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

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

This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia

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

Laparoscopy-assisted resection of a giant intra-abdominal seminoma in an adult undescended testis

The incidence of cryptorchidism in infants is 3.3-5.8%, incidence in adults is not known. Cryptorchidism in adults is not uncommon in India for various reasons. Orchiectomy is the best option as malignant transformation of the undescended testis is a very real risk. Our patient was 52 years old with an empty left hemiscrotum and a large lower abdominal swelling. Laparoscopy-assisted resection was performed successfully. Pathology and PLAP studies confirmed seminoma. Chemotherapy is being planned. Laparoscopy has a definite role in the diagnosis [determines exact location] and treatment of cryptorchidism. Both laparoscopic orchiopexy and orchiectomy have been described in the literature

rare cause of intermittent dysphagia: giant fibrovascular polyp of the proximal esophagus

Fibrovascular polyps account for only 0.5-1% of all benign esophageal tumors and causes intermittent dysphagia. The patient was a 63-year-old gentleman with gradually progressive intermittent dysphagia of 40 days duration. Investigations revealed a submucosal tumor of the proximal esophagus causing luminal compromise. Excision was performed through a cervical esophagotomy and specimen was subject to histopathological examination. Postoperative recovery was uneventful and he was completely relieved of his symptoms

Laparoscopic management of perforation of a manginal ulcer following anterior gastrojejunostomy

Marginal ulcer is a well-known complication following gastrojejunostomy especially if vagotomy is not done or is incomplete and in anterior gastrojejunostomies. We report a case of marginal ulcer perforation in a 45-year old male who presented with peritonitis and a history of undergoing surgery for peptic ulcer disease 20 years back. Diagnostic laparoscopy revealed extensive soiling and a 1.5cm perforation on the efferent Loop of an anterior gastrojejunostomy Laparoscopic closure was done. There are only few reports of similar conditions published in the literature. With experience, it is feasible to use laparoscopy for the management of uncommon acute conditions like this one