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Hepatocellular carcinoma (HCC) causes about 1 million deaths each year worldwide. The patients usually present at an advanced stage when the growth is irresectable as there are no early presenting symptoms. Extrahepatic metastases of HCC occur in approximately 37% of patients. Common sites of hematogenous metastatic spread include the lungs, intra-abdominal organs, bones, adrenals, lymph nodes and peritoneum and rarely skeletal muscle. Together, spread of disease to the bones and muscle account for approximately 16% of all metastases. HCC metastases are found primarily with advanced disease. Anterior abdominal wall metastasis is known to occur after laparoscopy and as a result of needle tract implantation after percutaneous biopsy. However, primary anterior abdominal wall metastasis is extremely rare.We would like to present such an unusual case of hepatocellular carcinoma with anterior abdominal wall metastasis. Keywords: Metastasis | Hepatocellular Carcinoma | Anterior abdominal wall, Introduction Hepatocellular carcinoma (HCC) is a primary malignancy of the liver. The outcome is poor, presentation is at a very advanced stage and only 10-20% of HCC's can be removed [...]

Background: Primary closure of common bile duct is a safe procedure following common bile duct exploration. Aim of this study is to investigate long-term results of primary choledochorrhaphy. Patients--Methods: Between 1982 and 1990, 152 patients underwent common bile duct exploration followed by primary closure of common bile duct. Their age ranged from 20 to 87 years old. Dilated common bile duct (>1.2cm) was found in 105 patients. To study long-term results, a specially developed questionnaire was answered by all patients reached by phone. Any symptoms referred were carefully recorded and symptomatic patients were called for re-examination. Results: There were no major complications related to primary choledochorrhaphy. Questionnaire was answered by 129 patients. Abdominal symptoms were referred by 12 patients who were re-examined. No obvious pathology of biliary tree was revealed by clinical examination and laboratory work-up. Conclusion: Primary closure of common bile duct is a safe alternative of common bile duct restoration following exploration for lithiasis, with good results in long-term follow-up. Keywords: common bile duct exploration | primary choledochorrhaphy | primary closure of common bile duct | laparoscopic exploration of common bile duct | ERCP, Introduction Primary closure is a usual procedure following exploration of common bile duct. In 1917, Halstead first reported primary closure of common bile duct (1), draining the biliary tree through [...]

Retroperitoneal cystic lymphangiomas are rare benign tumours of the lymphatic system, most often seen in children and rarely in adults. Although various imaging modalities have been described, accurate preoperative diagnosis is often difficult. Here we report a rare case of retroperitoneal lymphangioma in a 62 year old male which was confirmed at laparoscopy. The lymphangioma was excised intact. Diagnostic laparoscopy can be a useful pre-operative method to identify abdominal cystic lymphangiomas. Transillumination test and laparoscopic cushion test seem to be useful to identify cystic lymphangiomas during laparoscopy. Keywords: Laparoscopy | Adult | Retroperitoneal | Cyst | Lymphangioma, Introduction Retroperitoneal cystic lymphangiomas are a rare, benign mesodermal tumours arising from the retroperitoneal lymphatics and are rarer than abdominal lymphangiomas of mesenteric origin [1]. More than 95% of the [...]

Background/Purpose: The authors present their experience with laparoscopic ligation of varicoceles (LVL) with and without mass ligation. Methods: Over a period of 3 years, 76 patients underwent laparoscopic treatment of unilateral varicoceles (age range, 9 to 36 years). 35 underwent ligation of veins alone and 41 underwent ligation of testicular veins and artery. Results: The average operation time for artery preserved and artery ligated group was 36 minutes (range 14 to 50 minutes) and 19 (range 12 to 26) minutes respectively and the average hospital stay was 26hrs and 21 hrs respectively. There were no technical failures. Complications were less in mass ligation than artery preserved group. At an average follow-up of 24 months (range 6 to 30), all patients were asymptomatic and had marked reduction in the size of the varicoceles. Conclusion: LVL is safe, effective, less time consuming and has excellent post operative results. LVL should preferably be done with en bloc mass ligation with an attempt to spare lymphatics. Keywords: Laparoscopic Varicocelectomy | Varicocele | Mass ligation, Introduction Varicocele is an abnormal dilatation of the veins of the pampiniform plexus. It occurs in 6% of children at age of ten, 13% of adolescents and 15% of males [...]

In laparoscopic surgery, intracorporeal suturing is one of the most important and difficult techniques.Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is a difficult process with a long learning curve. Intracorporeal suturing is essential in advanced laparoscopy and is a rate-limiting step in many procedures. The technique we wish to describe makes the art of knot-tying simple and straightforward by the use of a single laparoscopic needle holder. This technique, which we called 'Dowais tie', is useful for totally trans-umbilical laparoscopic surgery. This simple and useful technique of intracorporeal knot tying is demonstrated in this report Keywords: Intracorporeal suturing | laparoscopic surgery intracorporeal knot | Dowais tie, Technique Pass the suitable suture with a straight needle through the abdominal wall, then cut the end of the suture, remove the needle and pass the suture around the target [...]

Background: Acute appendicitis is one of the most common conditions requiring surgical intervention. Laparoscopic appendectomy (LA) is becoming a safe and effective operation for acute appendicitis recently. Several authors proposed various newer techniques of LA. We present our experience with totally trans-umbilical LA (TTULA). Objectives: To present an initial experience of a new approach (Dowais's technique) of LA. Methods: Twenty-four patients were randomly selected for TTULA from February to April 2009 at King Khalid Hospital Najran, Saudi Arabia. A percutaneous silk loop was used in addition to two trans-umbilical ports. Results: The procedure was completed successfully in all the patients. Mean operative time was 40 minutes. No significant post-operative complications were encountered. The hospital stay was 1.3 days. Conclusion: LA can be performed using TTULA with Dowais's technique, which is a safe, effective technique that allows nearly scarless abdominal surgery. Keywords: Laparoscopic appendectomy | totally trans-umbilical laparoscopic appendectomy | TTULA | Dowais's technique., Introduction Acute appendicitis is one of the most common conditions requiring surgical intervention and afflicts one in seven individuals. The disease may occur at any age, but predominantly presents in [...]

Solitary cysts in the kidney are common, but rarely cause any symptoms. Asymptomatic renal cysts may simply be followed up and often do not require treatment; however, symptomatic renal cysts must be treated, initially beginning with analgesic medication, although poor responders may require other more invasive methods. At present, the commonly used treatment methods include percutaneous aspiration with or without sclerosing agent injection, surgical resection and laparoscopic surgery. Laparoscopic de-roofing involves draining the cyst and removing part of the cyst wall. Here we report to our knowledge the first case of large symptomatic renal cyst in a 54-year-old lady treated successfully by laparoscopic de-roofing through totally trans-umbilical trans-peritoneal technique using three percutaneous stitches which we called 'Najran technique'. Keywords: Renal cyst | laparoscopic de-roofing | totally trans-umbilical | Najran technique, Introduction Renal cysts are a very common condition that can occur in anyone from newborns to the elderly. Their incidence from birth to 18 years ranges from 0.1% to 0.45%, [...]

Acute epiploic appendagitis, caused by torsion, inflammation and necrosis of an appendix epiploica, is a rare clinical entity that can be easily misdiagnosed as acute appendicitis or diverticulitis. We report a case of a 23-year-old male, who presented to the emergency department complaining of an intense and persistent abdominal pain, localized to the left lower quadrant, accompanied by nausea. The suspicion of epiploic appendagitis was established by the findings of a contrast-study computed tomography of the abdomen. A diagnostic laparotomy was subsequently undertaken due to clinical deterioration of the abdominal pain despite antibiotic coverage. A necrotic epiploic appendage of the descending colon was revealed, which was removed laparoscopically. Laparoscopic exploration, diagnosis and secure management in acute abdominal conditions is highly recommended in the surgical literature and its value was proven once again in the herein presented case. Keywords: acute abdomen | epiploic appendage | inflammation | torsion, Introduction Epiploic appendages, referred also as 'appendices epiploicae' are small peritoneal fat pouches, between 0.5 and 5cm long, which are attached to the external surface of the colon by vascular [...]

The urinary tract constitutes one of the rare localizations of endometriosis, accounting for 1-2%, even rarer when it is the unique localization of the disease.In the present paper the authors present two cases of bladder endometriosis, the second one being the more peculiar, as the classic intra-abdominal foci were absent.The treatment is still controversial; exact diagnosis, patient age, desire for reproduction, severity of symptoms, location and extent of the disease should be taken into consideration in order to determine the appropriate therapy.In our opinion, laparoscopic segmental cystectomy will be the first option to be considered. Keywords: bladder endometriosis | laparoscopic partial cystectomy, Introduction Endometriosis involving the urinary tract is a rare condition, occuring in about 1-2% of cases (1). Ninety percent of these cases involve the urinary bladder (2) and this condition [...]

Keywords: Diagnostic laparoscopy | Acute abdomen, Introduction Acute abdomen is not a disease itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 [...]

Appendiceal fecaliths are composed of inspissated fecal material, mucus with trapped calcium phosphate, and inorganic salts. Appendicoliths favour appendicitis. Abscesses or fistulas secondary to retained appendicoliths will likely continue to increase in frequency with the more widespread use of laparoscopic appendectomy. We report the case of a patient who developed a fistula caused by appendicoliths that were accidentally dropped during appendectomy. After extraction of the fecalith and antibiotic therapy, the patient attained definitive healing. Keywords: Appendicitis | appendicoliths | CT | laparoscopy | abscess | fistula, Introduction Appendicoliths are composed of inspissated fecal material, mucus with trapped calcium phosphate, and inorganic salts. Dropped appendicoliths from appendectomy are rare, but the radiologist and surgeon should consider them [...]

Objective: To compare tension-free open mesh hernioplasty with total extra-peritoneal (TEP) laparoscopic hernia repair. Design: A prospective comparative study of 120 patients with inguinal hernias. Setting: Department of Surgery, Medical College Hospital, Kolkata between January 2005 and July 2008. Results: The laparoscopic method took significantly more time than the open procedure (p Duration of hospital stay (p Conclusion: The open technique is still superior to the laparoscopic technique for mesh repair of groin hernias in a developing country like India. Keywords: inguinal hernia | laparoscopy, Introduction Inguinal hernia repair in adults is one of the commonest surgical procedures performed worldwide. Since the original description of hernia repair by Bassini in 1889 (1), hernia surgery underwent [...]

The objective of this study was to find out the effectiveness of laparoscopic surgery in case of peptic perforation. A study was carried out on 50 patients with peptic perforation; 25 underwent open surgery and 25 laparoscopic surgery. There was a significant difference in the outcome of the patients of these two groups, which established laparoscopic surgery as preferred method over open surgery for peptic perforation closure. Keywords: Laparoscopic surgery, Peptic perforation, Omentopexy, Table of Contents Abstract Introduction And Aims Of The Study Material And Methods Results Discussion Conclusions References Introduction And Aims Of The Study Perforation is a life-threatening complication of peptic [...]

Introduction: Adrenal cysts are uncommon lesions with an incidence ranging from 0.064% to 0.18 %. Adrenal cysts are detected more commonly in the present times due to widespread use of imaging modalities. We present our technique of laparoscopic adrenal cyst excision. Methods & Materials: Two patients with large adrenal cysts underwent laparoscopic transperitoneal excision. The size of the cysts was 6cm x 8cm and 15cm x 16cm, respectively. The cysts were first aspirated through 5mm suction to provide more space for dissection. Results: The cysts were completely removed. Operative time was 190 and 170 minutes. Blood loss was 100 and 70 ml. Hospital stay was 2 days for both patients. Pathological examination showed that they were epithelial adrenal cysts--a histopathological rarity. Conclusion: Adrenal epithelial cysts are rarely encountered pathological entities. Laparoscopic dissection is a good treatment option for large adrenal cysts. Intracystic laparoscopic fluid aspiration helps in decreasing the size of cyst thus facilitating easy port placement, dissection and organ retrieval. This technique of meticulous aspiration of fluid is thus of immense help in laparoscopic surgery. Keywords: Adrenalectomy, Epithelial adrenal cyst, Laparoscopy, Table of Contents Abstract Introduction Patients And Methods Results Discussion Conclusion References Introduction Adrenal cysts are uncommon lesions. They are usually asymptomatic or without a characteristic symptom. The incidence in [...]

Introduction: Severe external blunt or penetrating trauma to the abdomen and/or chest is the most common cause of traumatic diaphragmatic hernia (TDH). Delayed TDHs, which develop after a period of one month following trauma, are observed in about 10% of diaphragmatic injuries. The stomach and colon are the most common organs found to be herniated. Most patients with delayed TDHs present with acute GI and/or respiratory symptoms, although, for the intervening period, they may be completely asymptomatic, or may give on and off history of mild symptoms. Helical CT has high sensitivity for detection and gives detailed information about the exact anatomy. Transthoracic approach for repair of delayed TDH is preferred. Laparoscopic, thoracoscopic, or combined techniques are also available for repair of TDHs. Here we present an interesting case of delayed TDH, presenting after a very long asymptomatic interval of 28 years of initial trauma. The patient was successfully treated by repair done laproscopically. Conclusion: This case report emphasizes the possibility of delayed presentation of TDH even after very long intervals, and its laparoscopic repair, as one of the available treatment options. Keywords: Diaphragmatic hernia, Traumatic diaphragmatic hernia, Delayed traumatic diaphragmatic hernia, Diaphragmatic injuries, Diaphragmatic tear, Laparoscopic repair of diaphragmatic hernia, Table of Contents Abstract Case Discussion References Case We present a case of a 52-year-old patient presented to the casualty department with complaints of acute onset chest pain, respiratory distress [...]

The presence of ectopic liver tissue is a rare developmental abnormality that has previously been found during autopsy and during laparoscopic procedures in the abdomen. We present two cases of incidental ectopic liver tissue on the gallbladder during elective laparoscopic cholecystectomy. Keywords: Ectopic Liver, Gallbladder, Cholecystectomy, Table of Contents Abstract Introduction Case Report 1 Case Report 2 Discussion Summary References Introduction The presence of ectopic liver tissue is a rare developmental abnormality that has previously been [...]

Epiphrenic diverticula of the oesophagus are often associated with a concomitant oesophageal motor disorder, which is thought to be the cause of the diverticulum and some of the patient's symptoms. We report a case of oesophageal pulsion diverticulum associated with achalasia, treated with laparoscopic mobilisation of the fundus, transthoracic diverticulotomy, cardiomyotomy and Belsey Mark IV anti-reflux procedure., Table of Contents Abstract Case report Discussion References Case report An 88-year-old man presented to Royal Gwent hospital with history of achalasia for many years. His symptoms had progressed to [...]

Table of Contents Abstract Case report Discussion References Abstract Cornual pregnancy is the least common type of ectopic pregnancy, occurring in less than 3% of cases and less than 1/100,000 [...]