Arterial injuries during laparoscopic cholecystectomy have been described frequently in literature. However, arterial injuries presenting in a delayed fashion as pseudoaneurysms are uncommon and the literature on the subject is also scant. Two patients are described here who developed pseudoaneurysms of the right branch of the hepatic artery following laparoscopic cholecystectomy along with lacerations of the common bile duct. One patient presented 7 days after the initial procedure with a bile fistula and bleeding from the drainage tube. The second presented as obstructive jaundice 4 months after the laparoscopic procedure. Both patients were operated upon after appropriate radiological evaluation. These are unusual complications but need to be kept in mind whenever patients present with bleeding or jaundice after laparoscopic cholecystectomy.

Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallstone ileus diagnosed preoperatively and successfully treated by laparoscopic-assisted enterolithotomy.

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BACKGROUND:Laparoscopic fundoplication (LF) has become the operation of choice for patients who need surgery for gastro esophageal reflux disease (GERD). Several studies have shown that the long-term results with surgery for GERD are better than medical therapy. In this retrospective study, we outline our experience with LF over an 8 year period. We analyzed factors that would affect the results of surgery and help in a better selection of patients for the operation.MATERIALS AND METHODS:From 1999 to 2007, 107 patients underwent a LF. Eighty five patients had surgery for GERD and form the basis of this article. The other 22 patients had paraesophageal hernias and were excluded from the study. Pre-operative evaluation consisted of endoscopy, a barium study, esophageal manometry and 24h pH monitoring. Patients were followed up every 3rd month for the 1st year, twice in the 2nd year and then annually. Follow up was by personal interview or telephonic conversation. At the last follow up the results of surgery were graded as good or poor as per a scoring system. Those with a poor result were evaluated and re-operation advised when an anatomical problem caused the poor result. Subjective, objective and technical variables were analyzed which could affect the outcome of surgery.RESULTS:In 84 patients, the operation was completed by laparoscopic access. One patient with bleeding was converted to open surgery. There were 5 intra-operative complications; 3 pnemothoracis, 1 esophageal perforation and 1 gastric fundus perforation. There was no mortality. Two patients underwent re-operation, 1 for delayed gastric emptying and 1 for dysphagia. Seventy four patients have been followed up from 7 months to 8 years. Eleven have been lost to follow up. Fifty seven patients (77%) have had a good result from surgery. Seventeen (23%) had a poor result; of these there were 4 wrap failures, 1 delayed gastric emptying and 1 excessive gas bloat as the cause. In 11 patients, there was no apparent cause of a poor result. Individual variables which predicted a good response to surgery (P<0.5); were a good response to proton pump inhibitors (PPis), volume reflux and a pH score of more than 14.CONCLUSION:LF gives good long-term relief of symptoms in patients with GERD. Strict selection criteria are necessary to optimize the results of surgery. Poor selection will result in a patient who is no better, or often worse than before surgery.