Introduction: The incidence of cesarean scar pregnancies (CSPs) has increased worldwide due to increase in cesarean deliveries. Laparoscopic management is an effective strategy to deal with CSP resulting in immediate recovery, remediation, and repair of the cesarean scar defect. The diagnosis and management of CSP are challenging, and awareness of this condition is needed among the patients and obstetricians. Aims and objectives: To study preventable factors, role of minimal access surgery, and outcome in CSPs over a period of 2 years. Materials and methods: It is a retrospective cohort study in which patient's demographic characteristics, previous obstetric and surgical record, β-hCG, USG parameters, clinical presentation, contraception, etc., were studied. Results: Eleven cases of CSPs were admitted in a tertiary care hospital from 2019 to 2021. Median maternal age was 28 years with a median parity of two. The most common presenting symptom was vaginal bleeding. Nine out of eleven cases were successfully managed by laparoscopy. Hysteroscopy and ultrasonography were found very useful intraoperatively. Two patients required exploratory laparotomy. One patient had an intrauterine pregnancy following the CSP. Conclusion: Minimal access surgery remains the mainstay for the treatment of CSP in stable patients. Hysteroscopy and ultrasonography could be very useful during laparoscopic management of CSP. Cesarean scar pregnancy preventable factors are to be taken into consideration while performing cesarean section as the CSP incidence is increasing. Clinical significance: This study will help in finding out risk factors to CSP. Preventive factors of CSP, if studied further in detail, can help in reducing the incidence of this dreadful pathology. Early diagnosis and timely intervention with the help of minimal access surgery can save young women from losing their fertility.

Background: Laparoscopic cholecystectomy (LC) is associated with an increased rate of bile duct injuries than open cholecystectomy (OC). Majority of the bile duct injuries result from structural misidentification. The surgeon needs some anatomical landmarks to guide him for a safe cholecystectomy. Rouviere sulcus (RVS) is one such landmark. M Henri Rouviere first described it in 1924, but it was forgotten and neglected. It is not mentioned in anatomy or surgery textbooks. Its importance was recognized only in the late 1990s with the acceptance of LC as gold standard surgery. As there is paucity of the literature on RVS, a study was conducted on RVS. Materials and methods: A prospective study of RVS was conducted in 130 cases of LC noting the presence, morphology, and use of the RVS in safe LC. Results: Rouviere sulcus was present in 81.5% of cases. Open type sulcus with a horizontal direction was the most common presenting type. Rouviere sulcus is an extrabiliary landmark in a solid organ, liver, which is not affected by the gallbladder disease or retraction. It is well visualized in laparoscopic surgery than the open cholecystectomy due to opening of the sulcus by CO₂ pressure and magnification of digital cameras. The cystic duct and artery lie in a safe zone ventral and anterior to the plane of RVS and the common bile duct (CBD) lies below it. Rouviere sulcus indicates a safe plane of dissection for surgeon to avoid bile duct injuries. Conclusion: Rouviere sulcus is an important and first landmark that a surgeon must look to achieve the safe cholecystectomy and minimize bile duct injuries.

Introduction: Laparoscopic fundoplication is also important after medical management failure of gastroesophageal reflux disease. Nissen's fundoplication effectiveness is widely regarded as safe and effective, with a mortality rate of less than 1%. The purpose of this study is to assess clinical outcomes after laparoscopic Nissen's fundoplication in a patient with hiatus hernia and evaluate postoperative symptom relief, to evaluate postoperative complications, and to evaluate postoperative improvement in patients’ lifestyles. Materials and methodology: This retrospective observational study was conducted in civil hospital Ahmedabad for 30 patients admitted to Civil Hospital, Ahmedabad from May 2019 to October 2021. The selection criteria for cases were based on the physical findings, clinical history, radiological findings, and endoscopic findings. Patient information was collected from the medical record office. Sociodemographic variables include age at diagnosis, marital status, religion, level of education, occupation, and socioeconomic status. Results: In this study, the 51–60 years of age-group is affected mostly and the mean age is 56 years. Females are affected by around 53% as compared with 47% of males. The most common presenting complaint is upper abdominal discomfort followed by heartburn, bloating, and regurgitation. The usual day of discharge is day 3 or 4. Conclusion: Laparoscopic Nissen fundoplication is the better surgery in patients with hiatus hernia with good clinical outcomes. Laparoscopic Nissen fundoplication is an effective surgery for hiatus hernia with minimal complications in expert hands.

Background: After cesarean section, hysterectomy is the second most common procedure performed in the OBGY department. In this study, we analyzed the safety and complications of total laparoscopic hysterectomy (TLH) at our tertiary care center. Total laparoscopic hysterectomy is the preferred procedure over the laparotomy because of higher feasibility and lower postoperative complications. Materials and methods: This is a retrospective cohort study conducted on 200 patients who underwent TLH due to various benign gynecological conditions from January 1, 2017 to July 31, 2022. The statistical analysis was done using EPIINFO software. Results: The mean age of the women undergoing TLH at our center was 42 years. About 52% of the women were having parity 2, 43% were having a uterine size between 6 and 12 weeks. The most common symptom and indication for TLH were heavy menstrual bleeding (75.5%) and AUB L (leiomyoma) is about 49%, respectively. The average blood loss in the study was 150 mL. The mean duration of surgery was 50 minutes. The mean duration of hospital stay was 3 days. And 4% of the patients had intraoperative complications, 9% had postoperative complications which were identified and managed successfully. Conclusion: Laparoscopic gynecological surgeries are safe procedures in terms of feasibility in obese patients, minimal blood loss, and postoperative complications in patients with benign uterine etiology. Greater technical challenges and advanced equipment with long learning curve make it difficult for all surgeons to practice it.

Aim: Selection of type of laparoscopic inguinal hernia repair procedure for patients. To observe the comparison of the outcome of laparoscopic totally extraperitoneal (TEP) with transabdominal preperitoneal (TAPP) inguinal hernia repair. Explore the safety and feasibility of laparoscopic TEP and TAPP inguinal hernia repair. Advantages and Disadvantages of laparoscopic TEP with TAPP inguinal hernia repair. Materials and methods: In this study, 100 cases of inguinal hernia were admitted to the Department of General Surgery, L.G. Hospital, Maninagar, Ahmedabad, Gujarat, India in during the study period of 2019–2021 and operated for either of the laparoscopic methods randomly and equal in number. Results: All of our laparoscopic inguinal hernia repair patients selected for TEP and TAPP and all of them have good outcomes in the form of no recurrence. Both TEP and TAPP are found to have safe procedures and our institute has all the facilities required to perform inguinal hernia repair so it is feasible as well. Both procedures have their advantages and disadvantages, but both were found to be equally effective. Conclusion: From our study, we concluded that any of the inguinal hernia patients can be treated with either of the laparoscopic methods with equal results. There is no recurrence in both TEP and TAPP procedures. However, there are some concerns regarding the feasibility of both the procedure in the form of laparoscopic setup it requires and higher cost. Laparoscopic TEP repair is marginally better than TAPP in the form of the duration of surgical time, port site infection, and seroma while TAPP is marginally better at fewer chances of subcutaneous emphysema, the technicality of the procedure and diagnosis of opposite site hernia. However, both techniques are comparable and commendable if performed with precision and expertise.

Aim: This study will be useful in evaluating the clinical profile of patients and to assess the outcome of laparoscopic and medical management of gastroesophageal reflux disease (GERD) with hiatus hernia. Materials and methods: We retrospectively analyzed patients who were diagnosed with GERD and hiatus hernia over a period of 4 years and looked for outcomes of laparoscopic fundoplication. Results: A total number of 30 cases between January 2018 and December 2021 were included in this retrospective study with male-to-female ratio of 2:1. Most patients with GERD present with abdominal pain which is localized to the epigastric region. About 72.1% (p-value = < 0.005) of patients had mainly reflux symptoms such as epigastric pain, heartburn, or regurgitation, of which, epigastric pain was the most common (68%). In our study, the most common investigation performed was upper gastrointestinal endoscopy which was able to highlight an underlying pathology in terms of hiatal hernia in 38.5% (p-value = 0.019) patients. Proton pump inhibitors were used more frequently in patients and outcome of medical management varied. Laparoscopic fundoplication is the standard surgical treatment for GERD and has very low complication rates. On routine follow-up of all patients treated surgically for GERD, 67% (p-value = 0.007) had complete symptomatic relief in contrast to medical management, wherein only 22% of patients had long-term symptomatic relief. Conclusion: Laparoscopic total fundoplication is fast being adopted as the surgical gold standard for the treatment of GERD after appropriate trial of medical management among the population presenting in an Indian tertiary care hospital. Clinical significance: The study results would improve treatment outcomes in patients with hiatus hernia.

Introduction: Gangrenous cholecystitis (GC) is difficult to diagnose preoperatively. A delay in diagnosis leads to increased complications. A high index of suspicion followed by early surgery leads to increased chances of laparoscopic cholecystectomy with decreased morbidity and early discharge. The aim of the study was to study the demographics, contrast-enhanced computerized tomography (CECT) and magnetic resonance imaging (MRI) findings, type of procedure (laparoscopic/open), and the outcome of the patients. Materials and methods: A retrospective study was undertaken on GC patients. Patients were divided into three groups depending upon the type of surgery (LC, OC, LC-OC). Patient demographics, comorbidities, preoperative biochemical, CECT, MRI findings, time taken from admission to surgery, type of surgery, post-op complications, and length of stay were compared. Results: During a 5-year period, a total of 55 patients were diagnosed with GC. Of these cases, 47.27% underwent laparoscopic cholecystectomy (LC), 41.82% were treated with OC, and the remaining 10.91% had a combination of LC and OC. The median age of the patients was 58.12 ± 16.66 years, 65.65 ± 11.13, 58.16 ± 12.79 years in LC, OC, LC-OC groups respectively. The male to female ratio was 1.4:1. Approximately 45.45% of the individuals had hypertension, while 41.81% were diagnosed with diabetes. Additionally, 16.36% of the patients were found to have coronary artery disease (CAD), and 14.54% were undergoing antiplatelet therapy. Moreover, leukocytosis was observed in 40% of the patient cases. The conversion rate from laparoscopic procedure to open procedure was 18.75%. Postoperative morbidity was seen in 18.18% of patients. Average hospital and ICU stay in the LC group was the shortest (3.76 ± 1.94 days, 0.53 ± 1.38 days respectively). Hospital and ICU stay in the OC group was 10.8 ± 5.76 and 2.43 ± 5.35 days respectively. The average stay of the LC-OC group in the hospital and ICU was 9 ± 6.75 and 3.5 ± CECT 68 days. The p-value for hospital and ICU stay was 0.0001 and 0.0179 respectively. Conclusion: A high index of suspicion, and increased use of CECT and MRI in suspected cases followed by early LC leads to favorable outcomes in GC.

Aim: To investigate the perioperative outcomes and cost-effectiveness of the laparoscopic approach for patients with periappendiceal abscess (PA) in comparison with the open approach. The controversy is still evolving as regards laparoscopic surgery in cases with complicated appendicitis in general. Materials and methods: Three-center analysis of the records’ data of candidates >14 years of age with PA operated from January 2017 until October 2020 by either laparoscopic or open approach. Demographic and clinical data, perioperative outcomes, and cost-effectiveness were recorded and analyzed. Results: Within the study period, 399 eligible cases with PA were identified by clinical evaluation conjoined with the US and/or CT, of which 143 patients underwent laparoscopic appendectomy (LA) and 256 patients had an open appendectomy (OA). The average operating time was 78 minutes for the LA group and 62 minutes for the OA group (p < 0.001). The mean hospital stay was 6.3 days for LA and 7.4 days for the OA group (p < 0.001). There were 18 cases in the LA group who had surgical site infections, and there were 27 ones in the OA group (p = 0.001). There were six patients who suffered from a recurrent intra-abdominal collection in the LA group and four cases in the other group (p = 0.37). Laparoscopic appendectomy had a lower odds for the development of any specific surgical complication in the multivariate analysis (OR, 0.381, p = 0.008). The total expenses of management were marginally higher by about $300 in the LA group. Conclusions: Laparoscopic appendectomy is an efficient and safe operative approach in the management of PA, and it exhibits clinically beneficial merits over OA against marginally longer operating time and higher management expenses. Clinical significance: Laparoscopic surgery for appendicitis complicated with an abscess is feasible and safe. It offers beneficial merits over the open approach.

Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue but is contributed to by physical posture, environmental hazards, and administrative deficiency. There is growing awareness of this issue, with several behavioral, educational, and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The aim of this review was to evaluate the literature on the current interventions used to minimize musculoskeletal occupational injury in surgeons and interventionalists. This review will focus on engineering interventions, administrative interventions, and personal protective equipment.

Common abdominal emergencies like acute appendicitis, acute pancreatitis, hollow viscus perforation, and diverticulitis are being managed with laparoscopy. We here present three cases of unusual abdominal emergencies which were managed successfully by laparoscopy at a tertiary care center. These cases are of anaphylactic shock due to hepatic hydatid cyst with free peritoneal rupture, upper GI bleeds due to early gastric volvulus in a patient with a posttraumatic left-sided diaphragmatic hernia and the last case was a patient of blunt abdominal trauma with splenic laceration with hypotension. The postoperative course was very satisfying and possibly laparotomy was avoided in all cases. We reviewed the literature on the role of laparoscopy in acute abdominal conditions.

Laparoscopic appendectomy is now the standard surgery of choice for acute and recurrent appendicitis. Development of stump appendicitis after 3 days of laparoscopic appendectomy is a very rare incidence. Presenting a case report of a 19-year-old male who underwent laparoscopic appendectomy for acute appendicitis, and on postoperative day 4, developed sudden onset of high-grade fever, pain over the right iliac fossa, vomiting, localized features of peritonitis, and raised total leukocyte count (TLC). On contrast-enhanced computed tomography (CECT), abdomen and pelvis revealed stump appendicitis with minimal pelvic collection. The patient underwent exploratory laparotomy, and a stump of size 1.5 cm was found with features of inflammation and surrounding minimal adhesion. A stump appendectomy was done. Stump appendicitis presentation immediately after appendectomy is very uncommon. Though the incidence of stump appendicitis is rare but should be kept as a differential diagnosis in a previously operated appendectomy patient. Awareness of such cases initiates early diagnosis and advocates proper intervention at the right time to prevent unnecessary morbidity and mortality.

Background: Mature cystic teratomas (dermoid cysts) are most frequently seen in the reproductive age-group. Torsion is the most common complication of dermoid cysts, with detachment from the adnexa in rare circumstances. Case description: A 38-year-old patient presented with dull pain in right lower abdominal region. Tenderness was elicited in the right iliac fossa with right forniceal fullness on per vaginal examination. The ultrasound diagnosis of a mature cystic teratoma was confirmed on computerized tomography. Laparoscopy showed torsion of the right adnexa, with the dermoid cyst seen detached and within the pouch of Douglas. The wandering dermoid cyst was removed laparoscopically, en masse using an endobag without spillage. Conclusion: The rare possibility of detachment of the dermoid cyst with or without the entire ovary exists in cases of torsion necessitating recognition and appropriate surgical removal.

Aim: We aimed to review a case with pulmonary thromboembolism while using tranexamic acid after laparotomy myomectomy. Background: Pulmonary embolism (PE) is life-threatening and early diagnosis and proper treatment are crucial. Case description: This case was a middle-aged healthy and active woman that referred to our gynecology clinic due to menometrorrhagia and dysmenorrhea. According to an ultrasound report, she had an enlarged myxomatosis uterus. Medical treatment did not work therefore she chose the surgery. During surgery due to massive blood loss, 1 gram of tranexamic acid was infused two packed cells were transfused. After 48 hours of the surgery, the patient complained of shortness of breath. More evaluations showed PE. The patient had no thromboembolism risk factors. It seemed that tranexamic acid caused thrombosis in this patient. After proper treatment measures such as anticoagulant medicines, she was discharged from the hospital. Clinical significance: Considering the risk of thrombosis in each case as prescribed tranexamic acid.

Repair of inguinal hernia is one of the commonest surgical procedures performed worldwide. Starting from Bassini's repair proposed in 1887, numerous methods and their modifications have overwhelmed the field of inguinal hernia surgery and after the introduction of laparoscopy there has been a procedural revolution for the same. Ger documented the first laparoscopic hernia repair in 1982 by approximating the internal ring with stainless clips. Since then, transabdominal preperitoneal and total extraperitoneal hernia repair have become increasingly popular with lesser postoperative pain, postoperative complications, early return to work, and less recurrence. However, when we talk about hernia repair, there is tissue handling and this tissue manipulation gives rise to seroma formation which is one of the most common postoperative complications.

Objectives: To evaluate the usefulness of employing laparoscopy to observe distal fallopian tube (FT) peristalsis and to compare its efficacy to the hysteroscopic viewing of proximal FT peristalsis in normal and hydrosalpingeal FT. Design: A prospective comparative cohort study. Patients and methods: One hundred and fifteen infertile women undergoing concomitant diagnostic or operative laparoscopy and hysteroscopy were divided into two groups. Group A comprised 59 cases with apparently normal FTs while group B comprised 56 cases with hydrosalpingies. Setting: Endoscopy unit of a tertiary university hospital. Methods: Fallopian tube status was assessed during diagnostic or therapeutic laparoscopy, including whether morphologically normal and patent or not. Whenever possible, monitoring of the distal ends of both FTs was performed to detect any potential peristalsis. The proximal portions of each FT were then subjected to hysteroscopy to assess proximal tubal peristalsis. The effectiveness of laparoscopy in assessing distal FT peristalsis and comparing its findings to the hysteroscopic assessment of proximal FT peristalsis in normal and pathologic FT were the primary outcomes. Results: Laparoscopic detection of distal tubal peristalsis either in normal or hydrosalpingeal FT was low [5 (4.2%) and 5 (4.4%)] in both groups, respectively. After the exclusion of cases with unilateral patent FT from group B, the percentage dropped to 3.2% (only three FT). Hysteroscopic detection of proximal tubal peristalsis was significantly higher in group A [80 (67.8%) vs 40 (35.7%)] in total group B. Conclusions: Laparoscopic evaluation of distal FT peristalsis, whether for healthy or pathologic FT, is of limited utility and is not advised. Its effectiveness is significantly lower than the hysteroscopic evaluation of proximal FT peristalsis.

Cholelithiasis is one of common health issues and about 10–20% population harboring the calculi without any clinical features. Only one-fifth of these asymptomatic individuals progress to develop clinical symptoms at a rate of around 5% per year. Laparoscopic cholecystectomy is indicated for symptomatic patients and considered to be a “Gold Standard’’ treatment for the last three decades. It is the commonest abdominal procedure performed globally in an elective setting. Myriad techniques have been evaluated with increasing experience, skills, need, and availability of laparoscopic instruments. We have witnessed lots of modifications in creating pneumoperitoneum, dissection of Calot's triangle, division and securing cystic duct and artery, dissection of gallbladder (GB) from liver bed, retrieval of specimen, and port closure. Here we are presenting our experience and modifications used over the last one and a half decades.