Background. The study presents the mesopancreas excision in patients with pancreatic head adenocarcinoma (PHA), with an attempt to evaluate the radicality of the mesopancreatic resection margin. Material and Methods. We retrospectively identified 173 patients with resectable PHA who had undergone either pylorus-preserving pancreaticoduodenectomy (PPPD) or a Kausch?Whipple procedure with mesopancreas excision between 2000 and 2016. Pathological examination of the mesopancreas was performed for three dimensions ? anterior, posterior and medial margin of the mesopancreas. The specimens were classified R1 if tumor cells were within 1 mm of the mesopancreatic resection margin (MRM). Cases with macroscopic tumor residues at the MRM were defined as R2. Results. A total of 6 patients (3.4%) died during the postoperative time. PD was defined as R0 resection in 122(70.5%) patients, R1 in 43(24.8%) and R2 in the remaining 8 (4.6%) patients. Our data suggested that margins were positive in 29.4% (n=51) of the specimens with the posterior or medial margin accounting for 7/44 positive margins. R1-2 resection is based primarily on residual tumor tissue around the superior mesenteric artery (SMA). Conclusion. We support the importance of a R0 resection in the surgical management of PHA. The margin most often positive is the medial portion of the mesopancreas and in particular the SMA margin. The unified definition of margin negativity and the universal reporting of positive margin locus will be required to better understand outcomes for patients with tumor involvement at different portions of the mesopancreas

Purpose: Choledocholithotomy followed by T-tube drainage has been a standard surgical treatment for choledocholithiasis. This randomized prospective study has compared primary closure versus T-tube drainage of the Common bile duct (CBD) following explo-ration for calculus disease. Patients and Methods: A total of 69 patients with choledocholithiasis were included in the study who were operated between June 2014 and December 2015, with age ranging between 24-66 years. Patients were randomized in to two groups using envelope meth-od. Group I included 37 patients in which primary closure of CBD was done and Group II included 32 patients in which T-tube was inserted in CBD. Comparison between the 2 groups was done for mean duration of hospital stay, mean duration of surgery, inci-dence of wound infection, post-operative bile leak. Data was analyzed using the statistical software SPSS version 19. Comparisons were done between the groups using paired t-test. P value with 95% confidence interval was considered as statistically significant. Results: 37 patients underwent primary closure of CBD and 32 patients underwent closure of T-tube. The postoperative stay was significantly prolonged in the T-tube group, to a mean of 12 +/- 2days, compared to 7 +/- 2 days in the primary closure group also there was a significant difference in the mean duration of operation (90 +/- 8 minutes in T tube group as compared to 85 +/- 7 minutes in primary closure group). There was no significant difference in the incidence of wound infection and bile leakage. The pa-tients were followed for a period of 6 months and no patient required any further biliary surgery. Conclusions: It was concluded from the above study that primary closure of CBD after open Choledocholithotomy is as safe as the CBD closure over the T-tube but mean duration of surgery and post-operative hospital stay is significantly reduced in patients with primary closure of CBD.

Introduction: Endovascular aneurysm repair (EVAR) has been associated with an increased number of reinterventions compared to open repair. This review evaluates various pre-operative factors and their influence on the rate of reintervention following an EVAR. Method: References of relevant studies to EVAR reintervention rates were obtained from the Medline and PubMed data-base, and publications were screened by title and abstract to select 62 which specifically related to risk of EVAR reintervention and the influence of pre-operative variables on the outcome. Of the 21 pre-operative variables that were looked at, several fac-tors were found to be protective against high reintervention rates, such as diabetes, smoking, the use of statins, and aneurysm thrombosis identified on pre-operative CT scan. Conclusion: The association between pre-operative factors as identified in the results has a role in determining an appropriate surveillance program, as ultimately this has a role in risk of reintervention in the future.

Aim of the study. To assess the prognostic value of Rockall scoring system for predicting re bleeding and mortality after upper gastrointestinal bleeding. To provide appropriate management to the patients based on the risk group they belong to. Methods and Results. 62 patients were included, 82% were males and 18%were female. Mean age was 57.2 yrs. 61% of patients were diagnosed as variceal bleeding and 39% as non-variceal bleeding. In-hospital re bleeding rate was 27.4% and mortality was 3.2%. For re bleeding the (AUC) area under curve is 0.81 for clinical Rockall score and 0.82 for total Rockall score and P value is <0.0001 for both which is statistically significant. But for mortality the AUC is 0.75 and 0.80 for clinical and total Rockall score respectively and P value is >0.05 for both, which is not statistically significant. Conclusion. Rockall risk scoring system is a useful scoring system for stratifying patients with acute UGIB into high and low risk categories for re bleeding. For the prediction of mortality, however, the performance of this scoring system was unsatisfactory. Our study demonstrated that the Rockall scoring system is useful in identifying patients with high risk and low risk and triage them appropriately, without affecting patient outcomes and utilisation of healthcare resources accordingly.

Adenomyoepithelioma is a unique tumor of the breast. The tumor most often presents as a benign breast lump with biphasic archi-tectural signatures. However, there have been cases reported of malignant transformations from the benign counterpart lesion. Here, we report a case of a patient with a recurrent breast lump. We further discuss the case with regard to its clinical features and the available options for its management.

Gallbladder volvulus is a rare cause of gangrenous cholecystitis related to an anatomical abnormality. Its preoperative diagnosis is difficult and its delayed management worsens the prognosis. Laparoscopic diagnosis by reducing the operative delay improves the prognosis of this disease. We report a case of gallbladder volvulus in an elderly woman, diagnosed and treated by laparo-scopic cholecystectomy. Exploration has shown a complete gallbladder volvulus in clockwise with gangrenous walls. Epidemio-logical, clinical and therapeutic aspects of this condition will be discussed.

Chondrosarcoma are the third most frequently seen primary malignant bone tumour characterised by neoplastic cartilage structure. The pelvis, humerus, femur and shoulder girdle are primarily affected, and location is rarely seen in the costa. The case is here presented of a 68-year old male who presented at our clinic with complaints of anterior chest wall pain and a mass 17x13x13cm was determined. Radical resection was applied. Pathology examination reported the mass as a grade 1 costal chondrosarcoma. As the costa is a rarely seen location of chondrosarcoma, the aim of this paper was to present the clinical, radiological and histopathological findings of this case in the light of the relevant literature.

Lipoma, the so called ?ubiquitous tumour? can occur anywhere in the human body. It is usually asymptomatic and rarely grows to enormous size. The anterior abdominal wall is one of the common sites for its occurrence and when ?large? mimics other surgical conditions causing a diagnostic dilemma. We present a 56-year-old lady who came with a large swelling in the lower abdomen clini-cally mimicking an irreducible ventral hernia. Investigations revealed it to be a soft tissue neoplasm. Excision was done and the final histopathology revealed it to be a ?giant? lipoma.

Tracheobronchial tree injury is a sporadic condition in blunt trauma, with significant mortality. High index of suspicion is needed for diagnosis. Advanced imaging techniques for its diagnosis are of low sensitivity and specificity. This condition can be treated with suc-cessfully if it is early. Features of total main bronchus transection are subcutaneous emphysema, respiratory distress and persistent pneumothorax. But the salient features are almost non-specific. High suspicion and recognition of the condition are of utmost im-portance. This case report aimed to raise awareness regarding the condition. We would also like to highlight that our case of delayed diagnosis was treated successfully with thoracotomy

Background: The presence of a diverticulum of the colon in a post-operative abdominal hernia has only rarely been reported in the literature, whereas its inflammation and rupture can lead to severe complications. We present a case of such a perforation in a post-operative epigastric hernia that was treated in our Department. Case Presentation: An 81-year-old man was referred to the Emergency Department due to acute epigastric pain and clinical characteristics of an inflamed strangulated post-operative epigastric hernia. Abdominal CT revealed an epigastric hernia contain-ing a segment of the transverse colon, with free air subcutaneously. The patient was submitted to exploratory laparotomy and a perforated tranverse colon diverticulum within the hernia was found. The diverticulum was excised and end-to-end colonic anas-tomosis, as well as hernia repair, was performed. Despite an initial health improvement, the patient presented respiratory com-plications ten days after the surgery, and he was re-intubated and died ten days afterwards. Conclusion: In patients with diverticular colon disease, the presence of a diverticulum in a hernia is not common, and moreover its perforation, although also rare, may lead to serious complications. Therefore, early recognition and immediate repair of such hernias is necessary in order to avoid these complications.

This rare surgical entity was named by a French surgeon who first described it back in 1731. We describe a case of an 81 years-old female who presented with an asymptomatic swelling in the right groin area. The pre-operative ultrasound examination confirmed the non-strangulated femoral hernia. The patient had an elective femoral hernia repair and surprisingly the content of the hernia was a non-inflamed appendix. We repaired the hernia without performing appendicectomy and the patient was discharged the day after. De Garengeot hernia is an uncommon hernia and usually presents as a painful groin bulge with signs of inflammation due to the inflamed appendix. In the case that appendicectomy is necessary and this could be done either via the inguinotomy or laparo-scopically in the cases that the hernia has been diagnosed pre-operatively.

Groove pancreatitis is a rare variant of chronic pancreatitis that occurs in the the triangular area involving the dorsocranial part of the head of pancreas, the duodenum and the distal bile duct. The clinical presentations seems quite varied. High index of sus-picion is necessary to diagnose this condition accurately. Pancreaticoduodenectomy is the mainstay in managing symptomatic patients with this condition.