Objective: This study was performed with the aim to evaluate the results of the treatment of vaginal fistulas caused by pelvic malignancy and to present a new surgical technique. Materials and methods: In this retrospective study, patients with vaginal fistula who have been treated in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences from 2004 to 2020 were studied. The inclusion criteria were the patients whose fistulas were caused by malignant neoplasia with pelvic organ origin. The patients with fistulas caused by other causes were excluded from the study. Patients’ information was collected from the electronic records and the hospital archives and also the information recorded by the surgeon. Results: Out of 26 patients with vaginal fistula caused by pelvic malignancies, 18 cases had enterovaginal fistula. Cancer of cervix (11 cases) was the most prevalent cancer. Time interval between the incidence of fistula and the onset of the disease was 43.5 months. About 16 patients had a history of radiotherapy before the onset of the fistula, and 23 cases had undergone surgery before the onset of fistula. About 11 patients were treated with resection, 8 patients with ostomy, and 5 with fistulized loop bypass. Discussion and conclusion: In cases of extensive pelvic involvement with a tumor, it is recommended to use intestinal bypass in fistula site with the technique provided in this article, since it controls the symptoms of the patient and has limited complications.

Aim: The present study was aimed to evaluate the effectiveness of enhanced recovery after surgery protocol (ERAS) vs conventional protocol in decreasing the duration of hospital stay after total laparoscopic hysterectomy. It also aims to assess the postoperative complications, compliance, patient comfort, and surgeon satisfaction among the ERAS and conventional protocol in total laparoscopic hysterectomy. Materials and methods: The present randomized controlled study was conducted by the Department of Obstetrics and Gynaecology at JSS Hospital, Mysuru, over a period of 1 year 18 months. A total of 120 patients scheduled for a laparoscopic hysterectomy with salpingectomy or salpingo-oophorectomy for a benign disease were included in the research and were randomized into ERAS (n = 60) and conventional protocol groups (n = 60). Both the ERAS protocol and the control group received care in accordance with accepted protocol. Results: In the present study, the mean VAS score in the ERAS study group was found to be 2.4 ± 0.6, and in the control group, is 4.6 ± 0.8 with a mean difference of 2.1 and p-value of less than 0.05. The mean total duration of hospital stay (in days) among the patients in the ERAS group is 1.6 ± 0.3 days. In the control group, is 4.4 ± 0.5 days with a mean difference of 2.8 days and a p-value of less than 0.05. None of the ERAS group patients had been readmitted to the EMD.100% of the patients in both the groups, are satisfied with the outcome of the surgery. Conclusion: The ERAS protocol implementation in laparoscopic hysterectomy procedures has resulted in decreased length of total duration of hospital stay and high patient satisfaction with no change in postoperative complications and readmission rates.

All laparoscopic surgeons, adult or pediatric, would be familiar with the ubiquitous Maryland forceps, a dissector used as an indispensable tool in various day-to-day laparoscopic procedures. However, it is limited in its use because it has a smooth surface on the outer surface of the jaws, which causes it to slip during dissection. Thus, it not only takes longer but also makes it more difficult to dissect tissues during the procedure. To tackle this problem, we came up with a modification of our own which would make it easier to use this instrument by reducing the slippage that occurs during the procedure.

Introduction: Inguinal hernia repair is one of the most frequent surgeries performed by a general surgeon. The novel laparoscopic modification of totally extraperitoneal (TEP) hernioplasty to enhanced-view totally extraperitoneal (e-TEP) hernioplasty was pioneered by J Daes in 2012. The e-TEP technique ensures that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. The e-TEP approach can quickly and easily create an extraperitoneal space, provide a flexible port setup adaptable to many situations, ease the management of the distal sac, and improve tolerance of pneumoperitoneum. (e-TEP) is now gaining popularity because of the lesser learning curve (LC). The aim of this study was to see the LC for laparoscopic e-TEP repair for inguinal hernia. The primary objective of this study was to evaluate the mean operating time (OT) and secondary objectives were to assess the complications and the rate of early discharge. Methodology: A retrospective analysis of the medical records of 42 patients scheduled for laparoscopic e-TEP repair for inguinal hernia was done from July 2018 to Feb 2023 in Dr. RMLIMS Lucknow India, a government medical Institute. Patients with complete or incomplete unilateral inguinal hernia and recurrences were included, complicated hernia and bilateral hernia were excluded from this study. Standard e-TEP access was created as described by Jorge D. All the procedures were carried out by a single surgeon under general anesthesia. Besides, demographic data such as age, sex, body mass index (BMI), umbilicus to pubic symphysis distance, Direct/indirect inguinal hernia, complete/incomplete hernia, and size of defect were collected. In addition to that OT, postoperative duration of hospital stay, and complications such as bleeding and peritoneal rents were also collected. The surgeon's competency was evaluated by the OT [moving average curve and LC by cumulative sum (CUSUM)] frequency of complications and length of hospital stay. Results: Reducing trend of the mean OT with the passage of phases I–III was observed. The curve is steep and first increases rapidly with a small plateau phase followed by a decreasing phase. Phase I had patients from 1 to 13, phase II had patients from 14 to 28, and phase III had patients from 29 to 42. Conclusion: In this study, the LC for e-TEP using CUSUM analysis for operative time and surgical failure was evaluated. For an experienced laparoscopic surgeon, we estimated that a minimum of 42 cases were needed to overcome the LC for e-TEP with an operative time of 78.71 ± 10.02 minutes.

Introduction: The gold standard surgical procedure for treating cholelithiasis has been cholecystectomy. The situation with regard to surgical management of gallstones (GS) has significantly changed with the advent of laparoscopic cholecystectomy. This laparoscopic approach has several theoretical advantages, such as lower hospitalization and recovery costs, pain reduction, avoiding large incisions for better cosmetic results, and quicker return to work following surgery. Recent trials indicate a rise in occurrence of operative complications, particularly common bile duct (CBD) injury, despite early promising results. Laparoscopy use is further restricted by costly equipment, specialized training requirements, and a protracted learning curve. Materials and methods: This study was done at MGM medical college and Hospital, Navi Mumbai, from August 2010 and September 2012. Fifty patients admitted in OPD and emergency department from the Department of Surgery fulfilling the inclusion and exclusion criteria were included in the study. After complete investigations and with written informed valid consent, patients were subjected to laparoscopic cholecystectomy. The duration of postoperative pain from the day of surgery including mild pain to severe pain and the number of postoperative days with postoperative pain and number of days of analgesia required were noted and documented for further comparison. Results: Time taken for operation was significantly longer in the laparoscopic cholecystectomy group (p < 0.001). Postoperative stay is less and faster recovery requirement of analgesics is also less in laparoscopic cholecystectomy group of patients. Conclusion: Laparoscopic procedure can be feasible in patients with acute cholecystitis with steep learning curve. Biliary duct injury is a common complication in laparoscopic procedure. Operating time is more in case of laparoscopic cholecystectomy group.

Background: Chronic pelvic pain (CPP) following a surgical procedure has been reported to affect a significant number of patients and is associated with a decreased quality of life. Objective: To evaluate CCP laparoscopically in patients who had previously undergone hysterectomy for benign lesions. Materials and methods: A multicentric study conducted over a period of 8 years. The study group included 88 females with posthysterectomy CPP of more than 8 months in whom a definitive diagnosis was either not reached or was in doubt despite thorough clinical and radiological investigations. Fifty-four patients agreed to the procedure while 34 patients were treated conservatively. Baseline characteristics, subjective pain relief, and overall patient satisfaction were compared between the two groups. Results: The mean age of the patients, body mass index (BMI), duration of symptoms, preoperative visual analog scale (VAS) for pain, and primary approach for hysterectomy were found to be statistically insignificant between the operative and conservative groups (p > 0.05). The most common indications for previous hysterectomy in both groups were dysfunctional uterine bleeding and leiomyoma. The most frequent findings at diagnostic laparoscopy were adhesions (53.70%), cystic lesions of preserved functional ovary (22.22%), and hydro/pyosalpinx (9.25%). Ten (18.51%) patients did not reveal any obvious positive finding. Adhesiolysis and ovarian cystectomy were the most frequently done procedures. Laparoscopic diagnosis was confirmed by histopathology in most of the patients. Improvement in VAS score was more significant in the operated group than in the conservative group. Conclusion: Diagnostic laparoscopy is an effective and accurate tool to evaluate CPP after gynecological surgery apart from being an excellent approach for therapeutic interventions.

Introduction: Appendicitis is one of the most frequent surgical diseases. In uncomplicated appendicitis, outpatient protocols have been shown to significantly reduce costs and can be replicated by residents. In Colombia, this type of protocol has never been evaluated. The aim of this study was to evaluate the outcomes of a low-cost, outpatient laparoscopic appendectomy protocol performed by first- and second-year general surgery residents in uncomplicated appendicitis. Materials and methods: A prospective longitudinal study of outpatient management after laparoscopic appendectomy was conducted in Bogotá, Colombia. It included patients with uncomplicated acute appendicitis and excluded those with evidence of perforation, abscess, or gangrenous appendicitis. The frequency of complications, readmissions, and postoperative pain were evaluated as outcomes. Results: 285 patients were included, with a median age of 28 years and 52.3% (n = 149) were female. All patients had modulated pain and tolerance of the oral route during the postoperative period. There were only 10 (3.5%) readmissions and 12 (4.2%) complications, of which 80% (n = 8) and 58.3% (n = 7) corresponded to the laparoscopic group. On bivariate analysis, no association was found between the frequency of complications and the surgical approach (open vs laparoscopic surgery, p = 0.10), the stage of appendicitis (edematous vs fibrinopurulent, p = 0.14), or the American Society of Anesthesiologists classification (I vs II, p = 0.44). Conclusions: This study demonstrated that the low-cost outpatient management protocol for uncomplicated appendicitis by laparoscopic appendectomy performed by first- and second-year residents had a low frequency of complications and readmission, with no significant differences compared with open surgery or appendicular phase. Clinical significance: The findings of this study have important implications for clinical practice. Outpatient postoperative management can reduce healthcare costs and improve patient satisfaction by reducing hospital stays and facilitating earlier recovery. This alternative should be considered for selected patients who meet the criteria for safe and effective care.

Background: Laparoscopic surgery is a minimally invasive surgical practice which is of diagnostic and therapeutic value. Aim: To determine the indications, operative findings and interventions at laparoscopy in our resource challenged settings. Methods: This was a two-year prospective study in the university of medical science teaching hospital Ondo and a private laparoscopy George and Martin laparoscopy center, Ore, Ondo State, Nigeria, between January 2020 and January 2022 which included 51 patients. Both diagnostic and therapeutic procedures were followed up during this period. Data on patients’ age, gender, indications for surgery, duration of hospital stay, outcome of surgery were analyzed. Data analysis was by the SPSS version 23 (IBM incorporated, Chicago, USA). Results: Fifty one patients were put under study. The median age was 42 years (mean = 41.73; age range of 8–75years). There were more females 29 (56.9%) than males 22 (43.1%). Laparoscopy was purely diagnostic (n = 6, 11.8%), therapeutic (n = 45, 88.2%), cholecystectomy (n = 11, 21.6%) and intraperitoneal onlay mesh (IPOM) (n = 11, 21.6%) were the two most common procedures done. The mean duration of surgery was 96.96 [minutes (diagnostic)], 150 [minutes (therapeutic)]; average duration of hospital stay was 2.3 (±1.7 days). Conclusion: Laparoscopic services are expanding in our center with improved facilities, females appear to benefit more in our study and the services involved the young and elderly.

Background: This study was undertaken to evaluate if the cyanoacrylate glue was superior to conventional suturing for skin closure of the laparoscopic port site. Materials and methods: A prospective randomized trial was performed on patients scheduled for elective laparoscopic surgery at the department of general surgery at a tertiary care hospital. Patients were followed up to evaluate postoperative pain using the visual analog scale (VAS). The time required for closing the wound, postoperative pain at the wound site, rate of surgical site infection (SSI), and the period for which the patients stayed in the hospital were studied. Results: A total of 70 patients were enrolled and divided into two groups. In group I (the study group) incisions were closed by applying N-Butyl-2-Cyanoacrylate glue and in group II (the control group) incisions were closed by conventional suturing method using Ethilon 2.0 RC. Statistically significant difference was found between the average time required for the closure of a single port site (p < 0.0001), surgical site infection (p < 0.021), and the average number of days the patient stayed in the hospital. It was less in the group I as compared with that of group II. There was no significant difference between the two groups for postoperative pain assessment. Conclusion: The use of N-Butyl-2-Cyanoacrylate at laparoscopic port site skin closure was beneficial as it took comparatively less time for laparoscopic port skin closure and had less rate of surgical site infection at the wound site.

Introduction: Nonspecific acute abdominal pain (NSAP) is considered a serious problem in the surgical field. To assess this condition, many approaches have been used, such as observation and early laparoscopy. Methods: This prospective interventional study was conducted at the tertiary care hospital in the Department of General Surgery and the Department of Emergency at Suez Canal University Hospital on 50 patients who presented with NSAP; the outcomes of early laparoscopy versus clinical observation were compared. Results: The current study results revealed that the definitive diagnosis was achieved in 88% of cases in the laparoscopy group and 80% of cases in the conservative group. The laparoscopy could recognize a pathology in 22/25 cases. Therefore, our research presents a diagnostic yield of 88% which aligns with other studies that have shown comparable rates of high definitive diagnostic rates (between 86 and 100%). Conclusion: Diagnostic laparoscopy (DL) is a safe and very effective minimally invasive therapeutic and diagnostic method, as it is used to identify and treat acute abdominal diseases. It minimizes morbidity, permits treatment and diagnosis in the same facility in most cases, shortens hospital stays, and reduces investigative costs.

Background: Even though, laparoscopy has evolved as the gold standard of treatment for abdominal surgical pathologies, a lot of problems and challenges are still associated with its routine use in the treatment of such patients in Nigeria. The hurdles involved in the use of laparoscopy are still pervasive even though most of the procedures performed are not advanced. This study aims to enumerate, via a qualitative synthesis performed on the selected studies, the challenges of laparoscopy in Nigeria. Methodology: We assessed articles, written in English language in the last 20 years, from PubMed, African Index Medicus and Scopus. A few were also manually added from bibliography and references of articles. The search terms were “challenges,” “laparoscopy,” and “Nigeria.” The inclusion criteria were studies on laparoscopy in Nigeria whose content could be assessed. The challenges and adaptations and reason for converting to open surgery were subsequently noted. The exclusion criteria included studies on gynecologic laparoscopy, case reports, articles with fragmented data and articles not discussing the challenges that were encountered. PRISMA guideline for systematic review was followed. Results: The search yielded 226 papers. Seventeen papers which met the inclusion criteria were studied in-depth. The challenges identified included incessant power outages during surgery, staff apathy, high cost of set-up and incessant strikes. The adaptive strategies noted include the use of uninterrupted power system (UPS), training of support staff, re-use of disposable instruments. The reasons for conversion to open surgery varied from excessive bleeding to difficult anatomy. Conclusion: The challenges facing the laparoscopic surgeon in Nigeria are peculiar and likely to snowball in the future. In order to ensure its sustainability, policymakers should solve the highlighted challenges and also provide enabling environment. This might promote the adoption of laparoscopy for treating patients with abdominal pathology in the future.

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors originating primarily from the stomach and small intestine. Preoperative diagnosis of GIST relies on improved computed tomography (CT), endoscopy, and endoscopic ultrasonography (EUS), but despite these tests, there is a high rate of misdiagnosis. The aim of this study was to review the literature focusing on diagnostic methods for such lesions by analyzing preoperative contrast-enhanced CT, endoscopy, EUS, and other tests. Materials and methods: A systematic search of articles using electronic databases (MEDLINE, and Embase) was conducted in the last 10 years and 106 items were filtered from the search list. Finally, we report our experience of “difficult diagnosis” in which several diagnostic methods were needed and a definitive diagnosis could only be made after surgical resection. Results: After a review of all papers, 95 studies were excluded, due to incorrect study design, wrong population, non-English language, or other reasons. Finally, 41 studies were included, with a total of 2860 analysis cases. Conclusions Difficult diagnosis when dealing with GIST is particularly notable. Our study emphasizes how the need to reach the correct diagnosis may lead to performing countless preoperative examinations without arriving at the goal. Our case presentation reports a GIST mimicking pancreatic cyst.

Aim and background: Laparoscopic splenectomy for enlarged spleen even for massive splenomegaly can be accomplished with a good overall outcome. Removal of specimens in toto, without morcellate, is also beneficial as it decreases the chances of splenosis. Case description: Here we are presenting our early experience of laparoscopic splenectomy in five cases where one patient had massive splenomegaly. Conclusion: Laparoscopic splenectomy for an enlarged spleen is a safe technique as it causes less post operative pain and the need for analgesia, early recovery, and less postoperative complication in the form of atelectasis. Clinical significance: Splenectomy by laparoscopic should be attempted even in massively enlarged spleen and specimen should be taken out in toto.

Aim and background: This case report documents the management of a 32-year-old female with a history of precipitate labor, failed cervical cerclage, and recurrent pregnancy losses with 2nd degree uterovaginal prolapse. The patient was counseled for a laparoscopic transabdominal cerclage and sacrocervicopexy to address cervical insufficiency and uterovaginal prolapse in single setting. Case description: A laparoscopic procedure where transabdominal cerclage with sacrocervicopexy with a single polyester tape was done. Postoperative recovery was uneventful, and the patient was discharged after 48 hours. Conclusion: This case report highlights a novel approach to managing complex obstetric issues, offering step-by-step guide to successful application of laparoscopic transabdominal cerclage and sacrocervicopexy for patients with recurrent pregnancy loss and uterovaginal prolapse using single polyester tape. Clinical significance: This is a novel single setting procedure to combat cervical insufficiency and uterovaginal prolapse using single polyester tape with several advantages over conventional treatment options available.