We present a case of Boerhaave’s syndrome managed thoracolaparoscopically. A 45-year- old man presented with hydropneumothorax following severe retching. He was treated with Intercostal drainage insertion as the primary management and referred to a tertiary care centre. There endoscopic stapling was attempted, following which he developed a leak. He presented to us with severe sepsis and mediastinal collection on the ninth day following the perforation. We treated him with thoracoscopic mediastinal toilet, laparoscopic-assisted feeding jejunostomy and cervical oesophagostomy. The patient was managed conservatively. A computed tomography (CT) scan was repeated at intervals of 15 days. He was continued on full jejunostomy feeds. Regular assessment of the oesophagus injury was conducted via the CT scan. The patient had complete healing of the perforation at end of two months. His oesophagostomy was closed and he remained symptom-free at follow-up. We conclude that thoracoscopy has an important role to play in the management of patients with mediastinal sepsis and late presentation of Boerhaave’s perforation.

Background: Pilonidal sinus is a pathology that occurs with acute or chronic infection in the natal cleft, especially in young men. In order to decrease complications and recurrence rates after pilonidal sinus excision, it is desirable to use a less invasive technique that allows patients to recover more quickly and permanently. Present study was aimed to evaluate laser Pilonidotomy, a new technique for the treatment of pilonidal sinus. Material and Methods: Present study was a prospective, observational study conducted in ppatients diagnosed as cases of pilonidal sinus disease, attending surgical OPD, underwent laser pilonidotomy. Results: Total 32 patients were evaluated. Male patients (90.63%) were far more than female patients (9.38%). Mean duration of procedure was 30.34 ± 8.24 minutes, mean duration of hospital stay was 14.65 ± 7.13 hours. Most of patients resumed normal activity in 1.96 ± 0.81 days while complete wound healing by secondary intention was noted after 4.5 ± 1.2 weeks. Successful primary treatment was done in 90.63 %. Recurrence was noted in 3 patients (9.38 %). Infection (6.25 %) was noted in 2 patients, less common complications were bleeding (3.13 %), severe postoperative pain (3.13 %), hypertrophic scar (3.13 %). VAS score analysis was done and a significant change in VAS score was noted between day 1 and day 7. Conclusion: Laser treatment in primary pilonidal disease is minimal invasive surgery, is easy to perform with major advantages such as shorter hospital stay, less post-operative pain and care and the final aesthetic aspect.

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