In 1769, Morgagni described the diaphragmatic hernia carrying his name, whist doing a post mortem on a head injury patient. Independently, Larrey had described a left-sided Banterior sternoscostal^hernia, and so left-sided Morgagni hernia is also known as a Larrey hernia. It is a very rare type of congenital diaphragmatic hernia with an incidence of 1-3%. It is caused by failure of fusion in the anterior portion of the pleuroperitoneal membrane resulting in retrosternal defect in the diaphragm. Although infants present with recurrent respiratory infections, they can often go unnoticed for several decades. In this case report, we present a 48-year-old male, diagnosed with Larrey hernia who underwent successful total laparoscopic suture repair and Meshplasty. The sac contents were reduced, and the sac was not excised. The edges were approximated, and the mesh was placed to widely cover the defect and suture to the abdominal wall all around. Relevant literature and technical considerations are discussed in this article.

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In our institute, laparoscopic splenectomy was performed in 27 patients over a period of 7 years for two major indications: hypersplenism and refractory variceal bleeding. 19 patients had Extra Hepatic Portal Venous Obstruction (EHPVO) and 8 patients had Non-Cirrhotic Portal Fibrosis ( NCPF). All the patients had hypersplenism, with thrombocytopenia( < 50,000/cu.mm),leukopenia (< 4000/Cu mm)as well in 9 (33% )of the patients, and anemia ( Hb<10gm) in 8(30%) . Variceal bleeding requiring Endoscopic Variceal Ligation (EVL) were found in 23 patients,17 in the EHPVO group and 6 in the NCPF group . 4 patients were females and 23 were male. The age range was from 12 to 37 years, the mean being 24 years. The laparoscopic procedure was successful in 25, but 2 patients needed conversion to left subcostal laparotomy because of extensive and giant collaterals around the hilum of the spleen; these conversions happened in the first three years of our laparoscopic splenectomy experience, with no conversions in the subsequent 4 years. Even in the presence of a relative contraindication like portal hypertension, laparoscopic splenectomy is still a viable proposition in the vast majority of cases. Technical considerations , like deployment of powerful energy sources, vascular staplers and preliminary splenic artery ligation are discussed in this article.

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Introduction: This case report is one of a fairly common tumour in an extremely uncommon anatomic location. Statistically liposarcoma is the commonest type of soft issue malignancy, but publications of such a tumour arising from the pouch of Douglas (POD) to involve the uterus, are very few and far between. Case details: A 52-year-old woman presented with a mass in the lower abdomen, post-menopausal vaginal bleeding, and lower abdominal discomfort. Investigations revealed a large pelvic tumour that was attached to the posterior wall of a bulky uterus. There was no evidence of dissemination of the tumour to distant sites, and a laparotomy was performed. A massive soft tissue tumour occupied the POD. The tumour was dissected out from the surrounding structures, and the uterus and its appendages were removed in to. The histopathological examination revealed a liposarcoma of the pleomorphic type which was arising from the pouch of Douglas (POD), and was attached to the posterior wall of the uterus. Extensive leiomyomatous changes were seen in the uterus. Immunohistochemistry confirmed the liposarcoma to be of pleomorphic type. Conclusion: This case report is being published for its rarity and to illuminate the specific issues in the treatment of this ubiquitous tumour in an unusual site. The involvement of a Multidisciplinary Team (MDT) helps to choose the optimal combination of cytoreductive surgery, chemotherapy, and radiation for a given case with a POD malignancy.