Anatomical variations of the biliary tree found with endoscopic retrograde cholagiopancreatography in a referral center in southern Iran

Background: Anatomical variations in the biliary system have been proven to be of clinical importance. Awareness of the pattern of these variations in a specific population may help to prevent and manage biliary injuries during surgical and endoscopic procedures. Knowledge of the biliary anatomy will be also of great help in planning the drainage of adequate percentage of liver parenchyma in endoscopic or radiological procedures

Methods: All consecutive patients undergoing endoscopic retrograde cholangiopancreatography [ERCP] from April 2013 to April 2015 at Nemazee Hospital, a referral center in the south of Iran, were included in this cross-sectional study. The patients with previous hepatic or biliary surgery, liver injury or destructive biliary disease were excluded from the study. All ERCPs were reviewed by two expert gastroenterologists in this field. The disagreed images by the two gastroenterologists were excluded. Huang classification was used for categorizing the different structural variants of the biliary tree, and the frequency of each variant was recorded

Results: Totally, 362 patients [181 men and 181 women] were included in the study. 163 patients [45%] had type Al Huang classification [right dominant], which was the most prevalent type among our patients. 55% of them had non-right dominant anatomy. The result of the Chi-square test revealed that there was no statistically significant difference between the men and women regarding the anatomical variations [p = 0.413]

Conclusion: The anatomical variation in the biliary system among Iranian patients is comparable to other regions of the world. Significant proportions of our patients are non-right dominant and may need bilateral biliary drainage

[Comparative evaluation of tubal sterilization by two method laparoscopy Filishie clips and minilaparotomy pomeroy technique]

Sterilization is the most prevalent means of family planning these days. Throughout the world, and different techniques have been employed to achieve this end. In this study two techniques of sterilization are being compared. 196 women who desired for sterilization, were randomly assigned in two groups: laparoscopy - Filishie clips [96 cases] and laparotomy-Pomeroy technique [100 cases]. We compared the duration of operation, surgical complications, post operative pain, wound infection and a long term follow-up [1-4 years] for changes in menstrual cycles, pelvic pain and failure rate. The mean duration of the procedure was shorter for the Flishie clips [P<0.07]. Post operative pain was lesser for clips [P=0.072]. The failure rate was 1.72% for clips and for Pomeroy it was 0% [P<0.05]. Other complications did not show significant differences. The Filshie clips technique as a sterilization procedure is simple and without any danger, can be conducted by means of laparoscopy and laparotomy, does not need much expertise, and as regards cosmetic effect and duration of operation seems better