Laparoscopic-assisted transhiatal oesophagectomy: An experience from a tertiary care centre over 10 years

Background: Minimally invasive surgeries have become the standard of care in oesophageal surgeries, but the transhiatal approach is still not widely in practice. As in the open surgical approach, laparoscopic transhiatal oesophagectomy has been accepted by many centres worldwide. The laparoscopic-assisted transhiatal oesophagectomy (LATE) has become a time-tested surgery. Many centres across the world have shown its feasibility and superiority regarding the lymph node yield with less morbidity with the added advantage of laparoscopy. We are pleased to share our 10-year experience with LATE and the long-term follow-up. Materials and Methods: Retrospective analysis of prospectively maintained data from our tertiary care centre from January 2010 to January 2021. Forty-six out of 74 patients with carcinoma of the lower end of the oesophagus who underwent LATE were analysed retrospectively. Results: Our study group included 46 patients. Six patients who required conversion to open surgery and those who underwent different procedures were excluded. The mean operative time was 220 (140–360) min. The mean blood loss was 230 (100–500) ml. Four (8.69%) patients had neck leaks. Twelve (26.08%) patients had minor pulmonary complications and one (2.17%) patient had a major pulmonary complication in the form of acute respiratory distress syndrome. The median hospital stay was 10.5 (8–28) days and 90-day mortality was 2.17%. 45 (97.82%) patients had an R0 resection rate with a median lymph node yield of 21 (16–28). The median overall survival was 44 months, with a 3 years disease-free survival rate of 63.04% and a 5-year overall survival rate of 36.50%. Conclusion: LATE is feasible and safe for adenocarcinoma of lower third esophagus and GEJ (gastroesophageal junction). The laparoscopic magnified view of lower mediastinum provides a better vision for lymphadenectomy especially in the neoadjuvant group. It has all the added benefits of minimal invasive surgery with acceptable short and long term oncological results

Clinical approach to patients with thick wall gallbladder

Abstract Background Thick wall gallbladder (TWGB) is not an uncommon finding on ultrasonography especially in region with high prevalence of gall stones disease like north India. On most occasion, these thickening could be because of benign disorders but malignancy are not a rare cause of it. Preoperative distinction between benign and malignant causes of TWGB is important as the surgical treatment entirely differ. Despite after thorough evaluation with various imaging modalities, a definitive diagnosis cannot be reached on many occasion. The aim of our study was to review the literature for the diagnosis and management approach in patients with TWGB. Methods We perform a thorough online search of full text articles related with thick wall GB published in English literature. After doing a critical appraisal of available literature, a comprehensive narrative review was described. Conclusions In this review, the authors have described a clinical algorithmic approach by detailing the diagnostic utility of various imaging modalities and also different surgical options for treatment especially in cases of ambiguity

Laparoscopic removal of a needle from the pancreas

Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects like fish bone, sewing needle and toothpick. Most of the ingested foreign bodies pass spontaneously through the anus without being noticed but about 1% of them can perforate through the wall of stomach or duodenum to reach solid organs like pancreas or liver. Once inside the pancreas they can produce complications like abscess, pseudoaneurysm or pancreatits. Foreign bodies of pancreas should be removed by endoscopic or surgical methods. We hereby report our experience of successful removal one a sewing needle from pancreas

Laparoscopic removal of a needle from the pancreas

Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects like fish bone, sewing needle and toothpick. Most of the ingested foreign bodies pass spontaneously through the anus without being noticed but about 1% of them can perforate through the wall of stomach or duodenum to reach solid organs like pancreas or liver. Once inside the pancreas they can produce complications like abscess, pseudoaneurysm or pancreatits. Foreign bodies of pancreas should be removed by endoscopic or surgical methods. We hereby report our experience of successful removal one a sewing needle from pancreas

The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique

Background: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods: This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure. Results: A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816). Conclusion: LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation