01CASE REPORT
Background: Nicorandil, a potassium-channel activator used as second-line anti-anginal therapy, has been increasingly recognised as a cause of mucosal ulceration affecting the oral cavity, skin, and gastrointestinal tract. Ileal and colonic ulceration with perforation is a rare but serious complication. Case presentation: We describe a 73-year-old man with ischaemic heart disease on long-term nicorandil who presented with abdominal pain, distension, vomiting, and absolute constipation. Computed tomography demonstra…
Dr. Faris Dawood Alaswad, Vinod Kumar Singhal, Mr Auday Alaswad
02CASE REPORT
Background: Recurrence of a repaired hiatus hernia after antireflux surgery is a well-recognised late complication, but recurrence within the first 24 hours, without disruption of the crural or wrap sutures, is exceptionally rare. Case Presentation: A 28-year-old man underwent laparoscopic Nissen fundoplication with hiatal repair for a large hiatus hernia with severe gastroesophageal reflux disease. Three crural sutures (Ethibond 2-0) were placed and a 360-degree wrap fashioned over a 40 French bougie, with the wra…
Manish Madnani, Kamran Khan, Shashi Tiwari, Suhail Kazim
03REVIEW ARTICLE
Background: Recurrence after laparoscopic repair of large hiatal hernias remains common, and reinforcement of the crural closure with prosthetic mesh has been proposed as a means of improving durability. However, the role of mesh relative to primary suture cruroplasty continues to be debated. Aim: This narrative review summarises the current evidence comparing mesh-reinforced and suture-only cruroplasty in laparoscopic hiatal hernia repair, with attention to recurrence, functional outcomes, and mesh-related complic…
Manish Madnani, Kamran Khan, Shashi Tiwari, Suhail Kazim
04REVIEW ARTICLE
The rapid advances in laparoscopic technology, robotic platforms, artificial intelligence, and image-guided surgery, minimally invasive approaches have increasingly transformed contemporary surgical practice. Despite growing adoption, uncertainty remains regarding comparative patient outcomes, long-term benefits, cost-effectiveness, accessibility, and the role of emerging technologies. Accordingly, this scoping review evaluated evolving minimally invasive and robotic surgical techniques, associated patient outcomes…
Vinod Kumar Singhal, Adil Md Suleman, Andrej Nikolovski, Hemant Sharma
05REVIEW ARTICLE
Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallbladder disease, although postoperative complications remain an important concern, particularly in patients with inflammatory and technically difficult conditions. Aim of the study: This study aimed to evaluate clinical outcomes following laparoscopic cholecystectomy and identify factors independently associated with postoperative complications. Methods: This prospective observational study was conducted among 250 consecutive adults undergoing elective or urgent laparoscopic cholecystectomy at a tertiary-care hospital in Bangladesh over a 2-year period, from (start) to (end). Demographic, clinical, ultrasonographic, operative, and postoperative data were collected, and complications were assessed during the 30-day follow-up and graded using the Clavien-Dindo classification. Multivariable logistic regression was performed to identify independent predictors of postoperative complications, with p<0.05 considered statistically significant. Results: Among 250 patients, the mean age was 46.8 ± 13.7 years, 68.8% were female, and 84.4% underwent elective surgery. Postoperatively, 86.4% had an uncomplicated recovery, while 13.6% developed complications; conversion to open surgery occurred in 3.6%, with no mortality. After adjustment, difficult operative procedures (aOR 3.57; p=0.006), dense adhesions (aOR 3.28; p=0.006), acute cholecystitis (aOR 2.31; p=0.049), and operative duration >60 minutes (aOR 2.14; p=0.047) independently predicted postoperative complications. Conclusion: Overall, laparoscopic cholecystectomy provided favorable short-term outcomes with low complication and conversion rates. Acute cholecystitis, dense adhesions, difficult surgery, and prolonged operative duration independently predicted postoperative complications, highlighting the importance of careful risk assessment and operative planning.
Adil Md Suleman, Vinod Kumar Singhal, Hemant Sharma, Andrej Nikolovski
06RESEARCH ARTICLE
Background: Appendiceal neoplasms are rare and biologically heterogeneous, with diverse clinical presentations, pathological features, and treatment requirements. Their rarity has limited detailed real-world outcome data, particularly from smaller health-care systems. Methods: We conducted a retrospective bicentric cohort study of patients with histologically confirmed appendiceal neoplasms treated at two tertiary surgical centres in Skopje, North Macedonia, between January 2016 and May 2026. Patients with appendic…
Haris Sulejmani1, Blagica Krsteska 1, 2, Svetozar Antovic 1, 3, Filip Vasilevski 4, Andrej Nikolovski *1, 4
07REVIEW ARTICLE
High-risk surgical patients with frailty, sarcopenia, malnutrition, multimorbidity, and impaired functional or cardiopulmonary reserve experience increased postoperative risk. This scoping review mapped contemporary evidence on nutritional optimization, prehabilitation, and complication-prevention strategies across 18 primary studies involving approximately 2,855 participants, finding that exercise was incorporated across all programs while functional and physiological benefits were more consistent than reductions in postoperative morbidity.
Vinod kumar Singhal, Andrej Nikolovski, Hemant Sharma, Adil Md Suleman
