Aim: Bile duct injury is an important complication of laparoscopic cholecystectomy. Nonbiliary injuries after laparoscopic cholecystectomy can be fatal and source of considerable morbidity. In this study we intend to highlight the importance of nonbiliary complications sustained during laparoscopic cholecystectomy and their outcome. Materials and methods: The study is analysis of patients managed in our unit with post-laparoscopic cholecystectomy nonbiliary complications from June 2010 to December 2018. Inclusion criteria—nonbiliary complications. Exclusion criteria—cases of bile duct injury, cases of surgical site infection, trocar-site hernia. Results: A total of nine patients with nonbiliary complications were managed. Mean age of the patients was 51.1 years (range 38–65). There were five males and four females. Nonbiliary injuries were categorized into access-related and procedure-related complications. Three cases (two colonics, one inferior vena cava) were access related. Six cases (five duodenal, one ileal) were procedure related. Conclusion: Nonbiliary injuries are of significant severity. Adequate attention in creating pneumoperitoneum and meticulous dissection helps in preventing complication. Timely detection and early therapeutic intervention can help reduce morbidity and mortality.

Aims: Laparoscopic subtotal cholecystectomies (LSCs) are occasionally performed for difficult gallbladder (GB) surgery. The aim of this study is to determine the rate, complications, and factors predictive of performing LSC in a hepatobiliary (HPB) unit, in comparison to patients who have undergone a conventional operation. Materials and methods: A 5-year retrospective review of laparoscopic cholecystectomies (LCs) was performed by HPB team at a tertiary center. Demographic, operative, and postoperative data were identified. A randomized group (generated using online randomization software Research Randomizer®) of LC patients was identified from the study cohort, who had the same data recorded for comparison. Significance level was set at p < 0.05 when comparing the two groups of LC and LSC. Results: A total of 1,613 patients underwent LC, of which, 102 (6.3%) underwent LSC. The complication rate was 12.7% in the LSC group, mainly consisting of bile leak (3.9%) and collection requiring drainage (0.98%). The LC group had a 4.9% complication rate, of which, one bile leak was reported, i.e., 1 (0.98%). The length of stay was significantly longer in the LSC group (2 days vs 0 days in the LC group), and this group also had a slightly higher readmission rate (8.8% vs 3.92%). Laparoscopic subtotal cholecystectomy was found to be more likely in patients with previous cholecystitis, thickened GB wall on imaging and previous endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure and the above characteristics may be used to potentially predict who is more likely to undergo LSC. This may aid in the consenting process and also help to create a score that predicts the probability of undergoing LSC.

Introduction: The incidence of esophageal cancer has been increasing in the last decade. Different types of treatments are available, including minimally invasive esophagectomy (MIE). The aim of this study was to compare the early outcomes of the open vs totally laparoscopic transhiatal esophagectomy. Materials and methods: This case–control study was conducted between May 2012 and January 2014. Patients with esophageal cancer who presented to Imam Reza Hospital, Mashhad, Iran, were assessed and their eligibility for the surgery type was investigated. Results: Ninety-three esophagectomies performed. The open group comprised 57 patients and the laparoscopic group consisted of 36 patients. Mortality occurred in three patients in the open group and seven patients in the laparoscopic group (p < 0.05). Chylothorax happened in four patients in the open group and only in one patient in the laparoscopic, which showed no significant difference. The mean operating time was 75 ± 16 minutes in the open group and 125 ± 25 minutes in the laparoscopic group (p < 0.05). Conclusion: Minimally invasive transhiatal esophagectomy is an available option for treatment of esophageal cancer, but our results should be interpreted with caution due to low sample size and our primary experience in patient selection.

Introduction: Hemorrhoidectomy is one of the most common surgical procedures, and other treatments such as laser hemorrhoidectomy had been used as an alternative. The aim of this study was to determine the outcome and postoperation complications of treatment by laser compared with open hemorrhoidectomy. Materials and methods: In this randomized clinical trial (RCT), 85 cases with a second or third degree of hemorrhoids were assigned to two groups at random and followed for 6 months. Those patients in the intervention group were treated by laser hemorrhoidoplasty (LHP) and those in the control group underwent Milligan and Morgan hemorrhoidectomy. At the end of follow-up, 80 cases remained in the trial on whom postoperative pain [visual analog scale (VAS)], complications, and quality of life according to the 36-item Short Form Health Survey (SF-36) questionnaire were studied. Data were analyzed using R 3.5.1 software and p value <0.05 was considered significant. Results: The most common complaints were bleeding (57%) and pain (41%). Postoperative pain immediately and after 6 months was not significantly different between the two groups (p > 0.05). No complications were seen in any groups in follow-up. All eight scales of SF-36 questionnaire, except general health, were significantly different in the two groups. Physical functioning was lower in patients who underwent LHP, whereas the patients’ quality of life in other scales was better in the laser group. The total score of SF-36 was 66.1 ± 3.6 and 56.0 ± 3.3 in laser and surgery groups, respectively (p < 0.001). Conclusion: Laser hemorrhoidectomy is a safe procedure, not associated with any excessive postoperative complications. It improves patients’ quality of life and can be a substitution of other surgical methods.

Introduction: Several techniques are used to close the appendicular stump during laparoscopic appendectomy. This is especially important in developing countries where resources for training with endoloop are insufficient, and the simplicity of application of polymer clips can enable easy acceptance of laparoscopic appendectomy as a method in the treatment of acute appendicitis. Aim: The aim of the study was to compare results of appendicular stump closure by polymer clip and endoloop with reference to • Days of hospitalization, • Infection rate, and • Ease of application Materials and methods: This is a prospective study of 70 cases of laparoscopic appendectomy operated in the Department of General Surgery, SSG Hospital, Vadodara, from October 2016 to October 2017 (35 patients in each group i.e., polymer clip application group and endoloop application group). Operative data were recorded, and the patients were followed up accordingly. Independent assessors were assigned to obtain days of hospitalization, infection rate, ease of application, and other secondary outcomes. Results: It is more feasible for surgeons to use polymer clip than endoloop to close appendicular stump as per the surgeon's opinion taken after each surgery. However, days of hospitalization and postoperative complication rates were not statistically significant in both groups. Conclusion: Closure of appendix stump with a polymer clip is a simple and safe method in laparoscopic appendectomy and is comparable with other methods of appendicular stump closure.

Aim of the study: To assess the results and complications of laparoscopic herniotomy in female children using percutaneous internal ring suturing (PIRS). Materials and methods: One hundred and ten consecutive female children who were admitted with a unilateral or bilateral inguinal hernia from January 2015 to June 2018 to a medical college referral hospital were included in the study. The technique used was PIRS, using spinal needle 23 gaze and 3.0 prolene. All patients were followed up postoperatively. Babies with recurrent hernias and complicated inguinal hernia were excluded from this study. Results: A total of 110 female children with unilateral or bilateral inguinal hernia were included in the study. Age ranged from 1 month to 15 years with a mean age of 3 years. The clinically unilateral hernia was present in 80 children but the patent internal ring was present on the contralateral side in 25 children and was repaired simultaneously. The bilateral inguinal hernia was present in 30 children. The total number of hernia units was 165. The mean operative time was 15 minutes, ranging from 12 minutes to 20 minutes for unilateral hernia and 15–30 minutes for a bilateral hernia. The mean postoperative stay was 1 day. The follow-up period ranged from 7 days to 2 years. Two babies had hematoma at the internal ring during the procedure, subsided with no postoperative sequel. One child developed hernia on contralateral side, who was operated for contralateral patent ring during repair of an ipsilateral clinical hernia. None other children who were operated for clinical hernia had a recurrence. Conclusion: Laparoscopic herniotomy using the technique of PIRS is safe, quick with minimal postoperative pain, and short hospital stay, and had a very low incidence of recurrence.

Introduction: In minimal access surgery, the technique of first entry in the human body with the telescope and instruments is called the access technique. Laparoscopic access is of two types: closed and open access.^1,2 Here we are analyzing the merits and demerits of two entry techniques and the incidence of complications in both techniques. Comparison is between the blind technique by using the Veress needle and the undervision technique by using Visiport. Aim of study: To assess, evaluate, and compare the incidence of complications in blind and clear view access techniques in laparoscopic surgery. Materials and methods: A total of 150 cases of laparoscopic surgeries using the Veress needle and 150 cases of laparoscopic surgeries done by Visiport have been reported. (All laparoscopic surgeries were done in the General Surgery Department in Rashid Hospital from January 1, 2015 to December 12, 2015.) Result: In this study of comparison, both techniques were seen to have been associated with their own complications. But Visiport is a safe and faster method of creating pneumoperitoneum, though there was a statistically insignificant major vascular injury. It happened with an inexperienced surgeon. Conclusion: Visiport is a safe and faster method of creating pneumoperitoneum in laparoscopic surgery.

Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated cholangiocarcinoma. Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented. Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25% Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and 50% of them via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was 5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance 2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up. Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery.

Laparoscopic surgery has been proved to be safe and better option for Child-Pugh (CP) score class I and II cirrhotic patients. Various challenging laparoscopic surgeries have been applied to this group of patients. This case report was of an obese man, CP class I alcoholic cirrhotic patient with radiological evidence of portal hypertension, inflicted with cecal adenocarcinoma. Laparoscopic right hemicolectomy was planned. First camera port incision was made on infraumbilical position and injured to large paraumbilical collateral, which drained blood from the main portal vein. The patient was survived but suffered from postoperative ascites and postponing definite surgery. The preoperative computed tomography was reviewed and detailed of these collateral vessels. This report aims to raise awareness of this potential complication and reveal the imaging with discussion of avoiding options.

A 27-year-old primigravida, married for 3 months, was admitted in the All India Institute of Medical Sciences (AIIMS), Delhi, with the diagnosis of live abdominal ectopic pregnancy. She had a history of scanty menstrual flow since 2 months and brownish discharge since 15 days. The patient had a history of normal menses priorly. Urine pregnancy test done was positive. The gestational age of the present pregnancy was 12 weeks. The patient had no complaints of pain in her abdomen, nausea, and vomiting, was doing her daily activity, which included gym and yoga. Per abdomen examination revealed a soft nondistended abdomen. Per vaginam examination showed bulky, anteverted uterus with fullness in right fornix and tenderness in right fornix. Investigations revealed Hb-10.6 g%, ultrasound, and CT scan showed right-sided live abdominal ectopic pregnancy, and the vessels involved were a right uterine artery and a branch from the lower level of T11 vertebral level, fetal pole ≈12 weeks in Pouch of Douglas (POD). With this case report we highlighted the medical emergency that diagnosed should be managed promptly. Proper preoperative evaluation, use of systemic methotrexate, availability of multidisciplinary surgical team, and proper operative technique like minimal invasive surgery which is invaluable in modern era when incidence of ectopic pregnancy is increasing due to parallel increase in etiological factor-like sexually transmitted diseases and assisted reproductive techniques by early detection with transvaginal ultrasound and CT scan which can reduce maternal mortality and morbidity, offer the couple a more optimistic outlook for subsequent reproductive potential and reduce mental, emotional trauma to the patient.