Journal Of Minimal Access Surgery[JOURNAL]
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200 papers
Robotic takedown of gastro-gastric fistula with revision of gastric bypass and reconstruction of gastrojejunostomy.
Mallick H, Ahmer H, Jacobson A … +4 more , Rebner L, Katsichtis T, Mahendraraj K, Goparaju A
J Minim Access Surg · 2026 Apr · PMID 41945514 · Publisher ↗
A 38-year-old female presented with chronic abdominal pain and nutritional decline due to a gastro-gastric fistula (GGF) following Roux-en-Y gastric bypass. Multiple endoscopic interventions, including OverStitch, fibrin...
A 38-year-old female presented with chronic abdominal pain and nutritional decline due to a gastro-gastric fistula (GGF) following Roux-en-Y gastric bypass. Multiple endoscopic interventions, including OverStitch, fibrin sealant and over-the-scope clip (OTSC) placement, failed to close the fistula. Pre-operative imaging and endoscopy confirmed a patent gastrojejunostomy and an 8-mm GGF with embedded OTSC. A robotic approach was undertaken. Dense adhesions were lysed, and the fistula was dissected and excised. The OTSC was identified and removed intraoperatively. The gastrojejunostomy-fistula complex was resected, and a new hand-sewn gastrojejunostomy was created robotically. The remnant stomach was resected. Endoscopy confirmed an intact anastomosis and a negative leak test. The patient tolerated oral intake on post-operative day one and was discharged on the same day. At 6 months, she remained asymptomatic with stable nutritional status. This case highlights the role of robotic surgery in managing refractory GGF, particularly after failed endoscopic interventions.
Comparison of fast and slow CO2 insufflation on hemodynamic parameters in elective laparoscopic cholecystectomy.
Pattillath RP, James NS, Rajan R … +2 more , Das R, Krishna VRA
J Minim Access Surg · 2026 Apr · PMID 41945507 · Publisher ↗
INTRODUCTION: Laparoscopic cholecystectomy (LC) uses carbon dioxide (CO2) insufflation to create pneumoperitoneum, which can affect haemodynamic stability. This study compares the effects of fast versus slow CO2 insuffla...
INTRODUCTION: Laparoscopic cholecystectomy (LC) uses carbon dioxide (CO2) insufflation to create pneumoperitoneum, which can affect haemodynamic stability. This study compares the effects of fast versus slow CO2 insufflation on haemodynamic parameters and post-operative pain in elective LC patients. PATIENTS AND METHODS: An observational study was conducted on American Society of Anestheisology category 1/2 patients undergoing elective LC from October 2023 to August 2024, consecutively assigned to Group A (slow insufflation, 2-4 L/min) or Group B (fast insufflation, 8-10 L/min). Intraoperative monitoring of mean arterial pressure (MAP), heart rate (HR) and end-tidal CO2 was performed immediately after induction of anaesthesia. Post-operative pain was assessed using the Visual Analogue Scale, with the first reading recorded 4 hours after extubation, followed by two additional readings taken at 12-hour intervals thereafter. RESULTS: Sixty-eight patients were analysed. Fast insufflation led to higher HRs at several time points and higher MAP at T4 and T5. Post-operative shoulder pain was more frequent with fast insufflation at 4 h (P = 0.001) and 12 h after the 1st reading (P = 0.002). No significant complications were noted in either group. CONCLUSION: Fast CO2 insufflation resulted in higher HRs, MAPs at certain time intervals, increased post-operative shoulder pain and surgical site pain at 4 h, while other haemodynamic parameters and surgical site pain at two subsequent 12-h intervals were comparable.
Thermal injury to the linea alba during laparoscopic ventral transabdominal pre-peritoneal repair leading to large incisional hernia: A case report.
Singh D, Sharma J, Grover N … +1 more , Rathore YS
J Minim Access Surg · 2026 Apr · PMID 41945505 · Publisher ↗
Laparoscopic ventral transabdominal pre-peritoneal (vTAPP) repair is gaining popularity as a promising technique for ventral hernia repair. However, data on complications specific to this approach are limited. We report...
Laparoscopic ventral transabdominal pre-peritoneal (vTAPP) repair is gaining popularity as a promising technique for ventral hernia repair. However, data on complications specific to this approach are limited. We report the case of a 35-year-old gentleman who underwent laparoscopic vTAPP repair for a 2 cm epigastric hernia at another hospital. The patient developed a progressive incisional hernia 6 months later, with imaging revealing a 13 cm × 10 cm midline defect. Re-exploration revealed necrosis of the linea alba, likely secondary to thermal injury during the initial surgery. Anterior component separation with placement of a large polypropylene mesh was performed, and the patient recovered well, with no recurrence at 12-month follow-up. This case emphasises the potential for thermal injury during laparoscopic vTAPP, resulting in fascial necrosis and formation of a large hernia. Careful dissection techniques and limited use of energy devices in the midline are critical to avoid this rare complication.
Laparoscopic mesohepatectomy with situs inversus totalis: A case report.
Jiang T, Huang X, Tang Z … +4 more , Xiong M, Li Z, Li J, Xiong Y
J Minim Access Surg · 2026 Apr · PMID 41945498 · Publisher ↗
Situs inversus totalis (SIT) is a rare congenital anomaly characterised by a mirror-image transposition of intra-abdominal and intrathoracic organs. SIT renders surgical procedures more complicated, but few studies have...
Situs inversus totalis (SIT) is a rare congenital anomaly characterised by a mirror-image transposition of intra-abdominal and intrathoracic organs. SIT renders surgical procedures more complicated, but few studies have described laparoscopic surgery for hepatocellular carcinoma (HCC) in such patients, especially the resection of centralised HCC involving intrahepatic vessels. In this report, we present the case of a 55-year-old male who experienced recurring pain in the right upper abdomen. Radiological investigations unveiled intriguing inversions of thoracoabdominal organs and the presence of a centrally located liver tumour, measuring 5 cm × 7 cm × 6 cm. The patient underwent laparoscopic mesohepatectomy (LMH) treatment, leading to the successful resection of the tumour. Subsequent follow-ups showed no signs of recurrence. Our article delves into a comprehensive analysis of the surgical approach employed, alongside an exploration of the anatomical abnormalities associated with SIT. Furthermore, we review similar literature to summarise the challenges and risks of LMH and share experiences and methods aimed at reducing the difficulty of the procedure. LMH can be considered as a feasible and effective surgical alternative to centralised HCC in patients with SIT if appropriate imaging techniques and careful perioperative strategies are employed.
Congenital diaphragmatic weakness as a cause of capnothorax during laparoscopic surgery: A case report and management insights.
Li L, Zhou L
J Minim Access Surg · 2026 Apr · PMID 41945496 · Publisher ↗
Capnothorax is a rare but potentially serious complication of laparoscopic surgery, typically attributed to diaphragmatic injury or retroperitoneal CO2 tracking. We report a case of intraoperative capnothorax in a 52-yea...
Capnothorax is a rare but potentially serious complication of laparoscopic surgery, typically attributed to diaphragmatic injury or retroperitoneal CO2 tracking. We report a case of intraoperative capnothorax in a 52-year-old woman undergoing laparoscopic common bile duct exploration. Two hours after pneumoperitoneum establishment (13-14 mmHg), the patient developed acute right-sided pneumothorax, presenting as a sudden increase in peak airway pressure (28 cm H2O) with stable end-tidal CO2 (36 mmHg). Intraoperative inspection and post-operative computed tomography excluded structural diaphragmatic defects, implicating transdiaphragmatic CO2 diffusion through a congenitally weakened diaphragm. Conservative management - including reduction of pneumoperitoneum pressure to 10 mmHg, application of 5 cm H2O positive end-expiratory pressure and real-time lung ultrasound - confirmed the diagnosis (stratosphere sign and lung point) and achieved resolution within 40 min without thoracic drainage or surgical interruption. This case highlights congenital diaphragmatic weakness as an under-recognised aetiology of capnothorax and supports a physiologically guided, non-invasive approach that challenges traditional protocols favouring emergent thoracostomy.
Vesicocutaneous fistula following laparoscopic transabdominal pre-peritoneal inguinal hernia repair: An unusual complication - A case report.
Singh P, Manglik S, Mukherjee S … +2 more , Narayan P, Dubey SK
J Minim Access Surg · 2026 Apr · PMID 41945480 · Publisher ↗
Vesicocutaneous fistula (VCF) represents an extremely rare complication following laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair, with fewer than twenty cases documented worldwide. We report a 4...
Vesicocutaneous fistula (VCF) represents an extremely rare complication following laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair, with fewer than twenty cases documented worldwide. We report a 46-year-old diabetic male who developed VCF 12 months after laparoscopic TAPP repair for left inguinal pantaloon hernia. The patient presented with malodorous watery discharge during micturition from a cutaneous opening in the left inguinal region. Magnetic resonance imaging demonstrated a fistulous tract connecting the anterior bladder wall to the overlying skin. Cystoscopy confirmed mesh erosion into the bladder with an internal opening on the anterior wall. Surgical management included complete fistulectomy, mesh removal and two-layer bladder repair reinforced with omental patch. Complete fistula healing was achieved at 3 months with no recurrence of either the fistula or hernia. This case demonstrates that VCF can occur despite technically adequate TAPP repair and emphasises the need for high clinical suspicion when patients present with delayed inguinal symptoms, particularly in diabetic patients.
Beyond symptom relief: Linking anatomy, physiology and quality of life after laparoscopic Heller myotomy with Dor fundoplication.
Anand A, Shiva S, Kumar A … +5 more , Ahmad F, Kumar S, Gaurav K, Ansari N, Sonkar AA
J Minim Access Surg · 2026 Apr · PMID 41945477 · Publisher ↗
INTRODUCTION: Laparoscopic Heller myotomy (LHM), usually combined with fundoplication, is an established treatment for achalasia cardia (AC). This study evaluated the anatomical and physiological outcomes of LHM and thei...
INTRODUCTION: Laparoscopic Heller myotomy (LHM), usually combined with fundoplication, is an established treatment for achalasia cardia (AC). This study evaluated the anatomical and physiological outcomes of LHM and their association with quality of life (QoL). PATIENTS AND METHODS: This ambispective observational study included patients undergoing LHM with Dor fundoplication. The ambispective design comprised retrospective extraction of perioperative and follow-up data from institutional records and a prospectively maintained database, with patient-reported outcomes collected at follow-up visits and, when in-person review was not feasible, through telephone interviews. Anatomical changes were assessed by imaging. Physiological parameters, including lower oesophageal sphincter function and oesophageal emptying, were evaluated using high-resolution manometry and timed barium oesophagography. QoL was assessed preoperatively and postoperatively using the Eckardt score (ES) and the Achalasia-dysphagia QoL (A-DsQoL) questionnaire. RESULTS: Mean oesophageal diameter decreased from 32.57 mm to 20.76 mm, with a reduction of 11.81 mm (standard deviation [SD]: 5.78; P < 0.001). Mean integrated relaxation pressure (IRP) declined from 27.29 mmHg (SD: 6.77) to 15.05 mmHg (SD: 4.19), with a reduction of 12.24 mmHg (SD: 5.19; P < 0.001). Mean ES improved from 6.05 (SD: 1.50) to 0.86 (SD: 0.85) at 1 year (P < 0.001) and mean A-DsQoL score improved from 25.86 (SD: 2.76) to 9.43 (SD: 1.33) (P < 0.001). Changes in ES showed weak, non-significant correlations with IRP change and oesophageal diameter change. CONCLUSION: LHM with Dor fundoplication is a safe and effective treatment for AC, improving symptoms and QoL. Symptom improvement does not consistently parallel anatomical or physiological changes, highlighting the need for assessment.
A novel technique of gall bladder splitting and extraction for thick-walled gall bladder and large stones in laparoscopic cholecystectomy.
Dhaigude PR, Neema A, Kalhan SK … +1 more , Khetan M
J Minim Access Surg · 2026 Apr · PMID 41944745 · Publisher ↗
INTRODUCTION: The exact techniques for the extraction of thick-walled gall bladder and large calculus during laparoscopic cholecystectomy are not well described. This may require to dilate the port site or to enlarge the...
INTRODUCTION: The exact techniques for the extraction of thick-walled gall bladder and large calculus during laparoscopic cholecystectomy are not well described. This may require to dilate the port site or to enlarge the incision size, which has its own complications. PATIENTS AND METHODS: This is a description of a simple technique that helps in easy extraction of the thick-walled gall bladder and large stone more than 1 cm during laparoscopic cholecystectomy. These cases may require to dilate the port site or to enlarge the incision size, which can lead to increased operating time, more post-operative pain, increased port site hernia and infection risk. In this technique, gall bladder is longitudinally split along its long axis and large calculus, if present, is crushed in the endobag. This endobag with specimen can be removed easily from the 1 cm port site without need for the port site dilatation. RESULTS: We have employed 'longitudinal gall bladder splitting Technique' in around 245 cases of laparoscopic cholecystectomy operated in the past 5 years. Only three cases of port site infection and no cases of port site hernia were noted in this study. Ease of extraction by surgeons was rated as 9.6 on a scale of 1-10. CONCLUSION: 'Longitudinal gall bladder splitting Technique' is a simple and easily reproducible technique used for the extraction of thick-walled gall bladder and large calculus which reduces complications and makes it easy for the surgeon.
Efficacy of Braun anastomosis after single-anastomosis sleeve jejunal bypass in prevention of bile reflux: A retrospective study.
Ghaffari Y, Alhurry AMAH, Hosseini SV … +4 more , Moeinvaziri N, Yusefzai S, Shojaei-Zarghani S, Vafa L
J Minim Access Surg · 2026 Apr · PMID 41944740 · Publisher ↗
INTRODUCTION: Post-operative complications or outcomes of bariatric surgery may result in dissatisfaction amongst obese patients. Bile reflux is considered a prevalent morbidity after some type of bariatric surgery. The...
INTRODUCTION: Post-operative complications or outcomes of bariatric surgery may result in dissatisfaction amongst obese patients. Bile reflux is considered a prevalent morbidity after some type of bariatric surgery. The aim of this study was to evaluate the impact of Braun anastomosis on reducing bile reflux symptoms after single-anastomosis sleeve jejunal (SAS-J) bypass surgery. PATIENTS AND METHODS: Patients with severe obesity and without a pre-operative history of gastroesophageal reflux disease (GERD), who underwent SAS-J bypass surgery from 2016 to 2022 in the Ghadir Mother and Child Hospital, Shiraz, Iran, were included in our retrospective study. The GERD severity and reflux-related symptoms were compared between subjects with and without Braun anastomosis. RESULTS: A total of 85 patients with a history of SAS-J bypass surgery were included in our study. Amongst these, 39 patients underwent SAS-J with Braun anastomosis. The reduction in body mass index (BMI) and improvement of hypertension were significantly better amongst patients who underwent the Braun procedure compared to those who did not. Furthermore, subjects with Braun anastomosis reported significantly better bile reflux symptoms and higher levels of satisfaction compared to those without it. After adjusting for age, sex and post-operative BMI, the Braun procedure significantly reduced the odds of GERD severity (odds ratio = 0.037, 95% confidence interval: 0.007-0.193, P < 0.001). CONCLUSIONS: Adding the Braun anastomosis to SAS-J bypass surgery significantly reduces the severity of bile reflux, which emphasises the importance of this procedure on reducing bile reflux.
Enhancing lymph node harvest in hemicolectomies: A before-and-after study of surgical preceptorship and audit feedback.
Arora P, Tilloo R, Konda SR … +5 more , Ahmed Z, Patil SM, Sekaran A, Rebala P, Rao GV
J Minim Access Surg · 2026 Apr · PMID 41944738 · Publisher ↗
INTRODUCTION: Adequate lymph node (LN) retrieval is a key quality indicator in oncological colon surgery, with ≥12 LNs considered the benchmark for high-yield lymphadenectomy. Variability in surgical performance, particu...
INTRODUCTION: Adequate lymph node (LN) retrieval is a key quality indicator in oncological colon surgery, with ≥12 LNs considered the benchmark for high-yield lymphadenectomy. Variability in surgical performance, particularly amongst early-career surgeons, can impact oncological outcomes. This study evaluates the impact of surgical preceptorship on LN yield in radical hemicolectomies through a before-and-after cohort analysis as part of a complete audit cycle. PATIENTS AND METHODS: A retrospective audit was conducted at a tertiary care centre, analysing 99 radical hemicolectomies performed between February and November 2022. The primary objective was to assess the mean LN yield and proportion of cases achieving high-yield lymphadenectomy. Following analysis, a structured surgical preceptorship programme involving didactic sessions, hands-on training and standard operating protocols was implemented. A re-audit of 114 hemicolectomies performed between April and September 2023 was then conducted. Data were compared between pre- and post-intervention groups, including subgroup analyses for senior and junior consultants and open versus laparoscopic procedures. RESULTS: The mean LN yield significantly improved from 15.4 ± 7.8 to 17.5 ± 6.5 postintervention (P = 0.033). The proportion of high-yield cases increased from 69% to 80.7% (P = 0.06). While senior and junior consultants had similar LN yields postintervention, a statistically significant improvement was noted in the junior group alone (14.6-17.69, P = 0.014). No significant difference was observed between the open and laparoscopic groups. CONCLUSION: Surgical preceptorship led to improved LN harvest across the team, particularly in junior consultants, demonstrating its effectiveness as a team-wide quality improvement tool beyond individual learning curves or surgical approach.
Laparoscopic percutaneous extraperitoneal closure in adolescents and young adults: Potential and pitfalls from a case series.
Ishimura R, Yokoyama S, Korai T … +11 more , Muramatsu R, Fujino H, Sato K, Chiba T, Kimura T, Yonezawa H, Kimura H, Funato O, Hamada H, Mizuno M, Takagane A
J Minim Access Surg · 2026 Apr · PMID 41944732 · Publisher ↗
INTRODUCTION: Inguinal hernias can occur at any age. Different surgical procedures are selected for different ages. Generally, hernias are repaired without a mesh in children and with a mesh in adults; however, the surgi...
INTRODUCTION: Inguinal hernias can occur at any age. Different surgical procedures are selected for different ages. Generally, hernias are repaired without a mesh in children and with a mesh in adults; however, the surgical approach of choice in the adolescent and young adult (AYA) population is unclear. The aim of this study was to explore the potential extension of the indications for the meshless procedure, laparoscopic percutaneous extraperitoneal closure (LPEC), in the AYA population. PATIENTS AND METHODS: We retrospectively included individuals aged 16-39 years who underwent laparoscopic inguinal hernia repair in our department from August 2015 to May 2023. We focused on hernias classified under the new Japanese Hernia Society Classification as L1 type. Patient background characteristics and surgical outcomes were collected, and a comparative analysis was conducted between the LPEC group (L group) and the laparoscopic transabdominal preperitoneal repair group (T group). RESULTS: Laparoscopic inguinal hernia repair was performed in 38 cases (50 sides), including nine patients (12 sides) diagnosed only with L1-type hernias. The L and T groups comprised six (nine sides) and three (three sides) patients, respectively. The operative time was 28 and 67 min in the L and T groups, respectively (P = 0.10). None of the patients experienced recurrence. No significant differences were observed in post-operative pain, post-operative hospital stay or surgical site infections. The median observation period was 1868 days. CONCLUSIONS: LPEC is a viable surgical option for inguinal hernia repair in the AYA population, warranting further exploration for its broader application.
Comment on "Prospective Analysis of 246 Fires of da Vinci SureForm SmartFire Stapler in Colorectal Cancer: First Indian Study".
Shiva S, Anand A, Sonkar AA
J Minim Access Surg · 2026 Apr · PMID 41944731 · Publisher ↗
Abstract loading — click title to view on PubMed.
Feasibility and safety of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery.
Yanar F, Sengun B, Basoglu H … +2 more , Azamat IF, Yanar HT
J Minim Access Surg · 2026 Apr · PMID 41944713 · Publisher ↗
INTRODUCTION: Previous lower abdominal surgery (PLAS) has traditionally been considered a relative contraindication to totally extraperitoneal (TEP) inguinal hernia repair due to concerns about adhesions, distorted anato...
INTRODUCTION: Previous lower abdominal surgery (PLAS) has traditionally been considered a relative contraindication to totally extraperitoneal (TEP) inguinal hernia repair due to concerns about adhesions, distorted anatomy and increased risk of complications or conversion rate. PATIENTS AND METHODS: A single-centre retrospective analysis of prospectively collected data was performed on 576 consecutive patients who underwent TEP repair for primary inguinal hernia between October 2021 and June 2025. Patients were divided into PLAS and No-PLAS groups. Demographic characteristics, operative details (operative time, conversion rate and intraoperative complications) and post-operative outcomes (seroma, haematoma and recurrence) were compared. RESULTS: The PLAS cohort (n = 43) included diverse previous operations (open appendectomy: 30.2%, prostatectomy: 27.9%, varicocelectomy: 18.6%, caesarean section: 14.0% and other surgeries: 9.3%). The groups were comparable in age, body mass index, smoking status, operative time (median 50 vs. 45 min, P = 0.95) and follow-up duration (37 vs. 35, P = 0.63). Patients with PLAS were less frequently male (81.4% vs. 95.8%, P = 0.03). Conversion rate was significantly higher in the PLAS group (7.0% vs. 0.8%, P < 0.01), as was post-operative haematoma (2.3% vs. 0%, P < 0.01). No significant differences were observed in seroma, drain usage or recurrence rates. CONCLUSION: TEP inguinal hernia repair is safe and feasible in patients with a history of varied lower abdominal surgery, offering short- and long-term outcomes comparable to those without prior surgery. Although the risk of conversion and minor haematoma is modestly higher (likely due to adhesion-related dissection challenges), these do not significantly affect overall results. Therefore, TEP should be reconsidered in patients with a history of PLAS in experienced hands.
A magnetically assisted titanium clip for colorectal lesion localisation: An ex vivo pre-clinical technical note.
Yang Y, Zhang S, Xie D … +4 more , Lu G, Tang X, Huang W, Zheng F
J Minim Access Surg · 2026 Apr · PMID 41944688 · Publisher ↗
OBJECTIVE: The objective of this study was to develop and evaluate a novel magnetic localisation clip for real-time magnetic detection of colorectal lesions in an ex vivo pre-clinical model. METHODS: A magnetic localisat...
OBJECTIVE: The objective of this study was to develop and evaluate a novel magnetic localisation clip for real-time magnetic detection of colorectal lesions in an ex vivo pre-clinical model. METHODS: A magnetic localisation clip incorporating a miniaturised neodymiumtings study magnet within a medical grade titanium structure was designed and optimised for mechanical stability, biocompatibility and consistent magnetic polarity. Ex vivo and benchtop experiments were performed to assess magnetic responsiveness, detection accuracy and mechanical performance. Clip stability was further evaluated under simulated peristaltic motion and following multiple sterilisation cycles. RESULTS: The magnetic localisation clip exhibited stable attachment and a reliable magnetic response, allowing accurate localisation through up to 3-5 cm of soft tissue in the ex vivo model. The mean localisation time was below 55 s. No slippage or surface corrosion was observed after repeated mechanical stress or sterilisation. Compared with conventional dye injection and radiologic marking, the magnetic method provided rapid, radiation-free and repeatable localisation of target lesions. CONCLUSIONS: The proposed clip demonstrated precise and stable localisation performance ex vivo, indicating potential for future intraoperative application pending in vivo validation.
Safety and feasibility of laparoscopic colorectal cancer surgery in the geriatric age group: A single-centre outcome.
Puntambekar SP, Puntambekar AS, Panse M … +4 more , Chitale M, Manerikar K, Inampudi S, Saoji K
J Minim Access Surg · 2026 Apr · PMID 41944679 · Publisher ↗
BACKGROUND: The increasing prevalence of colorectal cancer among the elderly necessitates exploring surgical options that minimise trauma and expedite recovery. Laparoscopic colorectal surgery has emerged as a promising...
BACKGROUND: The increasing prevalence of colorectal cancer among the elderly necessitates exploring surgical options that minimise trauma and expedite recovery. Laparoscopic colorectal surgery has emerged as a promising approach, yet its safety and efficacy in patients aged 65 and above require further investigation. This study aims to evaluate the perioperative outcomes, oncologic adequacy and post-operative recovery associated with laparoscopic colorectal cancer surgery in patients aged 65 years and older. PATIENTS AND METHODS: A retrospective analysis was conducted on elderly patients who underwent laparoscopic colorectal resection between January 2019 and January 2024 at a tertiary centre in India. Data on operative time, blood loss, complication rates, length of hospital stay and overall survival were collected and analysed. RESULTS: A total of 150 patients were included, with 23 undergoing surgery for right colon cancers and 127 for left colon or rectal cancers. The overall survival rate was 96% (95% confidence interval [CI]: 91.5%-98.5%). Laparoscopic surgery was associated with reduced post-operative pain, shorter hospitalisation and quicker return to baseline function. Notably, the minimally invasive approach resulted in lower complication rates and better tolerance of perioperative stress when patients were appropriately selected. CONCLUSION: Laparoscopic colorectal cancer surgery is a safe and effective option for selected elderly patients. With careful pre-operative assessment and optimisation, minimally invasive techniques can offer improved surgical outcomes and enhanced quality of life in the geriatric population. Further prospective studies are warranted to establish standardised guidelines for patient selection and perioperative care in this growing demographic.
Laparoscopic-guided microwave ablation for exophytic hepatic haemangioma: A case series.
Ni YJ, Wu MH, Ye JS
J Minim Access Surg · 2026 Apr · PMID 41944677 · Publisher ↗
BACKGROUND: Hepatic haemangioma (HH) is a common benign liver tumour and a potential risk factor for hepatic rupture and haemorrhage. There is currently no consensus on the optimal treatment approach. This study aims to...
BACKGROUND: Hepatic haemangioma (HH) is a common benign liver tumour and a potential risk factor for hepatic rupture and haemorrhage. There is currently no consensus on the optimal treatment approach. This study aims to evaluate the feasibility and safety of laparoscopic-guided microwave ablation (LMA) for exophytic HH. MATERIALS AND METHODS: A retrospective analysis was conducted on four patients admitted to our hospital from November 2023 to June 2024. The average age was 51 years (range: 39-61 years), and all patients were diagnosed with exophytic HH, with an average maximum diameter of 3.1 cm (range: 2.5-4.0 cm). RESULTS: Complete necrosis and shrinkage of the haemangiomas were achieved in all cases. The average operative time was 22.5 min, with blood loss ranging from 5 to 15 mL. No complications were observed, and the average hospital stay was 2-3 days. CONCLUSION: Based on our observations, LMA for exophytic HH is a safe and effective technique.
Skin stapler versus subcuticular suture for port-site skin closure in patients undergoing laparoscopic sleeve gastrectomy - A registry-based retrospective study over 4 years.
Ezzi MY
J Minim Access Surg · 2026 Apr · PMID 41944665 · Publisher ↗
INTRODUCTION: Port-site closure during laparoscopic sleeve gastrectomy (LSG) presents unique challenges owing to obesity, which can complicate wound healing and elevate the risk of wound-related complications. The aim of...
INTRODUCTION: Port-site closure during laparoscopic sleeve gastrectomy (LSG) presents unique challenges owing to obesity, which can complicate wound healing and elevate the risk of wound-related complications. The aim of this study is to compare skin closure outcomes, utilising subcuticular sutures versus staples in morbidly obese patients undergoing LSG. PATIENTS AND METHODS: This was a retrospective research performed on 1655 cases retrieved from Al-Emies Bariatric Center registry database, recording all cases having LSG between 1 January 2021 and 31 December 2024. Patients were divided based on the skin closure technique into stapler group (n = 1034) and suture group (n = 621). The primary endpoint was the rate of superficial surgical site infection (SSI) within 30 days postoperatively. RESULTS: The skin suture group demonstrated a significant increase in both skin closure time (seconds) and time to healing (days) compared to the skin stapler group. Superficial SSI was significantly more encountered in the skin suture group, compared to the stapler group (3.54 vs. 0.77%, P < 0.001). Patients in the stapler group had 79% lower odds of superficial infection, contrasted with odds in the suture group (odds ratio [OR] =0.21; 95% confidence interval [CI] [0.09-0.48]). No significant difference was reported amongst the groups, considering deep infection or wound dehiscence. CONCLUSION: Skin closure by staples is advantageous over sutures in morbidly obese cases undergoing LSG, being associated with shorter surgery duration, shorter time to healing and lower odds of wound infection, seroma and haematoma. There were no significant long-term differences in the scar cosmetic quality.
Clinical and patient-centred outcomes following one-anastomosis gastric bypass: A comprehensive evaluation of weight loss, patient satisfaction, quality of life and recommendation rates.
Veetil SK, Jolly HS, Sharma B … +2 more , Dhingra A, Jain A
J Minim Access Surg · 2026 Mar · PMID 41885284 · Publisher ↗
INTRODUCTION: Mini-gastric bypass/one-anastomosis gastric bypass (MGB-OAGB) represents a technical adaptation in bariatric surgery with proven efficacy in weight reduction. However, longitudinal data on weight loss traje...
INTRODUCTION: Mini-gastric bypass/one-anastomosis gastric bypass (MGB-OAGB) represents a technical adaptation in bariatric surgery with proven efficacy in weight reduction. However, longitudinal data on weight loss trajectories, patient satisfaction, quality of life (QoL) improvements and willingness to recommend are limited. PATIENTS AND METHODS: We retrospectively analysed 88 adult patients who underwent primary laparoscopic MGB-OAGB from January 2022 to December 2023. Early complications (Clavien-Dindo Grade II or higher) were recorded. At an average follow-up of 9.2 ± 1.8 months, patient-reported outcomes (PROs) were assessed via telephone survey, including reflux symptoms, dietary adherence, satisfaction (Likert scale; ≥4 considered satisfied), QoL change and willingness to recommend. Weight loss was evaluated as excess weight loss percentage (EWL%) and total weight loss percentage (TWL%). Multivariable logistic regression identified predictors of poor patient experience. RESULTS: Baseline body mass index (BMI) averaged 44.7 ± 6.1 kg/m2. The early complication rate was 11.4%. Among 69 respondents, 84.1% reported satisfaction, 88.4% QoL improvement and 81.2% would recommend MGB-OAGB. At 6-12 months, BMI decreased to 30.1 ± 4.9 kg/m2; TWL% was 32.4 ± 7.2 and EWL% was 78.3 ± 13.6. Early complications (odds ratio [OR] 3.2; 95% confidence interval [CI] 1.1-9.4; P = 0.03) and baseline BMI ≥45 kg/m2 (OR 2.8; 95% CI 1.0-7.6; P = 0.04) predicted a poor PRO. CONCLUSIONS: MGB-OAGB provides substantial weight loss, high satisfaction, significant QoL gains and strong patient endorsement at 1 year. Minimising complications and optimising care for patients with elevated BMI may further improve outcomes.
Faster, safer and easier: A randomised study on the outcomes of polymeric clips for appendicular stump management.
Arora T, Jain A, Bansal LK … +5 more , Nain S, Ansari MAM, Gupta SV, Kapur N, Naik BIS
J Minim Access Surg · 2026 Mar · PMID 41860112 · Publisher ↗
INTRODUCTION: Secure closure of the appendiceal stump is critical in laparoscopic appendectomy to prevent post-operative complications. Traditional methods such as Endoloop ligatures are effective but technically demandi...
INTRODUCTION: Secure closure of the appendiceal stump is critical in laparoscopic appendectomy to prevent post-operative complications. Traditional methods such as Endoloop ligatures are effective but technically demanding, while self-locking polymeric clips may offer a simpler alternative. OBJECTIVE: To compare intra-operative time, ease of application and safety between self-locking polymeric clips and Endoloop ligatures for appendiceal stump closure. PATIENTS AND METHODS: A prospective randomised controlled trial was conducted on 50 adult patients undergoing elective laparoscopic appendectomy. (CTRI-2023/12/060687; retrospectively registered) Patients were randomised into two groups: stump closure with Endoloop ligatures (n = 25) or self-locking clips (n = 25). Primary outcomes were intra-operative time and ease of application, measured using the Single Ease Question (SEQ) score. Secondary outcomes included post-operative complications and hospital stay. RESULTS: The clip group demonstrated significantly shorter operative times (mean difference: -9.04 min; 95% confidence interval: -16.76 to -1.32; P = 0.023) and higher SEQ scores (6.1 ± 0.9 vs. 4.6 ± 0.9; P < 0.0001) compared to the Endoloop group. Post-operative complications and hospital stay showed no significant differences between groups. Correlation analysis revealed a moderate negative relationship between operative time and ease of surgery. CONCLUSION: Self-locking polymeric clips provide a faster, easier and equally safe method for appendiceal stump closure compared to Endoloop ligatures. Their efficiency and simplicity make them particularly suitable for high-volume and resource-limited surgical settings.
Optimising pneumoperitoneum pressure to minimise post-operative shoulder tip pain: A randomised controlled trial of 10 versus 14 mmHg CO2 in laparoscopic cholecystectomy.
Viknesh KRP, Kumar SIS, Shantharam RV … +3 more , Rahuman ASAA, Ramadas AN, Loganathan P
J Minim Access Surg · 2026 Mar · PMID 41860108 · Publisher ↗
BACKGROUND: Post-operative shoulder tip pain (STP) is an established side effect of laparoscopic cholecystectomy, primarily attributed to diaphragmatic irritation from residual carbon dioxide (CO2) insufflation during su...
BACKGROUND: Post-operative shoulder tip pain (STP) is an established side effect of laparoscopic cholecystectomy, primarily attributed to diaphragmatic irritation from residual carbon dioxide (CO2) insufflation during surgery. The purpose of this trial was to evaluate the severity of STP and the day of discharge after surgery between patients undergoing laparoscopic cholecystectomy who had low-pressure (10 mmHg, CO2) and standard-pressure (14 mmHg, CO2) pneumoperitoneum. PATIENTS AND METHODS: In this single-centre, double-blind, randomised controlled experiment, 100 patients scheduled for laparoscopic cholecystectomy were randomly allocated to one of two groups of 50 patients each, receiving either standard-pressure or low-pressure pneumoperitoneum. The primary outcomes included post-operative STP scores measured using a validated 10-point numerical rating scale at 3, 6, 12, 24, 48 and 72 h postoperatively. The secondary outcome was duration of hospitalisation. P < 0.05 was considered statistically significant. RESULTS: Study participants comprised 69% of females with a mean age of 44.2 ± 12.8 years. Despite observed demographic variations, there were no statistically significant differences in baseline characteristics between the groups (P > 0.05 for all comparisons). The standard-pressure group had significantly higher mean pain scores than the low-pressure group at 3 h (2.3 ± 2.4 vs. 0.9 ± 1.3), 6 h (1.5 ± 1.8 vs. 0.5 ± 0.9), 12 h (1.0 ± 1.4 vs. 0.4 ± 0.8) and 24 h (0.4 ± 0.8 vs. 0.1 ± 0.5) after surgery, with P = 0.006, 0.007, 0.018 and 0.049, respectively. From the 2nd day onwards, pain scores became minimal and showed no significant difference between the groups (P = 0.662). The mean hospital stay was 2.04 ± 0.198 days versus 2.00 ± 0.000 days (P = 0.159), with no clinically meaningful difference. CONCLUSION: This study provides Level 1 evidence that low-pressure pneumoperitoneum during laparoscopic cholecystectomy significantly reduces STP for the first 24 h postoperatively, though this effect does not persist beyond 48 h. Hospital length of stay remained equivalent between the groups, suggesting that early pain reduction alone does not translate to accelerated discharge. This suggests the need for larger, multicentre trials to validate these findings and assess the effect of low-pressure pneumoperitoneum on additional patient-reported outcomes and healthcare economics.
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