Introduction: Laparoscopic gastrectomy is gaining popularity over open gastrectomy for carcinoma stomach because of better early postoperative outcomes. In most of the studies, it is now evident that laparoscopic gastrectomy has a similar oncological outcome as that of open gastrectomy. Materials and methods: In this study, we compared the outcomes of laparoscopic and open gastrectomy with D2 lymphadenectomy for locally advanced carcinoma stomach that were done in our institution from January 2015 to December 2019. We analyzed the intraoperative events, complication rate, duration of hospital stay, margin status, nodal yield, and the disease-free interval between the two groups. Results: In the study period, 43 patients underwent gastrectomy for carcinoma stomach and 28 patients were on regular follow-up. Out of the 28 patients, 13 patients underwent open gastrectomy and 15 patients underwent laparoscopic gastrectomy. The disease-free interval for open gastrectomy was 13.3 months and for laparoscopic gastrectomy, it was 12.9 months. The average hospital stay was 18 days for open gastrectomy, and it was 11 days for laparoscopic gastrectomy with comparable postoperative complication rate, nodal yield, and margin status in histopathological examination. Conclusion: The long-term oncological outcomes of laparoscopic gastrectomy with D2 lymphadenectomy were comparable with the conventional open surgery for patients with locally advanced gastric cancer with a reduced hospital stay and complication rate.

Objective: To evaluate the role of diagnostic laparoscopy for staging in gastrointestinal (GI) and hepatobiliary malignancies and to avoid unnecessary laparotomies. Materials and methods: We conducted a retrospective review of the medical records of all patients admitted to the Department of General Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India from 2011 to 2021. The patients having abdominal malignancy were admitted to Surgery Department and following procedures undertaken that is history taking, clinical examination, routine examination, and special investigations. After initial assessment, they were subjected to laparoscopy. Results: The study group had 30 cases (13 males and 17 females): 15 cases of stomach tumors; 13 cases of colorectal and 2 cases of biliary tract tumors. Laparoscopy could accomplish proper staging in 29 cases (96.7%) that is the sensitivity of staging laparoscopy is 0.97 and the specificity of the test is 1. Unnecessary and futile laparotomies were avoided in 13 patients (43.3%). Only 1 patient (3.3%) had to be subjected to laparotomy following staging laparoscopy and was found to be unresectable. Staging laparoscopy means duration in the resectable group was found to be 17.35 minutes which was lower than the mean duration in the unresectable group which is 20.76 minutes. There were no complications in 25 (83.7%) and only 5 (16.7%) had complications, in which 3 (10%) had operative wound sepsis, 2 (6.7%) had major respiratory complication. Staging laparoscopy was associated with decreased morbidity and pain, faster recovery and quicker initiation of adjuvant therapies. Conclusion and interpretation: Staging laparoscopy has a very significant role in abdominal malignancies. It is very accurate in assessing peritoneal seedlings, and hepatic metastasis which are not found in imaging modalities. It is found to be more useful in staging gastric and extra-hepatic biliary tumors compared to colorectal cancers. It gives additional information regarding the extent of the disease intra-abdominally which changes the course of management in a significant number of patients. It has added benefit of performing biopsy from sites of dissemination and having histological confirmation. It spares malignancy patients from unnecessary laparotomies thereby decreasing hospital stay and cost expenditure when compared to open exploration.

Aim: Surgical management of inguinal hernia (IH) through laparoscopic approaches is becoming increasingly common in surgical practice. However, there is still controversy regarding the indications and techniques used, such as totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) repair. The purpose of this study was to evaluate the short- and long-term postoperative outcomes of TAPP hernioplasty in a series of 288 cases. Materials and methods: A consecutive series of 288 patients who underwent laparoscopic TAPP repair between January 2006 and December 2019 were included. The inclusion criteria consisted of patients with a symptomatic bilateral hernia, recurrent hernia, suspicion of occult IH, and unilateral hernia for whom the procedure was specifically requested. Demographic data, operative details, and postoperative outcomes were registered. Results: A total of 524 TAPP repairs were included in the study. The median operative time was 100 minutes for bilateral hernias and 75 minutes for unilateral hernias. The postoperative morbidity rate was 4.8%, and no mortalities were recorded. The median follow-up period was 21 (6–60) months. The recurrence rate at 60 months was 3.24%, and the incidence of chronic postoperative pain was 0.2%. Recurrence and neuritis were mainly associated with polyester meshes. Conclusion: Transabdominal preperitoneal is a safe and effective surgical option for managing IHs, provided that patients and meshes are carefully selected. Clinical significance: Nonpolyester meshes and nontraumatic fixation are associated with better outcomes.

Introduction: Laparoscopy provides an alternative approach to open surgery in addressing the surgical need of the society. The absence of adequately qualified personnel has limited its use in Ethiopia. Objectives: To describe the laparoscopic gynecologic procedures and determine the prevalence of grossly visible endometriosis in Ethiopia. Materials and methods: Facility-based cross-sectional study conducted from 2018 to 2022 GC at 14 university hospitals across the country. Women who had gynecologic laparoscopic surgery with adequate documentation were included. Data were collected by the investigators. Data were compiled and analyzed using SPSS version 25. Results: Data were collected from 236 study participants. The participants’ mean age was 30.6 years (±5.43). Majority, 71.2% (168/236) were nulliparous. Tubal factor infertility alone was the commonest, 84.7% (200/236), indication for laparoscopy. Intraoperatively pelvic adhesion of different degrees was found in majority, 52.5% (124/236) of cases. The prevalence of grossly visible endometriosis was 3.4% (8/236). The prevalence of procedure-related intraoperative complications was 2.5% (6/236). Three of the six complications were inadvertent uterine perforation during inserting uterine manipulator for chromopertubation. All of the complications were detected intraoperatively and managed. No significant association was found between a dependent variable (presence of intraoperative complications) and selected independent variables. Conclusions and recommendations: Tubal factor infertility was the commonest indication for laparoscopy in the present study. The prevalence of grossly visible endometriosis was low (3.4%). The prevalence of procedure-related intraoperative complications was low (2.5%) probably due to the less complex cases and procedures.

Background: Laparoscopic cholecystectomy in management of gallbladder (GB) diseases requires scrutiny in term of indications, success and failure to give benefit to the patient. Its relevance and validity require to be assessed in present era. Materials and methods: The study is carried out on patients admitted to municipal general hospitals of Ahmedabad. A total of 100 patients were observed and data were collected in the prescribed proforma consisting of details of the patient's history, clinical findings, pathological findings, radiological findings, operative findings, postoperative outcome. Results: Observation and analysis of the data of the present series were interesting and important aspects were compared with the standard series. Injury to the biliary tree was the common reason for the conversion of laparoscopic cholecystectomy to open cholecystectomy. Conclusion: With proper laparoscopic training and increasing experience of surgeons there is less chance to conversion of an open approach. Laparoscopic cholecystectomy is the best in terms of early recovery to routine life without any significant morbidity to the patient.

Extraskeletal osteosarcoma (EOS) is a highly aggressive and rare mesenchymal tumor. We present a case of 50-year-old woman who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Histopathological examination confirmed high-grade osteosarcoma of the gallbladder.

Cystic artery pseudoaneurysm post laparoscopic cholecystectomy is a rare complication associated with potential risk of morbidity and mortality. This is a case of cystic artery pseudoaneurysm post laparoscopic cholecystectomy in a 27-year-old female who presented postop. day 10 post laparoscopic cholecystectomy with abdominal pain, melena, and hematemesis. Esophagogastroduodenoscopy showed no active bleeder, and initial computed tomography (CT) only showed gallbladder bed hematoma that was treated in percutaneous drainage. However, recurrent symptoms prompt a CT angiography that revealed a cystic artery pseudoaneurysm with hemoperitoneum. The pseudoaneurysm was successfully treated with transarterial catheter embolization of the cystic artery stump. She was well post intervention but required parenteral antibiotics resulting in a 2-week hospitalization, and eventually discharged. Literature review reports only 10 cases of iatrogenic cystic artery pseudoaneurysm post laparoscopic cholecystectomy in the last two decades. Based on our literature review, the main presentation is usually hemobilia (70%), age of the patient ranging 26–79 years old, and timing of presentation ranging from 1 week to 3 years post laparoscopic cholecystectomy. The pathophysiology is often due to indirect or direct thermal injury during cauterization. Computed tomography angiography is the investigation of choice. Transarterial embolization is the treatment of choice with high success rate. However, surgery still plays a role in complex cases where embolization failed. There should be a high index of suspicion of such pathology, especially in patients who present with upper gastrointestinal bleed post cholecystectomy, so early diagnosis and treatment can be done.

Among the numerous anatomical variations in the hepatobiliary-vascular anatomy, Moynihan's hump, although rare, is a dangerous one. Failure of a surgeon to recognize it while operating can lead to complications like bile duct injury, bleeding and conversion to open surgery. We report a case of cholelithiasis, in which Moynihan's hump was identified during laparoscopic cholecystectomy and tackled with successfully. Further, we discuss the anatomy and surgical significance of this variation and conclude with the importance of adequate prior knowledge of hepato-biliary-vascular anatomy, achievement of critical view of safety and the use of indocyanine green dye as an adjunct to safely tackle this dangerous anomaly and prevent complications.

The triad of heterotopic pancreas and gastric mucosa in Meckel's diverticulum is an extremely rare condition. It is usually asymptomatic and often diagnosed only during surgery or diagnostic examinations for other diseases. Since it has no symptoms, it is found incidentally when the complications onset. We describe a case of Meckel's diverticulum with heterotopic pancreas and gastric mucosa who presented with a bowel obstruction in a patient with mental disability.

Hydatid cysts of the pancreas are quite uncommon. Even more uncommon are pancreatic hydatid cysts associated with portal hypertension. The illness may manifest either simultaneously with systemic involvement or as an isolated pancreatic involvement. Both of these scenarios are possible. We provide the first instance of a patient who had a laparoscopic distal pancreatectomy for treatment of a pancreatic hydatid cyst associated with lateral portal hypertension. There were neither complications nor recurrences of the condition. A male patient of 25 years old was brought into our facility complaining of epigastric and back discomfort. The patient's upper abdominal contrast enhanced computed tomography showed a unilocular cystic lesion (10 cm × 9 cm × 7 cm) in the tail of the pancreas, coupled with several collaterals at the splenic hilum, along the greater curvature of the stomach, and at the pylorus. He had a laparoscopic procedure of distal pancreatectomy, along with a splenectomy. His recovery from surgery went well, and a histological analysis revealed a hydatid cyst in both the pancreatic tail and body.

Background: Bezoars are ingested foreign materials accumulated most commonly in the stomach as a hard mass. A gastric bezoar composed of hair (Trichobezoar) that has a long tail that extends beyond the pylorus throughout the small bowel and very rarely to the cecum is described as Rapunzel syndrome. Case presentation: A 14-year-old girl presented with abdominal pain (4 days) with bilious vomiting (1 day). Contrast-enhanced computed tomography (CECT) scan showed a bezoar extending from the stomach to the small bowel within a jejunojejunal intussusception. Serum amylase levels were also elevated. The entire bezoar was extracted laparoscopically after reducing the jejunojejunal intussusception, subsequently, the patient recovered well and has been well after 2 years. Conclusion: Patients with Rapunzel syndrome can present with intussusception or with pancreatitis, or rarely with both, as seen in our patient.

There is no consensus regarding the clinical management of hepatic choristoma, which is a rare condition during cholecystectomy surgeries. Data regarding the increased risk of malignancy are questioned. In our case, we added a new case to this discussion.

Aim: The aim of reporting this technique is to show the new surgical method and its feasibility. Background: Stapled colo-anal anastomosis is preferred in laparoscopic and open anterior and low anterior resection (LAR). Placement of purse-string suture around the anvil in the colon is an important step. Failing to place these sutures properly can lead to an incomplete doughnut, which can further lead to an anastomotic site leak and a whole spectrum of complications thereafter. Technique: We adopted an innovative method, where we inserted an anvil through the specimen site of the colon and brought out its pin through the antimesenteric site of the colon just before the division. It ascertains a complete doughnut each and every time in a quick time. Conclusion: Stapled colo-anal anastomosis is an easy and quick method with equal safety as a handsewn method; however, failure of the purse-string suture is responsible for an anastomotic leak, which leads to short-term and long-term complications. This could be avoided by our adapted technique. Clinical significance: This paper describes our technique, which can decrease the incidence of colo-anal anastomosis leak and all the spectra of postoperative complications, most importantly, sepsis and anastomotic stricture.

Aim: The aim was to develop a simplified technique of correct wrap creation that is reliable, easy, and reproducible so that failure of antireflux surgery due to wrong wrap creation is prevented. Background: Improper creation of the wrap is one of the causes of failure of antireflux surgery. Anatomical failures in wrap creation cause morbidity to the patient and will require reoperations. There is a need to standardize this technique so that correct floppy wrap with respect to the site of creation on the fundus of the stomach, position, and length of the wrap can be achieved. Technique: The anterior wall and posterior wall of the fundus of the stomach are marked by silk sutures to aid in the creation of a 360-degree Nissen or a 270-degree Toupet wrap. This results in symmetry of the wrap on both sides, ensuring a floppy wrap with exact position and length. We have performed 20 cases of antireflux surgery (ARS) using this technique of wrap creation between January 2022 to September 2022. There was no recurrence of reflux symptoms, dysphagia or wrap failure requiring endoscopy or redo surgery in the postoperative period. Conclusion: This technique of wrap creation is safe, reliable, easy to learn, teach, and is reproducible during laparoscopic Nissen (LN) and laparoscopic Toupet (LT) fundoplication. Clinical significance: Our technique helps to standardize wrap creation in antireflux surgery. This results in a lesser chance of failure due to wrong wrap creation.