Background:Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts, and multiple organ dysfunction syndromes. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. AP is most often associated with gall stone disease or hypertriglyceridemia.Material and Methods:We present 2 years of experience during which we had eight patients of AP.Results:Of the eight patients, three underwent laparoscopic cholecystectomy and five were treated conservatively. One had multiple cysts in the abdomen which were drained. All the patients delivered at term. Prophylactic tocolysis was given for 48-72 h to only those patients who had laparoscopic cholecystectomy. All the patients recovered completely. There was no maternal or fetal mortality.Conclusion:When properly managed AP in pregnancy does not carry a dismal prognosis as in the past.

Background and Aims: COVID-19 disease has imposed challenges in caring for non-Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID-19 pandemic so as to provide a road-map for safer approach. Material and Methods: We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5-week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS- CoV-2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID-19 by quantitative RT-PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID-19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level-3 protection without delay. The clinical data was reviewed and analysed. Results: A total of 764 surgical procedures were conducted, of which 70.7% were elective essential surgeries, with 95.4% of these patients being discharged in stable healthy condition. Approximately 23% of the elective and 26% of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04%, but the overall mortality rate was approximately 2.5%. Only two patients (0.3%) tested positive for COVID-19 in our series. Conclusion: A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.

Background: Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.Methods: A retrospective observational study was conducted on eight patients.Results: In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.Conclusions: Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy.

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Background Oesophagectomy is challenging procedure involving multiple body cavities. The traditional open procedure being either transthoracic or transhiatal, carries significant morbidity and mortality. There is continuing debate between the two approaches. Minimally invasive oesophagectomy has swung the pendulum towards transthoracic procedure, though it remains a complex and technically demanding procedure. This study was done to assess the feasibility, and benefit of hybrid minimally invasive technique over open technique. Methods Patients of oesophageal cancer were selected from January 2005 to December 20,017. After 2012 open technique was replaced with minimally invasive technique. Open technique included Ivor Lewis, McKeown's or transhiatal. Hybrid minimally invasive technique included laparoscopic gastric mobilisation and thoracic part using small thoracotomy. Anastomosis was done using hand sewn technique. The short term outcome, including postoperative complications were analysed from prospectively collected data. Results One hundred sixty three patients underwent open procedure and 103 patients underwent hybrid minimally invasive esophagectomy. Total operative time was shorter in laparoscopic group (325.6 minutes vs 232.6 minutes, P < 0.05). The number of transfused patients were significantly smaller in laparoscopic group (40.75% vs 13.6%, P < 0.05). The postoperative course without complication was observed in 68.1% and 79.3% in open vs laparoscopic group respectively. Serious complications included myocardial infarction and gastric tube necrosis and bleed. There was no anastomotic leak in chest anastomosis but there was overall 17.3% leak in neck anastomosis, higher in open group 20.8% vs 16.6% in minimally invasive group. Mortality was higher ion open group (5.5% vs 2%, P < 0.05). On multivariate analysis, age more than 60 years, chest complications and cardiovascular comorbidity were associated with increased mortality. Conclusion Hybrid minimally invasive procedure is feasible and safe procedure for patients with oesophageal cancer. it is associated with shorter operative time and less postoperative complications. Even laparoscopic gastric tube mobilisation alone adds to in decreasing the morbidity in esophagectomy. Disclosure All authors have declared no conflicts of interest.