Boerhaave syndrome is the spontaneous transmural rupture of the esophagus due to an increase in intraesophageal pressure when vomiting against a closed glottis. There are various methods of managing it, with the main principles of limiting sepsis, draining the area, and maintaining nutrition. These include conservative management, open repair with drain insertion, and laparoscopic repair, depending on the timing of presentation and the amount of sepsis. Although the gold standard is open thoracotomy and/or laparotomy, we present a case where an esophageal rupture, presenting within 24 hours and hemodynamically stable, was managed with laparoscopic repair and drain insertion with good results. There is a paucity of literature regarding this mode of management and we have discussed the various options available in literature. We conclude that this is a safe and viable option in the management of Boerhaave syndrome in a nonseptic patient presenting early.

Laparoscopic adjustable gastric banding (LAGB) in patients with a sliding hiatus hernia has become an accepted procedure. However, LAGB in patients with less common types of diaphragmatic hernia is rarely described. We report a super-super-obese woman with a para-hiatal hernia (non-hiatal, diaphragmatic hernia) where LAGB was performed. The para-hiatal hernia was successfully repaired laparoscopically at the same time that the LAGB was performed. A para-hiatal hernia is not a contraindication to LAGB and can be repaired at the same operation.

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Techniques for vascular intervention have been evolving in the past decades. Trans-radial artery access (TRA) has been emerging and is favorable over trans-femoral access in recent years due to the lower risk of bleeding complications, vascular injury, early mobilization, shorter hospitalization and lesser cost. TRA has its own limitations such as radial artery stenosis, dissection, spasm and crossover. When access from the conventional sites is complicated or unsuccessful, trans-ulnar artery may serve as a feasible and alternative route. Despite posing potential complications similar to TRA, trans-ulnar artery is a relatively safe approach in an experienced trans-radial operator. We, herein, present a challenging case of subclavian artery revascularization performed via retrograde trans-ulnar approach.