Gall bladder duplication is a rare congenital anomaly that is often asymptomatic and frequently goes undiagnosed until surgery. We present the case of a 47-year-old female who reported abdominal pain, vomiting, loss of appetite and generalised weakness. Initial imaging, including ultrasound and magnetic resonance cholangiopancreatography, identified cholelithiasis but did not reveal the presence of a duplicated gall bladder. During a laparoscopic cholecystectomy, a double gall bladder with two separate cystic ducts was unexpectedly discovered. Both gall bladders were successfully removed using standard laparoscopic techniques. Histopathological examination confirmed chronic cholecystitis in both specimens. This case highlights the challenges in pre-operative diagnosis of biliary anomalies and underscores the importance of intraoperative vigilance.

Appendectomy is the most common surgical emergency managed by laparoscopic surgeons and is usually a straightforward procedure with minimal morbidity. However, rare complications can arise in the immediate post-operative period. We report a late occurrence of intra-abdominal abscess 2 years after laparoscopic appendectomy probably related to silk suture used to ligate the base of the appendix during index surgery. The patient recovered after laparoscopic drainage of the abscess and retrieval of silk suture.

Gastrointestinal polyps are associated with risks such as bleeding, intussusception, obstruction and malignancy, necessitating removal. Technological advancements in endoscopic and laparoscopic surgery have introduced minimally invasive options like laparoscopic intragastric surgery (LIGS), especially beneficial for polyps that cannot be resected endoscopically. This report presents a 37-year-old male patient with Peutz-Jeghers Syndrome who exhibited symptoms of nausea, vomiting and weight loss. Endoscopy and computed tomography imaging revealed obstructive polyps in the bulbus and gastric cardia. The patient underwent single-port LIGS with preoperative botulinum toxin injection to facilitate pyloric opening. This combined approach allowed effective lesion resection without requiring extensive gastric resection. Pathology confirmed a hamartomatous polyp in the bulbus and high-grade dysplasia with negative margin in the gastric cardia. LIGS, particularly with botulinum toxin assistance, appears to be a safe and effective method for excising intraluminal lesions in complex anatomical areas, such as the duodenal bulbus and cardia.

Sleeve gastrectomy is the most commonly performed bariatric procedure but remains limited by high proximal staple-line leak rates and post-operative reflux, largely due to disruption of the angle of His and loss of fundic support. This study describes a technical modification designed to strengthen the proximal sleeve, preserve key anti-reflux anatomy and optimise gastric flow. The procedure uses a 40 Fr bougie and preserves a small, well-vascularised fundic remnant by positioning the final staple firing 2 cm lateral to the native angle of His. The proximal staple line is reinforced with oversewn sutures, and the fundic remnant is anchored to the left diaphragmatic crus to restore the physiological flap-valve mechanism. In patients with a 2-5 cm hiatal hernia, posterior or anterior cruroplasty is performed prior to anchoring. This modification aims to reduce leak risk, enhance sleeve geometry and improve post-operative reflux control by re-establishing a more competent gastro-oesophageal junction.