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.

A duplicated cystic duct draining a single gall bladder is an exceedingly rare congenital biliary anomaly. Fewer than 25 cases have been described in published literature, and the condition is almost never diagnosed before surgery. We report a 19-year-old male who presented with recurrent right upper quadrant pain. Abdominal ultrasonography confirmed cholelithiasis but revealed no biliary ductal abnormality. During elective laparoscopic cholecystectomy, meticulous dissection of Calot's triangle unexpectedly identified two separate cystic ducts, both draining a single gall bladder. Each duct was individually traced to confirm its distal course, then clipped and divided under direct vision after establishing the critical view of safety. The procedure was completed laparoscopically without complication. The patient was discharged on the post-operative day 2 and remained well at the follow-up. This case underscores that standard pre-operative imaging does not guarantee normal biliary anatomy and that systematic, unhurried dissection with a critical view of safety remains the only reliable safeguard against inadvertent bile duct injury.

Sciatic hernias containing adnexa are exceedingly rare and prone to misdiagnosis. This study reports the case of an 84-year-old multiparous female (body mass index: 18 kg/m 2) who presented with acute right lower abdominal pain. Initially, the patient was misdiagnosed clinically with an obturator hernia; however, rigorous multidisciplinary computed tomography re-evaluation confirmed a right-sided adnexal sciatic hernia. Laparoscopic exploration revealed the adnexa and a mesosalpingeal cyst herniating through a 2.0-cm suprapiriform defect. Given her advanced age and the mechanical risk posed by the cyst, a right salpingo-oophorectomy was justified. The defect was concurrently repaired using a transabdominal pre-peritoneal approach, with the mesh secured solely by continuous peritoneal suturing. Prior to mesh placement, the ureter was mobilised medially to maintain a safe distance from the repair site. The post-operative course was uneventful, and she was discharged on day seven. This case highlights the crucial role of accurate radiological differential diagnosis in high-risk women and demonstrates a safe, minimally invasive management strategy.

Biliary cystadenoma (BC) of the liver is a rare benign cystic lesion. Recurrence following excision is uncommon, and aberrant hepatic arterial anatomy adds further surgical complexity. A 25-year-old female underwent laparotomy 3 years earlier for a presumed hydatid cyst; histopathology revealed mucinous BC. She presented with abdominal pain. Computed tomography (CT) showed an 8 cm × 8 cm × 7 cm multiloculated cystic lesion in segments 4a/4b/5 and another in segments 5/8 compressing the porta hepatis structures. CT angiography demonstrated both accessory right and left hepatic arteries. After pre-operative endoscopic retrograde cholangiopancreatography with common bile duct stenting, laparoscopic resection was performed with careful preservation of the portal vein and all hepatic arteries. A minor left hepatic duct injury was repaired primarily. Operative time was 210 min; blood loss was 250 ml. Recovery was uneventful. Histopathology confirmed biliary mucinous cystadenoma without malignancy. This case illustrates a rare combination of vascular anatomy encountered during laparoscopic resection of recurrent hepatic BC, and to our knowledge, it is the first published report describing this precise surgical scenario. Laparoscopic resection of recurrent BC with dual accessory hepatic arteries is feasible and safe in expert hands following detailed vascular mapping and meticulous dissection.