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.

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.

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.

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.

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.

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.

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.

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.

Neoadjuvant chemoimmunotherapy has emerged as a promising strategy in the multimodal treatment of locally advanced non-small cell lung cancer (NSCLC). However, concerns remain regarding its impact on surgical complexity and the feasibility of video-assisted thoracic surgery (VATS) in this setting.

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.

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.

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.

Shoulder tip pain (STP) is a post-operative complication seen in up to 60% of patients after LC. It occurs because of diaphragmatic irritation from residual carbon dioxide from pneumoperitoneum. This study evaluated the effect of intraperitoneal normal saline irrigation in relieving STP.

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.

Recently, there has been a growing emphasis on assessing the functional outcomes of hernia repair, particularly focusing on the quality of life (QOL). The aim of this study was to assess and compare the QOL amongst Nepalese patients undergoing laparoscopic ventral hernia repair (LVHR) and open ventral hernia repair (OVHR) during the initial 3 months following surgery.

Bile leakage is a serious complication that can lead to life-threatening conditions if not promptly addressed. We present a rare case of a 38-year-old male patient who sustained a liver laceration due to a gunshot injury, resulting in a multisegmental bile leak. Despite percutaneous transhepatic biliary drainage (PTBD), a persistent bile leak was observed. Selective embolisation was performed by interventional radiology via microcatheterisation of the affected peripheral biliary branches, using a mixture of Lipiodol and Histoacryl. The patient showed complete clinical recovery, and the bile leak resolved during follow-up. This case highlights a minimally invasive and effective treatment alternative for refractory bile leaks unresponsive to PTBD, potentially reducing the need for surgical intervention and its associated risks.

Spigelian hernia is a rare type of ventral abdominal wall hernia, and urinary bladder herniation into the inguinal canal is an uncommon complication typically seen in elderly males. The simultaneous occurrence of multiple abdominal wall hernias with bladder involvement is exceedingly rare and diagnostically challenging. We present the case of a 62-year-old male who underwent abdominal computed tomography (CT) due to chronic lower abdominal discomfort and right groin swelling. Imaging revealed a small midline umbilical hernia, a right-sided Spigelian hernia, bilateral inguinal hernias and partial urinary bladder herniation into the right inguinal canal. All hernias were clearly visualised on contrast-enhanced CT with multiplanar reconstructions. While individual hernias are common, the coexistence of four different types - particularly with bladder involvement - has not been previously reported in the radiological literature. Accurate CT imaging was instrumental in detecting the defects and guiding referral for surgical management. This case highlights the importance of comprehensive cross-sectional imaging in elderly patients with nonspecific abdominal or groin symptoms. This rare case underscores the diagnostic value of CT in identifying multiple synchronous abdominal wall hernias and emphasises the need to consider urinary bladder herniation in the differential diagnosis, especially in older male patients.

Robotic-assisted cholecystectomy enhances precision and visualisation compared to traditional laparoscopy. This study compares single-incision robotic cholecystectomy (SIRC) with multi-port robotic cholecystectomy (MPRC) in elective settings.

This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).

Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the anatomical alterations inherent to LSG can lead to significant nutritional challenges. These modifications in gastrointestinal physiology may result in various micronutrient deficiencies, particularly affecting iron, Vitamin B12 and folate status.