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in this study from India is at par with the published data. Aggressive post-bariatric follow-up is required to improve nutritional outcomes.Surgical internal drainage of pancreatic pseudocyst can be done into the stomach, duodenum or jejunum depending on the anatomic relation of pseudocyst with hollow viscera. For cystojejunostomy, a Roux-en-Y loop is preferred over loop cystojejunostomy as former is thought to avoid the reflux of jejunal contents into the cyst cavity. This study presents our experience with laparoscopic loop cystojejunostomy showing loop cystojejunostomy for the pseudocyst of the pancreas can be safely performed laparoscopically with simpler technique with no complications including reflux.Robot-assisted minimally invasive oesophagectomy (RAMIE) has been developed to overcome the technical limitations of conventional thoracoscopic oesophagectomy. Hand-assisted laparoscopic surgery (HALS) is used as a practical and useful technique during the abdominal phase of thoracoscopic oesophagectomy. During RAMIE, a robotic vessel sealer cannot be used with HALS; another vessel sealer or ultrasonic coagulating device for laparoscopic surgery is required. We report an initial experiment using hand-assisted robotic surgery (HARS) for abdominal manipulation during RAMIE as a novel method. Under the pneumoperitoneum induced by insufflating the abdomen to 10 mmHg with carbon dioxide, the assistant surgeon lifted the stomach and greater omentum using the left hand through a 7 cm upper abdominal midline incision at approximately 2 cm below the xiphoid. Subsequently, gastric mobilisation was performed by robot-assisted surgery. Between January 2019 and February 2020, eight patients with thoracic oesophageal cancer underwent RAMIE with HARS at our hospital. The median operative time for extracorporeal manipulation and preparation for the roll-in of the robot was 39.5 min. The median console time was 47.5 min. There were no intraoperative or postoperative complications related to the use of the robot and no in-hospital mortality. In conclusion, HARS seems to be feasible and safe for abdominal manipulation during oesophageal cancer surgery.

Locally advanced long Siewert type II tumor requires total gastrectomy and D2 lymphadenectomy with distal esophagectomy and mediastinal lymphadenectomy for curative resection. In this scenario, a laparoscopic transhiatal approach is not feasible, and the conventional left thoracoabdominal approach is associated with increased morbidity.

To describe a novel technique of fourth jejunal artery based jejunal conduit for thoracoscopic esophagojejunostomy after laparoscopic esophagogastrectomy.

The laparoscopic total gastrectomy with distal esophagectomy specimen is extracted through the periumbilical incision. A pedicled jejunal conduit based on the fourth jejunal artery is prepared, and the jejunal conduit is placed in the mediastinum under laparoscopic guidance. Using the thoracoscopic approach in a prone position, additional esophageal clearance and subcarinal lymphadenectomy are performed. Handsewn end to side esophagojejunostomy is performed at the level of the carina.

Three patients with long Siewert type II underwent this procedure after neoadjuvant chemotherapy. None of the patients had conduit related complications. All three patients had abdominal lymph node involvement and two patients had mediastinal lymph node involvement.

Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.

Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.Cholecystoenteric fistulas are rare complications of cholelithiasis, with cholecystogastric fistulas (CGFs) being the rarest. Recommended treatment is surgery; however, select asymptomatic patients can be managed conservatively. The population frequently involved is old age with multiple comorbidities. Open surgery comes with its added morbidities, especially in this subgroup and hence laparoscopic surgery might be beneficial. Sometimes, these fistulas can be incomplete. Here, we describe a case of incomplete CGF managed by laparoscopic cholecystectomy and omental patching along with a brief review of the literature.

Long-term dysphagia is a known complication of laparoscopic anti-reflux surgery (LARS). Of the several factors, inadequate hiatal closure is one of the major reasons for its occurrence. https://www.selleckchem.com/products/epz015666.html The aim of this study is to develop a technique for the quantitative assessment of crural closure during LARS to reduce dysphagia.

It is an analysis of prospectively collected data of 109 patients who underwent LARS at a tertiary healthcare centre in India. To identify the adequacy of hiatal closure intraoperatively, a 7 French Fogarty catheter was used, and its balloon was inflated with 1 cc air at the repaired hiatus. This inflated balloon in the repaired hiatus following cruroplasty gives an accurate quantitative assessment of the adequate closure and adequate space for food bolus to pass without causing mechanical obstruction after hiatus repair. Pre- and post-operative 12 months' DeMeester scores and lower oesophageal sphincter (LES) pressures were calculated.

The patients had a significant reduction in DeMeester scores postoperatively from a mean of 68.5-12.3 (P < 0.0001). None of the patients had long-term dysphagia or the need for long-term proton-pump inhibitors. The mean LES pressures on post-operative manometry showed increase to 15.1 mmHg from a mean of 6.4 mmHg, which was statistically significant (P = 0.0001). None of the patients had a recurrence of hiatus hernia.

Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia.

Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia.