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Background Perforation of oesophagus and stomach during paraoesophageal hernia (POH) repair can be caused by traction on the lower oesophagus, gastro-oesophageal junction (GOJ) and fundus, or a thermal injury from the energy device during dissection. Iatrogenic complete transaction of oesophagus during elective laparoscopic POH repair is extremely rare. Here we reported this unusual complication. Methods A 79-year-old man with a history of hypertension and hypothyroidism underwent elective laparoscopic POH repair in a district hospital. During the surgery, oesophagus was transacted above the level of GOJ due to constant traction on the lower oesophagus and GOJ. Patient remained haemodynamically stable and was transferred to our tertiary centre next day. Patient was taken to theatre for midline laparotomy. Intraoperatively, stomach, omentum and transverse colon were in the chest and reduced carefully. The oesophageal stump, approximately 20cm from hiatus, was found in the mediastinum with the use of a nasogastric tube. It was also noted that there were several serosal tears on the proximal stomach and left gastric vessels were already divided. Unfortunately, oesophageal stump was ischaemic and friable. Therefore we decided to perform transhiatal oesophagectomy. Oesophagus was fully mobilised via cervical and abdominal incisions and was resected above the level of clavicle. Cervical oesophagogastric anastomosis was performed with semi-mechanical end-to-side EndoGIA 30mm blue and interrupted 3-0 PDS. Postoperatively, he was transferred to intensive care unit for ongoing care. Results Patient was off inotropes of Day 2 and extubated on Day 3 postoperatively. He developed pneumonia and atrial fibrillation and was treated with intravenous antibiotics and amiodarone. He has recovered well and is currently awaiting transfer to the ward. Conclusions Complete transection of oesophagus due to of traction in laparoscopic POH is an extremely uncommon complication. Transhiatal oesophagectomy can be considered as a management option in selected cases.

Background Anastomotic leak is one of the major complications following oesophagectomy and is associated with a prolonged ICU and hospital stay with high mortality. Over the years, endoscopic vacuum therapy (EVT) has an evolving role in managing anastomotic leak. The aim of this study was evaluate our experience in the use of EVT in managing anastomotic leak. Methods A retrospective analysis was conducted in patients who underwent elective oesophagectomy at our tertiary centre from May 2021 to April 2022. Patient demographics, complication profiles, length of stay (LOS) and survival outcomes were collected. The details of endoscopic procedure, therapy results, and adverse events were evaluated. Endo-SPONGE® by B Braun Medical Ltd was used at our centre. Results Over the last 12 months, 3 out of 11 patients (27.3%) who had anastomotic leak were treated with EVT. All 3 patients were males and diagnosed with anastomotic leak on Day 8, 9, 9. Two patients were treated with a stent at the time of the diagnosis and the management changed to Endo-Sponge on the subsequent endoscopy as the defect increased in size. They required 3 and 8 times of sponge exchange respectively. One patient was managed with Endo-Sponge at the time of diagnosis and required 7 times of sponge exchange. The successful anastomotic leak healing rate was 100% and none of them required further endoscopic or surgical interventions. The median changing time interval of sponges was 3 days (range 2–5 days). The average sponge exchange rate was 6 times. The median duration of EVT was 25 days (range 18–29 days). No other adverse events occurred during EVT. The average LOS was 49.3 days. Conclusions EVT is an effective and safe treatment option in patients with anastomotic leak post oesophagectomy for oesophageal cancer. With careful patient selection, EVT can be considered as the first-line treatment instead of surgery. Future studies involving a greater number of patients are essential to evaluate the efficacy of EVT.

Introduction Laparoscopic TAP block has been used in various surgical subspecialties to reduce postoperative opioid requirement and hence its side effects. The aim of our study was to evaluate the effect of laparoscopic TAP block in bariatric surgery. Methods We performed a retrospective analysis in patients who underwent bariatric surgery by two surgeons at a metropolitan public hospital from January 2019 to March 2020. One surgeon routinely performed laparoscopic TAP block (TAP group) with 80ml of 0.2% ropivacaine and the other surgeon performed port-site infiltration (non-TAP group) with either 0.2% or 0.75% bupivacaine. Patients with chronic pain were excluded. Baseline characteristics (age, gender, pre-op BMI, types of bariatric surgery), postoperative usage of opioids (in recovery, in the first 24 hours and opioid dosage) and length of stay (LOS) were collected and analysed. Results Seventy-nine patients were included in this study, of which 46 (58.2%) received laparoscopic TAP block and 33 (41.8%) received port site infiltration. Opioid requirement rates were lower in the TAP group: 54.3% (n = 25/46) received no opioids in recovery and 21.7% (n = 21/46) in the first 24 hours, compared to 48.5% (n = 16/33) in recovery and 9.1% (n = 3/33) in the first 24hours in the non-TAP group. However, there was no statistically significant difference (p = 0.61 and p = 0.13 respectively) between the two groups. Mean LOS was comparable in both groups. Conclusion Our study showed a non-statistically significant trend in reducing postoperative opioid usage with laparoscopic TAP block. Further evaluation with a prospective randomised controlled trial is warranted.

Introduction Length of stay (LOS) in laparoscopic sleeve gastrectomy (LSG) is affected by multiple factors, including gender, BMI >50, comorbidities, socioeconomic status and increased operative time (OT). This study aimed to evaluate the effect of reduced OT on LOS. Methods Analysis was conducted using a prospective database in patients who underwent LSG by a single surgeon at a single institution from January 2015 to December 2019. Patients receiving other operations (e.g. adhesiolysis, cholecystectomy, para-oesophageal hiatal hernia repair or ventral hernia repair) during LSG were excluded. All the patients were divided into two groups: OT ≤ 60 minutes and OT > 60 minutes. Patient demographics and outcome variables, including LOS, 30-day readmission, unexpected return to operating theatre, complications and mortality, were collected and analysed. Results A total of 1412 patients were included. In OT ≤ 60 minutes group (N = 804), the average LOS was 1.37 days and the average operative time was 51.31 minutes. In OT > 60 minutes group (N = 608), the average LOS was 1.66 days and the average operative time was 77.95 minutes. OT ≤ 60 minutes group showed a statistically significant decrease in LOS compared to OT > 60 minutes group (P-value Conclusion Our study demonstrated that reduced OT (≤60 minutes) in LSG was associated with reduced LOS but without increase in complication rates and mortality. This has implications for economic considerations for both hospitals and patients, especially in self-funded payer models.