Journal Of Minimal Access Surgery[JOURNAL]
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200 papers
Modified abdominal access for the obese population requiring laparoscopic cholecystectomy: Our recommendation.
Shrestha A, Pangeni A, Regmi P … +3 more , Fernandes R, Shrestha AK, Basu S
J Minim Access Surg · 2025 Dec · PMID 41351224 · Publisher ↗
INTRODUCTION: Conventional umbilical access can be time-consuming, surgically challenging due to inadequate 'Critical View of Safety' and pneumoperitoneum maintenance for high body mass index (BMI) patients undergoing la...
INTRODUCTION: Conventional umbilical access can be time-consuming, surgically challenging due to inadequate 'Critical View of Safety' and pneumoperitoneum maintenance for high body mass index (BMI) patients undergoing laparoscopic cholecystectomy (LC). The aim of the study is to assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30. PATIENTS AND METHODS: A prospective study of 1762 consecutive patients undergoing LC in a large district general hospital (2007-2023) that included age, sex, BMI, American Society of Anesthesiologists (ASA), grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer's point. After 2 L (minimum) insufflations, an optical port was introduced at the intersection of two imaginary lines: A 15-cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3 cm to the right of midline. Remaining 3 ports at standard positions (10 mm epigastric port [I] at or just right of midline below the xiphoid process, 5 mm port [II] at the midclavicular line below the costal cartilage and another 5 mm port [III] between 5 cm and 10 cm lateral to port II) as used in LC. Group B (BMI <30): Conventional umbilicus entry followed by 3 standard remaining ports for LC (as above). RESULTS: Group A: 549 with female: male 4:1, the median of age 49 (16-83) years, BMI 36 (30-65), ASA 2 (1-3), Grade 1 (1-4), operating time 50 (15-200) min and post-operative (PO) stay 0 (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections. Group B: 1213 with female: male 3:1, the median of age 53 (16-89) years, BMI 26 (17-29), ASA 2 (1-3), Grade 1 (1-4), operating time 45 (15-240) min and PO stay 0 (0-12) day. CONCLUSION: Our modified abdominal access is quick and safe that maintains sustained pneumoperitoneum and provides an excellent 'Critical view of Safety' for obese patients undergoing LC with a good outcome.
Post-bariatric surgery nutritional supplementation: An evaluation of compliance and nutrient adequacy in the Indian patients.
Singh A, Kapoor D, Vats R … +1 more , Goel D
J Minim Access Surg · 2025 Dec · PMID 41351220 · Publisher ↗
INTRODUCTION: Bariatric surgery (BS) is the most effective treatment for morbid obesity. Despite a high number of BS performed in India, there is limited research on post-operative nutritional follow-up. The study aimed...
INTRODUCTION: Bariatric surgery (BS) is the most effective treatment for morbid obesity. Despite a high number of BS performed in India, there is limited research on post-operative nutritional follow-up. The study aimed to assess patient compliance and adequacy of nutritional supplementation protocols in the post-operative period. PATIENTS AND METHODS: This prospective, single-centre observational study (August 2022-July 2023) assessed post-operative nutritional status in the Indian patients undergoing BS. Baseline and follow-up nutritional assessments (serum albumin, ferritin, B12, calcium and D3) were performed, and patients were given a supplementation regimen based on the American Society for Metabolic and BS guidelines. Compliance with prescribed supplementation was monitored. Patients were considered compliant if they took ≥80% of the prescribed doses. RESULTS: The study involved 32 patients, with 65.6% (21) undergoing sleeve gastrectomy and 34.4% (11) undergoing Roux-en-Y gastric bypass. Over 6 months, the mean body mass index decreased from 47 to 36.1 kg/m2. Compliance rates for supplementation varied, with high rates for iron (96.9%) but lower rates for protein (28.1%) and Vitamin B12 (43.7%). However, compliance with supplements did not statistically affect deficiencies for most nutrients, except for Vitamin B12. After 6 months post-surgery, Vitamin B12 deficiency was significantly higher in non-compliant patients than in compliant ones (50% vs. 0%, P = 0.001). CONCLUSION: This study suggests that the prescribed supplements are adequate in maintaining nutrient levels post-surgery. Compliance is particularly important in preventing Vitamin B12 deficiency, as non-compliant patients tend to show persistent deficiency. The level of other nutrients improved regardless of compliance.
An unusual cause for Melena: The role of endoscopic mucosal resection in a rare case of the duodenal Brunner's gland hamartoma.
Easwaramoorthy S
J Minim Access Surg · 2025 Dec · PMID 41351209 · Publisher ↗
Brunner's gland hyperplasia (also referred to as adenoma or hamartoma) is a rare, benign proliferative lesion of the duodenum. Although often asymptomatic, it can occasionally present with gastrointestinal (GI) bleeding,...
Brunner's gland hyperplasia (also referred to as adenoma or hamartoma) is a rare, benign proliferative lesion of the duodenum. Although often asymptomatic, it can occasionally present with gastrointestinal (GI) bleeding, anaemia or obstructive symptoms. We report a case of a 65-year-old woman who presented with melena and symptomatic anaemia. Upper GI (UGI) endoscopy revealed multiple sessile polyps in the duodenum, with the largest measuring 2 cm. Given her history of a recent myocardial infarction and ongoing antiplatelet therapy, an endoscopic approach was chosen. Endoscopic mucosal resection (EMR) was successfully performed after temporarily withholding antiplatelets. Histopathology confirmed Brunner's gland hamartoma with no dysplasia or malignancy. The patient's haemoglobin levels improved, and follow-up endoscopy at 1 and 6 months showed no recurrence. Brunner's gland hyperplasia is a rare but important differential for upper GI bleeding. EMR or endoscopic snare polypectomy is a safe and effective treatment modality, particularly in high-risk surgical candidates.
Traumatic diaphragmatic hernia presenting as gastric outlet obstruction: A delayed presentation.
Dave KH, Suthar KR, Vaghela SJ … +7 more , Dalal AD, Saraf NA, Viajkhora MA, Patel CN, Patel KA, Khatri DH, Damor SN
J Minim Access Surg · 2025 Dec · PMID 41351201 · Publisher ↗
Traumatic diaphragmatic hernia (TDH) is a rare acquired condition usually occurring due to blunt thoracoabdominal trauma, most commonly in road traffic accidents (RTAs). It may also occur due to penetrating trauma. Diagn...
Traumatic diaphragmatic hernia (TDH) is a rare acquired condition usually occurring due to blunt thoracoabdominal trauma, most commonly in road traffic accidents (RTAs). It may also occur due to penetrating trauma. Diagnosis may be delayed due to the masking effect of other severe injuries in a patient with polytrauma. Here, we present the case of a 23-year-old male patient having a history of thoracoabdominal injury due to RTA before 3 months, presenting with severe vomiting, respiratory discomfort and weight loss. He was treated at other places symptomatically for gastritis and flatulence. He was diagnosed with gastric outlet obstruction due to left-sided TDH. He was successfully treated with laparoscopic repair and mesh placement. He needed thoracotomy for left lung decortication in post-operative period owing to persistent pleural effusion and lung collapse. He recovered well and remains asymptomatic on follow-up. Upon asking detailed history, he remembered that he had trauma following being struck by a vehicle. We aim to present this case to highlight the importance of detailed history taking for arriving at a timely diagnosis.
A comparative study of efficacy of laparoscopic transabdominal pre-peritoneal-plus versus intraperitoneal onlay mesh-plus repair for small umbilical hernias.
Kenawadekar R, Yadav GND, Nayak RM
J Minim Access Surg · 2025 Dec · PMID 41351185 · Publisher ↗
INTRODUCTION: Umbilical hernias are a frequent subset of ventral hernias. Although laparoscopic intraperitoneal onlay mesh with defect closure (IPOM-plus) repair is widely used, concerns remain about mesh contact with vi...
INTRODUCTION: Umbilical hernias are a frequent subset of ventral hernias. Although laparoscopic intraperitoneal onlay mesh with defect closure (IPOM-plus) repair is widely used, concerns remain about mesh contact with viscera and associated pain. The transabdominal pre-peritoneal with defect closure for umbilical hernias (TAPPu-plus, where 'u' denotes umbilical) approach attempts to mitigate such complications by placing the mesh in a pre-peritoneal pocket. This study compares the feasibility, operative time, post-operative pain, hospital stay and recurrence rates between TAPPu-plus and IPOM-plus techniques for small-sized (≤4 cm) umbilical hernias. PATIENTS AND METHODS: A prospective, single-centre randomised controlled trial was conducted on 50 symptomatic patients with primary umbilical hernias measuring ≤4 cm. Patients were randomised in a 1:1 ratio into Group A (TAPPu-plus, n = 25) or Group B (IPOM-plus, n = 25) using block randomisation with sealed opaque envelopes. Mesh repair was performed in all patients. The primary outcome was procedural feasibility. Secondary outcomes included operative time, estimated blood loss, post-operative pain visual analogue scale, analgesic use, hospital stay and 1-year recurrence. RESULTS: All procedures were completed laparoscopically. Two patients in the TAPPu-plus group were converted to IPOM-plus due to restricted dissection space, resulting in 23 patients in Group A and 27 in Group B for final analysis. TAPPu-plus was associated with a longer operative time (117.3 ± 14.9 min vs. 80.5 ± 19.7 min), but significantly lower post-operative pain scores throughout follow-up. Estimated intraoperative blood loss was lower in the TAPPu-plus group (mean 1.68 vs. 2.55 soaked gauze pieces [6 cm × 6 cm]; P < 0.01). The mean hospital stay was also shorter in the TAPPu-plus group (5.4 vs. 6.9 days, P < 0.01). No recurrences were observed in either group at 1-year follow-up. CONCLUSION: Both techniques were safe and effective for laparoscopic repair of small umbilical hernias. TAPPu-plus, although more technically demanding, demonstrated superior outcomes in post-operative pain control and recovery. It represents a promising alternative to IPOM-plus in appropriately selected patients when performed by experienced surgeons.
Case report of an inverted appendicitis mimicking colon cancer.
Gagliardi BM, Arru GG, Angelicchio LF … +1 more , Schumacher G
J Minim Access Surg · 2025 Dec · PMID 41351165 · Publisher ↗
Inverted appendicitis is a rare surgical event, which mostly leads to the wrong pre-operative diagnosis. Nevertheless, the therapy is usually correct. In case of clinical acute appendicitis, we usually proceed to surgery...
Inverted appendicitis is a rare surgical event, which mostly leads to the wrong pre-operative diagnosis. Nevertheless, the therapy is usually correct. In case of clinical acute appendicitis, we usually proceed to surgery without further examinations. We report about a 65-year-old woman who presented with abdominal pain for 4 days and typical pain at the McBurney's point. Blood examination showed only a slight elevation of the C-reactive protein with 4.62 mg/dl. The ultrasound strengthened the suspicion of acute appendicitis. Laparoscopy was performed, and a severe purulent pericaecal infection was detected, but the appendix was absent. However, the caecum had typical palpatory aspects of cancer. Consequently, we converted to laparotomy and performed a radical right hemicolectomy. The pathology report revealed the inverted appendicitis without any signs of malignancy. It remains difficult to make the correct pre-operative diagnosis. The type of treatment has to be chosen individually.
Diagnostic dilemma in gastroduodenal lesions: Heterotopic pancreas mimicking gastrointestinal stromal tumours managed by minimally invasive approach - A case series and review of the literature.
Raghavendra D, Jebakumar SGS, Muthiah J … +4 more , Chinappa G, Tasgaonkar SS, Munikrishnan V, Swain SK
J Minim Access Surg · 2026 Jan · PMID 41351162 · Full text
BACKGROUND: Heterotopic pancreas (HP) is a rare congenital anomaly, characterised by ectopic pancreatic tissue lacking anatomical and vascular continuity with the main pancreas. Its clinical and radiological presentation...
BACKGROUND: Heterotopic pancreas (HP) is a rare congenital anomaly, characterised by ectopic pancreatic tissue lacking anatomical and vascular continuity with the main pancreas. Its clinical and radiological presentation often mimics gastrointestinal stromal tumours (GIST), making pre-operative diagnosis challenging. They are usually asymptomatic but can rarely present with symptoms like GI bleed. METHODS: This retrospective study analysed the four cases of HP in the gastroduodenal region, diagnosed over the past 4 years. All patients underwent minimally invasive surgical excision based on pre-operative suspicion of GIST. Clinical presentation, imaging findings, surgical approach and histopathological results were reviewed. RESULTS: The study included four male patients aged 18-62 years. The symptoms ranged from post-prandial abdominal pain and discomfort to asymptomatic incidental findings and haemoptysis. Contrast-enhanced computed tomography (CECT) revealed nodular lesions (1.6-2.7 cm) with exophytic or endophytic growth patterns, raising the suspicion for GIST. Robotic-assisted excision was performed in three cases and laparoscopic excision in one. Histopathological examination confirmed HP in all cases, classified as Heinrich type 1 or 2, with one case showing an additional adenomyoma. CONCLUSION: HP should be considered in submucosal or intramural GI lesions, especially when mimicking GISTs or showing umbilication on endoscopy. Surgical resection is recommended for the symptomatic cases or diagnostic uncertainty, with minimally invasive approaches preferred. Our series highlights the first robotic excision of duodenal HP in the literature.
Incidental simultaneous caecal adenocarcinoma with appendix lymphoma in chronic lymphocytic leukaemia.
Singla L, Kalaiselvan R
J Minim Access Surg · 2025 Nov · PMID 41277481 · Publisher ↗
Simultaneous occurrence of colonic adenocarcinoma and appendiceal lymphoma in a patient with chronic lymphocytic leukaemia (CLL) is exceedingly rare. This unique coexistence presents diagnostic and therapeutic challenges...
Simultaneous occurrence of colonic adenocarcinoma and appendiceal lymphoma in a patient with chronic lymphocytic leukaemia (CLL) is exceedingly rare. This unique coexistence presents diagnostic and therapeutic challenges, particularly in elderly patients with comorbidities. We report an unusual case of caecal adenocarcinoma and diffuse large B-cell lymphoma (DLBCL) of the appendix in a patient with known CLL. An 87-year-old male with a known diagnosis of CLL presented with a suspected caecal mass on imaging. Colonoscopy revealed a polypoidal caecal lesion, and biopsy confirmed adenocarcinoma. He underwent laparoscopic right hemicolectomy. Histopathology revealed moderately differentiated adenocarcinoma (pT3N0M0) and synchronous DLBCL in the appendix and mesenteric nodes, consistent with Richter's transformation. The patient was restarted on ibrutinib postoperatively. At 1.5 years, he developed an anastomotic recurrence managed with laparoscopic re-resection. He remains disease-free 3 years post-index surgery under multidisciplinary follow-up. This case highlights the importance of considering dual pathology in CLL patients presenting with gastrointestinal symptoms. Curative surgical resection, combined with targeted haematological therapy and regular surveillance, can result in favourable outcomes even in elderly patients with complex malignancies.
Laparoscopic transabdominal retromuscular ventral hernia repair (L-TARUP): Outcomes from a single institution with mid-term follow-up.
Sanna A, Bagolini F, Mantovan B … +4 more , Buzzi G, Destro C, Targa S, De Luca M
J Minim Access Surg · 2025 Nov · PMID 41277476 · Publisher ↗
INTRODUCTION: The use of extraperitoneal mesh over intraperitoneal mesh is gaining popularity in minimally invasive ventral hernia repair. We adopted a laparoscopic lateral approach with retromuscular mesh placement by o...
INTRODUCTION: The use of extraperitoneal mesh over intraperitoneal mesh is gaining popularity in minimally invasive ventral hernia repair. We adopted a laparoscopic lateral approach with retromuscular mesh placement by opening the posterior rectus fascia on the ipsilateral side of trocar insertion. This study aims to evaluate operative times and early outcomes of this laparoscopic alternative to a conventionally robotic procedure for ventral hernia repair. PATIENTS AND METHODS: This single-centre retrospective study included 23 patients treated between 2022 and 2025. Data were reviewed from a retrospectively maintained database of patients undergoing laparoscopic transabdominal retromuscular umbilical prosthetic hernia repair (L-TARUP). RESULTS: Both operative time and hospital stay were reduced compared to the conventional approach. No intraoperative or major post-operative complications were observed. Two cases of seroma were identified during the first 4 weeks of follow-up. No hernia recurrences or wound infections were reported. CONCLUSION: Our preliminary results suggest that laparoscopic transabdominal prosthetic retromuscular ventral hernia repair (L-TARUP) is a safe and effective technique, with favourable operative times for ventral hernia management.
Enhanced laparoscopic transabdominal preperitoneal plus technique with dual defect closure for spigelian hernia: A novel modification and technical insight.
Motiwala MA, Singh D, Grover N … +2 more , Ranjan P, Chumber S
J Minim Access Surg · 2025 Nov · PMID 41277473 · Publisher ↗
Spigelian hernia (SH) is a rare lateral abdominal wall defect that poses diagnostic and technical challenges, especially in large cases. Conventional laparoscopic approaches, such as intra peritoneal onlay meshplasty, to...
Spigelian hernia (SH) is a rare lateral abdominal wall defect that poses diagnostic and technical challenges, especially in large cases. Conventional laparoscopic approaches, such as intra peritoneal onlay meshplasty, total extra peritoneal and standard transabdominal preperitoneal (TAPP), may fall short in achieving ideal closure and mesh placement. We report two female patients presented with left flank swelling and intermittent pain. Imaging confirmed SHs measuring 4-5 cm. Both patients underwent laparoscopic repair using a modified TAPP plus technique. This approach combines transfascial sutures with intracorporeal reinforcement, enabling tension-free closure and optimal mesh fixation while preserving neurovascular structures. Both patients recovered uneventfully, were discharged on post-operative day 1, reported minimal pain and returned to normal activities within 10 days. At 8-month follow-up, no complications or recurrences were observed. The modified TAPP plus technique represents a novel and feasible technique for SH repair, ensuring tension-free closure, secure mesh fixation and early recovery.
Slipped hip acetabular cortical screw: Laparoscopy to the rescue.
Paswan N, Bains L, Khan SA … +2 more , Vindal A, Maini L
J Minim Access Surg · 2025 Nov · PMID 41277354 · Publisher ↗
Displacement of screw following acetabular fracture is rare and causes significant complications resulting in pain, functional impairment, neurovascular compromise, infection and intrapelvic migration requiring additiona...
Displacement of screw following acetabular fracture is rare and causes significant complications resulting in pain, functional impairment, neurovascular compromise, infection and intrapelvic migration requiring additional surgical intervention. This case describes the successful laparoscopic retrieval of a displaced 40 mm × 4.5 mm cortical screw from the psoas muscle who underwent open reduction and internal fixation for a complex acetabular fracture. A 54-year-old male patient was referred from the orthopaedic department with persistent left lower abdominal pain radiating to the lower limb after open reduction and internal fixation. Computed tomography revealed screw migration into retroperitoneum abutting external iliac artery (EIA). Laparoscopy confirmed the screw's retroperitoneal position and was abutting EIA posterior to it, embedded in psoas muscle and was removed through 10 mm port without any visceral or vascular injury. The patient had uneventful recovery. Intrapelvic migration of screw after hip screw fixation has been reported at 4.8%, rising to 6.2%. It poses dangerous complications if vascular structures are involved like in our case as abutting EIA. Open surgical approaches were used for screw retrieval. Few cases have been reported where diagnostic laparoscopy was used, and successful laparoscopic removal of a migrated screw was performed from pelvis. This case highlights the efficacy of laparoscopy over open approaches for retrieving displaced screw in anatomically challenging locations. Laparoscopy can be considered in cases of implant migration for safe and effective retrieval while avoiding the risks of extensive dissection. With expertise and adequate equipment, it reduces operative morbidity, shorter recovery and provides better visualisation of retroperitoneal structures.
Effectiveness of multimodal analgesic regimen versus standard care during laparoscopic cholecystectomy: A randomised controlled trial.
Badkur M, Patel S, Choudhary IS … +8 more , Karthik N, Raj S, Goel AD, Paliwal B, Shukla KK, Lodha M, Meena SP, Singh RS
J Minim Access Surg · 2025 Nov · PMID 41277345 · Publisher ↗
INTRODUCTION: Laparoscopic cholecystectomy is associated with significant post-operative pain, often hindering same-day discharge. Multimodal analgesia (MMA) combining non-opioid agents is advocated to address this chall...
INTRODUCTION: Laparoscopic cholecystectomy is associated with significant post-operative pain, often hindering same-day discharge. Multimodal analgesia (MMA) combining non-opioid agents is advocated to address this challenge, yet standardised protocols remain elusive. This trial evaluates the efficacy of a structured MMA regimen versus standard care (SOC) in reducing pain, opioid use and surgical stress. PATIENTS AND METHODS: This randomised controlled trial enrolled 121 patients undergoing laparoscopic cholecystectomy, assigning 60 to standard care and 61 to MMA. The MMA group received intraoperative 0.5% ropivacaine at incision sites, gall bladder fossa and subdiaphragmatic region. The primary outcome was 24-h post-operative pain intensity, measured using the Visual Analogue Scale (VAS). The secondary outcomes included rescue analgesia requirements, inflammatory markers such as C-reactive protein (CRP), cortisol, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). Intention-to-treat and per-protocol analyses were conducted using the Mann-Whitney U -test, the Chi-square test and linear mixed-effects models. RESULTS: MMA significantly reduced median VAS scores by 40% at 3 h (5 [Interquartile range: 4-8] vs. 9 [8-10], P < 0.001, effect size r = 0.61) and 20% at 24 h (3 [1-4] vs. 5 [4-6], P < 0.001, r = 0.49). Rescue analgesia use was 63% lower in the MMA group (67.2% vs. 85%, odds ratio = 0.37, P = 0.02). Inflammatory markers - CRP and cortisol were significantly reduced in the MMA group, while IL-6 and TNF-α showed no differences at the 24 h post-operative period. CONCLUSION: The MMA regimen effectively reduces post-operative pain, opioid reliance and surgical stress in laparoscopic cholecystectomy, aligning with enhanced recovery protocols. The attenuation of CRP and cortisol highlights MMA's anti-inflammatory benefits.
Impact of lower oesophageal sphincter pressure on surgical outcomes in achalasia cardia: A comparative study.
Anand U, Saha B, Parasar K … +4 more , Singh BN, Kant K, Kumar R, Kodali R
J Minim Access Surg · 2025 Nov · PMID 41277323 · Publisher ↗
INTRODUCTION: Laparoscopic Heller myotomy (LHM) is the preferred treatment approach to reducing lower oesophageal sphincter pressure (LOSP). However, less than half of the patients show high LOSP. This study primarily ai...
INTRODUCTION: Laparoscopic Heller myotomy (LHM) is the preferred treatment approach to reducing lower oesophageal sphincter pressure (LOSP). However, less than half of the patients show high LOSP. This study primarily aims to evaluate how LOSP affects operative results. PATIENTS AND METHODS: From 2019 to 2023, a total of 52 patients were treated with LHM combined with partial fundoplication, diagnosed by integrated relaxing pressure (IRP) >15 mmHg on high-resolution manometry (HRM). Based on HRM, patients were assigned into two arms: normal LOSP (≤35 mmHg, n = 30) and high LOSP (>35 mmHg, n = 22). Symptoms were assessed preoperatively, and the median duration of follow-up of 24 months using the Eckardt score (ES), the achalasia-specific quality of life (ASQ) score and the SF-36 questionnaire quality of Life (QOL). Treatment failure was defined as ES ≥4 or an ASQ score ≥16. RESULTS: Pre-operative Eckardt and ASQ scores were similar between groups. The high LOSP group had significantly younger populations (≤50 years: 90.90% vs. 60%, P = 0.013). The normal LOSP group had significantly less dysphagia ( P = 0.007) and regurgitation ( P = 0.011), reflecting significantly lower post-operative ES (0.80 vs. 2.00, P = 0.002). In addition, post-operative ASQ scores (11 vs. 14, P = 0.005) and QOL were significantly better in the normal LOSP group. The high LOSP group experienced a significantly greater failure rate (31.80% vs. 6.7%, P = 0.027). CONCLUSION: Normal LOSP results in better surgical outcomes and QOL, as younger patients with high LOSP have poorer responses, due to higher LOS muscle tone.
Laparoscopic repair of an incidental Morgagni hernia during cholecystectomy: A case report.
Singh D, Sharma J, Grover N … +3 more , Mishra PR, Rathore YS, Chumber S
J Minim Access Surg · 2025 Nov · PMID 41277243 · Publisher ↗
Morgagni hernia is a rare congenital diaphragmatic defect, often asymptomatic and incidentally discovered. Its co-occurrence with gallstone disease is exceedingly rare. We present the case of an 84-year-old female, plann...
Morgagni hernia is a rare congenital diaphragmatic defect, often asymptomatic and incidentally discovered. Its co-occurrence with gallstone disease is exceedingly rare. We present the case of an 84-year-old female, planned for laparoscopic cholecystectomy, with an incidental diagnosis of a 3 cm × 2 cm Morgagni hernia during laparoscopy. She underwent simultaneous primary repair of the hernia along with laparoscopic cholecystectomy. Post-operative recovery was uneventful, and the patient remains asymptomatic at 6-month follow-up. This case highlights the rare co-existence of gallstone disease and Morgagni hernia. Existing literature reports few such cases, and simultaneous laparoscopic management remains infrequent. This case also emphasises the benefit of laparoscopy, offering both diagnostic clarity and therapeutic benefit in managing concurrent intra-abdominal pathologies.
Clinical efficacy and safety of endoscopic retrograde cholangiopancreatography versus laparoscopic surgery in the management of acute obstructive suppurative cholangitis: A retrospective comparative study.
Liu Q, Zheng X, Yuan J
J Minim Access Surg · 2025 Nov · PMID 41277236 · Publisher ↗
INTRODUCTION: Acute obstructive suppurative cholangitis (AOSC) is a life-threatening biliary tract infection requiring urgent intervention. With the advancement of endoscopic techniques, endoscopic retrograde cholangiopa...
INTRODUCTION: Acute obstructive suppurative cholangitis (AOSC) is a life-threatening biliary tract infection requiring urgent intervention. With the advancement of endoscopic techniques, endoscopic retrograde cholangiopancreatography (ERCP) has become a preferred alternative to traditional surgery. This study aimed to compare the clinical efficacy and safety of ERCP with laparoscopic common bile duct exploration (LCBDE) in patients with AOSC. PATIENTS AND METHODS: This retrospective study included 174 patients diagnosed with AOSC at Shangrao Municipal Hospital between December 2021 and December 2024. Participants were retrospectively assigned to two exposure groups based on treatment received: ERCP group ( n = 70) and LCBDE group ( n = 104). No matching was performed. Clinical outcomes, including intraoperative parameters, post-operative recovery, complications and treatment efficacy within 30 days, were analysed. Logistic regression was used to identify independent predictors of treatment success. RESULTS: Compared to the laparoscopic group, the ERCP group showed markedly reduced intraoperative blood loss and shorter operation time ( P < 0.001). On post-operative day 7, the ERCP group had lower white blood cell (WBC) counts and serum aspartate aminotransferase levels ( P < 0.05). The overall complication rate (17.14% vs. 35.58%, P = 0.008) was lower, and the treatment efficacy rate (85.71% vs. 66.35%, P = 0.004) was higher in the ERCP group. Multivariate analysis identified ERCP, higher pre-operative alanine aminotransferase and lower post-operative WBC as independent predictors of successful treatment. CONCLUSION: ERCP is a safe and effective minimally invasive treatment for AOSC, offering advantages in recovery and complication reduction. It is especially suitable for elderly and high-risk patients.
Clinical analysis of 18 cases of obturator hernia.
Qian H, Chen Z
J Minim Access Surg · 2025 Oct · PMID 41071086 · Full text
INTRODUCTION: Obturator hernia is a relatively rare type of abdominal external hernia.The diagnosis is often delayed because of its rarity and nonsepcific symptoms and signs. PATIENTS AND METHODS: Retrospective study of...
INTRODUCTION: Obturator hernia is a relatively rare type of abdominal external hernia.The diagnosis is often delayed because of its rarity and nonsepcific symptoms and signs. PATIENTS AND METHODS: Retrospective study of 18 patients undergoing surgery for obturator hernia in a 11-year period. RESULTS: 15 female and 3 male patients were recorded. Low body mass index (BMI) was the common predisposing factor. Accurate preliminary diagnosis were made only in 8 patients with support of timely computed tomography (CT) scans. The rate of strangulated hernias was 33.33% (6/18)and intestinal resection was required in 4 cases. 11 patients underwent open surgery while 7 received laparoscopic surgery. Simple closure of the hernia defect or hight ligation was performed in 12, mesh repair in 6. No serious operative complications was observed. CONCLUSIONS: Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in elderly women with low BMI. Early surgical intervention is imperative to avoid intestinal resection and reduce complications. Laparoscopy has a tendency to rapid recovery but has its limits.
Implementing laparoscopic enhanced-view totally extraperitoneal technique for ventral hernias in Korea: Real world feasibility and surgical outcomes.
Park IK, Yang SS, Park DJ
J Minim Access Surg · 2025 Oct · PMID 41059958 · Publisher ↗
INTRODUCTION: The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising minimally invasive option for ventral hernia repair. Despite the global uptake, data from East Asian populations remain...
INTRODUCTION: The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising minimally invasive option for ventral hernia repair. Despite the global uptake, data from East Asian populations remain limited. This study presents the first Korean experience with laparoscopic eTEP, underscoring its real-world feasibility, safety and technical versatility. PATIENTS AND METHODS: We retrospectively analysed 39 patients who underwent eTEP repair for primary or incisional ventral hernias at a Korean tertiary centre between October 2018 and December 2023. Port placement strategies - conventional multi-port, reduced-port, single-port and hybrid approaches - were tailored to hernia characteristics. Patient demographics, operative details and short-term outcomes were evaluated. RESULTS: Of the 39 patients, 32 (82.1%) were initially approached laparoscopically and seven (17.9%) underwent preplanned hybrid repair. Transversus abdominis release was conducted in seven patients. The mean operative time was 186 ± 35.9 min, and the mean hospital stay was 7.05 ± 4.10 days. The overall postoperative complication rate was 20.4%, including a 5.1% recurrence rate and 10.2% wound complications. No surgical site infections were observed. Five conversions to open surgery occurred in the early learning phase. Diverse port placement techniques improve access and ergonomics, particularly in complex cases. CONCLUSION: Our initial experience in Korea supports the feasibility and safety of laparoscopic eTEP for ventral hernia repair. The technique's adaptability to various hernia types and compatibility with the Korean healthcare environment indicate a strong potential for broader adoption. These findings may help guide implementation in similar surgical settings.
Effect of 4-point transversus abdominal plane block on diaphragm thickness in patients undergoing laparoscopic cholecystectomy.
Ekinci NA, Yazar MA, Tire Y … +3 more , Karaarslan E, Kozanhan B, Mutluay Y
J Minim Access Surg · 2025 Oct · PMID 41059951 · Publisher ↗
INTRODUCTION: This study investigates the effect of a 4-point transversus abdominis plane (TAP) block on diaphragm thickness (DT) and post-operative recovery following laparoscopic cholecystectomy (LC). This study aims t...
INTRODUCTION: This study investigates the effect of a 4-point transversus abdominis plane (TAP) block on diaphragm thickness (DT) and post-operative recovery following laparoscopic cholecystectomy (LC). This study aims to evaluate whether the 4-point TAP block preserves DT closer to baseline values and enhances post-operative pain control and recovery quality. PATIENTS AND METHODS: This prospective randomised controlled trial was conducted at a tertiary care hospital. A total of 86 American Society of Anesthesiologists I-II patients aged 18-65 years undergoing elective LC were randomly assigned into two groups. Group B received a 4-point TAP block postoperatively, whereas Group C received no interventional analgesia. In Group B, 10 mL of 0.25% bupivacaine was administered bilaterally under ultrasound guidance to the upper abdominal (Th6-Th9) and typical TAP (T10-T12) regions. DT, the primary outcome, was measured by ultrasonography preoperatively and at 5 and 30 min post-extubation. Secondary outcomes included Visual Analogue Scale pain scores and Quality of Recovery-15 (QoR-15) scores. Statistical analysis was performed using SPSS v22.0. The Shapiro-Wilk test, Chi-square, independent samples t-test, Mann-Whitney U-test and repeated-measures ANOVA were used. P < 0.05 was considered statistically significant. Based on power analysis, 86 patients were sufficient. RESULTS: Group B demonstrated significantly better preservation of inspiratory DT, lower post-operative pain scores and higher QoR-15 scores compared to Group C (P < 0.05). CONCLUSIONS: The 4-point TAP block improves DT preservation and enhances post-operative pain control and recovery following LC. Further large-scale studies are warranted to support these findings.
Unveiling the hidden ring: A case report of unique presentation of internal hernia.
Philip AM, Kumar SS, Christopher PJ … +4 more , Natarajan R, Cumar B, Ramakrishnan P, Chinnusamy P
J Minim Access Surg · 2025 Oct · PMID 41059912 · Publisher ↗
Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in...
Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in a virgin abdomen. Initial imaging suggested SBO but failed to identify a clear transition point. Diagnostic laparoscopy revealed a rare internal hernia caused by a ring formed by the inflamed epiploic appendages of the sigmoid colon. The entrapped bowel was successfully released, and histopathological examination confirmed epiploic appendagitis. This case highlights the diagnostic challenges of SBO due to internal hernias and underscores the importance of surgical exploration in unclear cases. Early identification and intervention are crucial to prevent complications such as bowel ischaemia. This report contributes to the limited literature on epiploic appendage-induced internal hernias, emphasising the need for multidisciplinary collaboration in managing rare abdominal pathologies.
Critical appraisal of 'comparison of laparoscopic versus open oesophagogastric devascularisation with splenectomy in portal hypertension: A meta-analysis'.
Karthik N, Lodha M, Swathi M
J Minim Access Surg · 2025 Oct · PMID 41059841 · Publisher ↗
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