Laparoscopic cholecysto-jejunostomy as a palliative procedure in advanced cancer head pancrkas [a preliminary report]

Only 20% of patients with pancreatic cancer undergo curative resection. Therefore palliative treatment of pancreatic cancer assumes the utmost clinical importance. The aim of palliative treatment of pancreatic head carcinoma is to relieve the jaundice and/or duodenal obstruction. Endoscopic decompression of the obstructed biliary system can be accomplished in most cases, but the durability of that technique is not as great as that of a surgically created bypass. Many authors reported with open, hepaticojejunostomy higher morbidity and mortality rate than the former nonsurigcal methods. In order to promote long lasting palliation with low morbidity and mortality rates, minimally invasive palliative treatment using laparoscopy can be used. This study was done on 10 patients with advanced pancreatic head cancer. Cholecystojejunstomy, and jejunojenostomy were done in all patients as a palliative bypass for obstructive jundice while gastrojejunostomy was done only in 3 cases for impending duodenal obstruction. The results were encouraging as regard shorter hospital stay, no perioperative mortality and less post operative complications

Evaluation of the role of vascularised omental pedicled flaps in the management of liver injuries [experimental canine study]

This experimental study was done to evaluate the role of a vascularized pedicle omental flap as an autogenous pack to control hemorrhage and to decrease the incidence of sepsis and bile leakage. The study was done on 10 dogs with liver injuries in which the liver wound was packed with a vascularized pedicled omental flap sutured in place and sacrificed after 15 days in 5 dogs and after 30 days in the other 5. A postoperative follow up for hemorrhage, sepsis and bile peritonitis was done. The healed omental flaps with adjacent liver tissue were histologically examined. They all showed heavy infiltration of different types of inflammatory cells, especially lymphocytes with a deposition of collagen fibers and bile ductules like channels in the omentum. This work supported the use of omentum in the control of bleeding, the decreased incidence of sepsis and absorption of bile in cases of liver injuries