Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Purpose: This study examines the impacts of omitting nasogastric tube (NGT) placement following cervical esophagogastric anastomosis (CEGA) in Enhanced Recovery After Surgery (ERAS) protocols, comparing outcomes to those from early NGT removal. Methods: In a retrospective cohort of esophagectomy patients treated for esophageal cancer, participants were divided into two groups: group 1 had the NGT inserted post-CEGA and removed by postoperative day 3, while group 2 underwent the procedure without NGT placement. We primarily investigated anastomotic leak rates, also analyzing hospital stay duration, pulmonary complications, and NGT reinsertion. Results: Among 50 esophageal squamous cell carcinoma patients, 30 in group I were compared with 20 in group II. The baseline demographic and tumor characteristics were similar between both groups. The overall incidence of anastomotic leak was 14.0%, comparable in both groups (16.7% vs. 10.0%, p = 0.63). The postoperative hospital stay was significantly shorter in the no NGT group (median of 7 days vs. 6 days, p = 0.03) with similar major morbidity (Clavien-Dindo grade ≥IIIa; 13.3% vs. 5.0%, p = 0.63). There was no 30-day mortality, and one patient in each group had reinsertion of NGT for conduit dilatation. Conclusion The exclusion of an NGT across CEGA after esophagectomy did not influence the anastomotic leak rate with comparable complications and a shorter hospital stay.

Purpose: Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. Methods: A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. Results: Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. Conclusion Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.

Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.