Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We present a case of SILS splenectomy performed with conventional laparoscopic instruments in a 7-month-old boy with the diagnosis of multiple splenic abscesses. A 3-cm umbilical incision was used for the placement of two (5 mm) trocars and one 10-mm videoscope (30°). Conventional laparoscopic dissector and grasper were the main tools during surgical procedure. Spleen was removed through the umbilical incision. Although procedures like aingle-incision cholecystectomy have been reported, to the best of our knowledge this is the first report of SILS splenectomy using conventional laparoscopic instruments reported from India and is perhaps the first in an infant in the world literature.

We analyzed perioperative outcome of distal pancreatectomies with or without splenic preservation both in laparoscopic and open method to determine best approach. Retrospective data was collected from 1999 to 2013. We divided all distal pancreatectomies into four groups. Group 1-laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Group 2-laparoscopic splenectomy + distal pancreatectomy (LSDP). Group 3-open spleen-preserving distal pancreatectomy. Group 4-open splenectomy + distal pancreatectomy. We recorded demographic data, intra and post operative complications, operative time, estimated blood loss, length of stay, pancreatic leak rate, and final pathology result. A total of 38 distal pancreatectomies were included. In group 1, patients were significantly younger (mean 29 vs 47 to 50 in other groups, p=0.014). Tumor size (average 2.5 vs 5 to 9.5 cm in other groups, p=0.023) and operative time (average 98 min vs 125 to 141 in other groups, p=0.004) and hospital stay (average 6 vs 8 to 19 days in other groups, p=0.009) in LSPDP were all significantly less than other groups taken together. However, intra-operative blood loss was equivalent. We further analyzed that between LSPDP and LSDP, age and tumor size were significantly less in LSPDP. Further we analyzed between spleen-preserving (groups 1+3) vs spleensacrificing (groups 2+4) distal pancreatectomies and between overall laparoscopic (groups 1+2) vs open (groups 3+4). Laparoscopic spleen-preserving distal pancreatectomy has all the advantages of minimal access surgery especially in small lesions and low-grade malignancy.

The results of cardiomyotomy in patients of achalasic megaesophagus with axis deviation are not satisfactory. Usually, an esophagectomy is advocated. We describe the technical details and outcomes of laparoscopic esophagogastroplasty for end-stage achalasia. The patient had end-stage achalasia, characterized by tortuous megaesophagus with axis deviation. The surgery was performed in supine position using four abdominal ports. The steps included mobilization of the gastroesophageal junction and lower intrathoracic esophagus, straightening the pulled intrathoracic esophagus into the abdomen, and a side-side esophagogastroplasty using purple Endo GIA Articulating Tri-Staple load, two firings. Duration of surgery was 52 min. The patient was ambulated on the first postoperative day. Oral feeding was initiated by the third postoperative day. The patients had significant improvements of dysphagia. At 3 months of follow-up, the patient is euphagic without significant symptoms of gastroesophageal reflux. Laparoscopic esophagogastroplasty is an effective option for relieving dysphagia in megaesophagus due to achalasia with axis deviation. It is a reasonable alternative before subjecting to a major and potentially morbid esophagectomy. It creates a large gastroesophageal (GE) junction, which, with the help of gravity, helps food transit. By dividing the muscles of the GE junction completely, it also achieves a complete cardiomyotomy. Less operative time and blood loss, quicker recovery, and better cosmesis make it an attractive option. While potential reflux is a possibility, the reported case has not shown significant GERD symptoms.

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