repair as regards the periprocedural data. Patients and methods: This prospective study was conducted on 60 patients with a ventral hernia in the period from May 2018 to August 2019. All eligible fit cases, who were 18-year-old and on with non-complicated ventral hernia (the size defect, ≤60 mm), were included. They were simply randomized between the two techniques to compare operative time, intraoperative complications, postoperative pain, postoperative hospital stay, postoperative complications, and cosmetic results. Results: The IPOM repair (1st group) was done in 24 patients, while TARM repair was completed in 36 patients. The operative time of group I was significantly shorter than that of group II. The repair in group I was cheaper than that in the other one. There was no significant injury to viscera or vessel and no recurrence in either group. The hospital stay was shorter for both groups (28.0 ± 9.2 vs 26.0 ± 6.93 hours; p = 0.527) as well as return to normal daily activity. More wound infection occurred in group II (16.7%) than in the other group (8.3%) (p = 0.511). No important difference statistically was observed between the two groups regarding postoperative pain (p = 0.885). Conclusion: Laparoscopic hernia repair by either of both techniques has less postoperative pain, shorter hospital stays, faster return to normal daily activity, a lower rate of postoperative complications as regard wound infection, and ileus. The TARM repair technique is more time-consuming than the other technique, but early results indicate that it can be performed as a cheaper alternative to the other one.

Introduction: Laparoscopic cholecystectomy is the gold standard for treatment of symptomatic cholelithiasis. Although relatively safe and effective, laparoscopic cholecystectomy is a difficult procedure. The rate of conversion to open cholecystectomy is estimated to be 1–15%. A preoperative predictive model may be helpful in determining whether open cholecystectomy is preferred over laparoscopic cholecystectomy to prevent morbidity and mortality associated with conversion. Conversion from laparoscopic to open cholecystectomy (CLOC) score can potentially predict the risk of conversion based on preoperative parameters. The purpose of this study is to validate the application of CLOC score in Dr Cipto Mangunkusumo Hospital's patient population. Materials and methods: This was a retrospective study of patients undergoing laparoscopic cholecystectomy from January 2018 to December 2019 in Dr Cipto Mangunkusumo Hospital. Patient data were obtained from medical records. Descriptive analysis, Chi-square test, logistic regression analysis, and score validation using receiver-operating characteristic (ROC) curve by calculating the area under curve (AUC), sensitivity, and specificity were conducted. Based on the CLOC Score, the patients were stratified into two groups: low-risk (<6) and high-risk (>6). Results: There were 163 subjects with a mean age of 51.06 ± 13.3 years. The rate of conversion was 3.1% (n = 5). Most of the subjects were 40–69 years of age (111 subjects, 68.1%). Of all 163 subjects, 103 (63.2%) were female. The indications for surgery were colicky pain (symptomatic gallstone disease) in 144 subjects (88.3%). Based on the logistic regression analysis, common bile duct dilation was found to be the only statistically significant variable [odds ratio (OR) = 10.97; 95% confidence interval (CI): 1.72–69.95]. The AUC approached 78.8% (fair) (95% CI: 58.2–99.4%; p = 0.029) for a cut-off value of 6.5 (sensitivity = 80.0%; specificity = 79.1%). The median duration of procedure in the low-risk group vs the high-risk group was 120 minutes (30–330) vs 180 minutes (45–405) (p = 0.001), respectively. Conclusion: Common bile duct dilation was the only risk factor found to be significantly associated with conversion of laparoscopic cholecystectomy to open surgery. Other factors, such as age, sex, indication for surgery, gallbladder wall thickness, and ASA score were not found to be statistically significant risk factors. Conversion from laparoscopic to open cholecystectomy score was considered valid and useful in predicting the risk of conversion. A CLOC score of 7 or more was associated with a higher risk of conversion to open surgery.

Background: Bleeding after bariatric surgery is one of the most common early postoperative complications that can cause morbidity or even mortality. Therefore, in this study, we investigated the relationship between demographic features and postoperative hemorrhage rate. Materials and methods: We reviewed the patients’ database who underwent laparoscopic bariatric surgery [sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB)] from 2018 to 2020 in Loghman Hakim Hospital, Tehran, Iran. The patients’ demographic features such as age, sex, weight, BMI, and history of diabetes mellitus and hypertension were accessed in all patients. Patients who required postoperative blood transfusion were then identified. Red blood cell transfusion or the need for reoperation to control bleeding was considered as significant acute bleeding after surgery. The Hb cut-off for red blood cell (RBC) transfusion was 7 gm/dL. The rate of bleeding was determined. By comparing the two groups (with and without the need for blood transfusion) by Chi-square test and independent t-test, the relationship between demographic features and postoperative bleeding was investigated. Results: In total, 1481 morbidly obese patients (257 men and 1224 women) who underwent bariatric surgery SG and OAGB were studied. Twenty patients (0.13%) suffered a postoperative hemorrhage. In SG, 17 patients (1.3%), and in OAGB, 3 patients (4.3%) required blood transfusion. The difference in diabetes (p <0.03) and hypertension (p <0.048) in the two groups (with and without the need for blood transfusion) was statistically significant. Only two patients (10%) who underwent SG were taken to the operating room at the surgeon's discretion to control the bleeding (both had a blood transfusion before reoperation). Diabetes (35%) and hypertension (25.7%) were significantly more common in postoperative bled patients. Conclusion: Despite all measures to reduce hemorrhage during and after bariatric surgery, bleeding is still one of the most common early postoperative complications after bariatric surgery. Therefore, recognizing the risk factors for bleeding is still important. In this study, an association was observed between hypertension and diabetes with postoperative bleeds.

Ovarian torsion is one of the common gynecological emergency occurring in women during reproductive age. Here, we are presenting a case of 19-year-old unmarried young girl who came with complaints of pain in abdomen associated with vomiting. She had a history of left-sided ovarian torsion for which she underwent laparoscopic left salpingo–oophorectomy. She underwent right-sided oophoropexy for recurrent torsion.

Introduction: Achalasia cardia (AC) is a primary motility disorder of esophagus, characterized by aperistalsis and defective relaxation of lower esophageal sphincter. It is predominantly a disease of adults and the incidence in children is extremely rare, 0.11 in 100,000. The presenting symptoms among children predominantly are dysphagia, regurgitation, vomiting, and failure to thrive. The diagnosis is made by barium studies and esophageal manometry. Per oral endoscopic myotomy (POEM) is a novel technique in adult population but its efficacy and safety in pediatric population is not known. Cardiomyotomy is the treatment of choice for childhood achalasia. Case description: A 4-year-old boy presented to us with complaints of recurrent vomiting since 6 months of age and failure to thrive. He used to vomit immediately after ingestion of both solids and liquids. He had history of bronchopneumonia at around 1 year of age. He was malnourished and less than the third percentile for his age. His barium esophagogram (Fig. 1) showed persistent narrowing at the lower end of esophagus with proximal dilatation suggestive of achalasia. He was nutritionally rehabilitated and taken up for laparoscopic Heller's cardiomyotomy. Post-surgery, he improved well and was able to tolerate both solids and liquids. On follow-up, he had gained weight and was feeding normally. This case highlights the importance of recognizing the fact that achalasia though rare can present in pediatric age-group as well. Diagnosis is usually delayed or misdiagnosed as gastroesophageal reflux disease (GERD), esophageal webs, etc. Patients usually become extremely malnourished and developmental milestones are delayed. Hence, the early diagnosis and treatment with cardiomyotomy is the key.

Aim: This case report aims to show the feasibility of minimally invasive surgery in the management of impacted denture in the esophagus complicated with perforation and mediastinitis. Background: Foreign body impaction in the esophagus due to accidental or intentional swallowing is a rare but serious gastrointestinal emergency. Dentures are among the common causes of esophageal foreign body impaction in elderly, merely due to the presence of sharp clasp at the edges and their sheer size. The surgical intervention in these situations is rare but may be required following failed endoscopic extraction and for management of underlying esophageal perforation. Case description: A 54-year-old lady presented to us within 24 hours following repeated attempts at endoscopic extraction of an accidentally swallowed denture. She had developed esophageal perforation with mediastinitis. Computed tomography (CT) showed a denture impacted 4 cm above the gastroesophageal junction with esophageal perforation, minimal mediastinal contamination, and extensive subcutaneous emphysema. After hemodynamic stabilization, the patient underwent an emergency laparoscopic transhiatal esophagectomy with end cervical esophagostomy and feeding jejunostomy. Elective reconstruction was performed after six weeks. A laparoscopic retrosternal gastric pull-up with cervical esophagogastric anastomosis was performed. Conclusion: Laparoscopic transhiatal esophagectomy in the emergency setting is feasible when carried out in stable patients who are not amenable for primary repair and is associated with all the advantages of minimal access surgery. Minimally invasive reconstruction is feasible at a later date using a gastric conduit and the retrosternal route. Clinical significance: This case emphasizes that multiple attempts at endoscopic retrieval should be avoided in patients with an impacted foreign body as it carries the risk of multiple perforations, precluding a primary repair at surgery, necessitating a major undertaking of a staged esophagectomy and gastric conduit reconstruction.

Post-pancreaticoduodenectomy (PD) benign hepaticojejunostomy stricture (PDHJS) is an infrequent long-term complication. The therapeutic options in these patients are endoscopic or percutaneous balloon dilatation and surgical revision of the anastomosis. We herein describe the preoperative diagnosis and operative steps of laparoscopic revision hepaticojejunostomy (LRHJ) in an elderly male presenting with a hepaticojejunostomy stricture (HJS) 12 years post-open PD who had a failed percutaneous intervention.

Aim: The aim of this study is to evaluate the results of laparoscopic reversal of Hartmann's procedure assisted by transanal circular stapler as a primary treatment modality. Materials and methods: About 32 patients presenting with an end colostomy due to various elective and emergency surgical, gynecological, and obstetric indications were selected for this study, from April 2010 to March 2016. All the patients were subjected to ultrasonography of the abdomen and pelvis, a colostogram and contrast enema, and colonoscopy. Patients selected for the study were subjected to all routine workup. Pre-anesthetic evaluation was done. Parameters such as operative time, conversion rates, intraoperative blood loss, postoperative complications, return of bowel movements, starting on oral feed, anastomotic leak, port-site infection, and hospital stay were studied. Results: About 32 patients, including both male (12) and female (20), were included in the study. The age ranged between 30 years and 65 years (mean 47.5 years). The mean operative time was 150.6 ± 20.4 minutes. Four cases were converted to open. Oral feeds were started on 2 ± 1 postoperative day. Patients tolerated solid soft diet 96 hours after surgery. Postoperative hospital stay was 7 days (range 6–8 days). No patients had anastomotic leak or required revision surgery. Three patients had port-site infections. Conclusion: We conclude that transanal stapler-assisted laparoscopic Hartmann reversal can be considered as a primary modality of treatment in the hands of an experienced surgeon though having a steeper learning curve and a higher difficulty score compared with other laparoscopic colorectal surgeries with benefits of lesser intraoperative time, early return of bowel movements, faster initiation of oral solid feeds, decreased incidence of anastomosis leak, and lesser hospital stay.

Introduction: In the era of laparoscopic surgery, total extraperitoneal (TEP) hernia repair has become the standard procedure for treatment of inguinal hernias. While balloon is used to create extraperitoneal space in most Western countries, the financial burden of buying a balloon in a developing country like India is overwhelming. So, we present a case series of extraperitoneal space creation using a zero-degree telescope to reduce the cost of the surgery to a few thousand rupees (less than 100 dollars). Context: Laparoscopic total extraperitoneal inguinal hernia repair. Aims: To study the feasibility of creation of extraperitoneal space using a zero-degree telescope in laparoscopic total extraperitoneal hernia repair. Materials and methods: It is a case series of 500 patients from June 2011 to July 2021. Furthermore, it is a single-surgeon experience. Results: A Total of 500 laparoscopic TEP hernia surgeries were performed over a period of 10 years. Out of these, 485 patients were male and 15 patients were female. The age of patients ranged from 5 years to 85 years. Out of these, 50 patients (10%) were converted to transabdominal preperitoneal (TAPP) hernia repair. During the follow-up period, no hernia recurrence was found. No major complication was noted in any patients during this period. Seroma formation was noted in 25 patients (5%). Retention of urine was noted in 25 patients (5%). All patients returned to normal routine work within 2 weeks. Conclusion: Zero-degree telescope is a feasible method of creating extraperitoneal space in laparoscopic total extraperitoneal repair. Key messages: Slight changes in advanced laparoscopic methods can make these costly procedures accessible to a vast population of poor people in the world.