Laparoscopic fundoplication with mesh repair of a large type III hiatal hernia

Mixed [type III] hiatal hernias - with sliding and paraesophageal components - are uncommon, accounting for 10-15% of all hiatal hernias. Symptoms are that of gastroesophageal reflux disease. The paraesophageal hernia may get incarcerated and present as an emergency. We present a 50-year old patient with symptoms of severe reflux disease who was diagnosed with type III hiatus hernia. Laparoscopic mesh repair with fundoplication was performed, as the defect was large. Postoperatively, patient's symptoms were almost completely relieved. Follow up manometry was done, which showed normal pressure range. Thoracotomies or laparotomies were the traditional methods of surgery for type III hiatal hernias, though now thoracoscopy and laparoscopy are becoming popular. We favor the laparoscopic approach as the hernial sac can be dealt with and crurorraphy with fundoplication can also be done. The hernial sac may or may not be completely excised. Some feel that if it is not excised, the residual sac may be filled with fluid and it can present as paracardiac cyst. Hence it is preferable to excise the hernial sac. Though controversial, we feel mesh repair of hiatus is advisable in case of large hiatal defects. Laparoscopic repair of type III hiatal hernias is more or less well established and carries all the benefits of minimally invasive surgery

Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy

Laparoscopic surgery in pregnant patients have been reported in the literature, laparoscopic cholecystectomy being the most common. A pregnant patient in her second trimester of pregnancy underwent emergency laparoscopic cholecystectomy for empyema of gallbladder. The distended gallbladder was decompressed before dissection was commenced. There was no morbidity conversion, or complications for either mother or child related to general anaesthesia. The major advantages of the minimally invasive therapy can be utilized in the surgical disorders of the pregnant patient

Diagnostic laparoscopy and resection of a rare case of large mesenteric liposarcoma

Liposarcoma arising from the mesentery of the bowel is a rare lesion. Some of the most common presenting symptoms of primary mesenteric liposarcoma is increasing abdominal girth, weight loss, abdominal pain, abdominal discomfort with meals and the presence of a freely movable abdominal mass or masses. Our patient presented with a large intra-abdominal mass. Diagnostic laparoscopy revealed tumor confined to the mesentery of the ileum. Laparoscopy was attempted, though conversion was necessary to achieve negative margins. Laparotomy was required to resect the tumour with wide margins. Myxoid and well-differentiated types of liposarcoma are by far the most common histological type. Tumor size greater than 20cm predict significantly poorer prognosis. The treatment of choice for primary mesenteric liposarcoma is surgical resection with clear margins. Radiotherapy or systemic chemotherapy has no benefit in increasing long-term survival. Laparoscopy is of limited value