Bile leaks following surgery for hepatic hydatid disease.

BACKGROUND: Conservative surgery (cyst evacuation and partial pericystectomy) for hydatid cysts of the liver is known to be safe but is often associated with bile leak and its sequelae. METHODS: Case records of 86 patients undergoing surgery for hydatid cysts of the liver at a tertiary-care center in northern India over a 14-year period were reviewed retrospectively. RESULTS: Sixteen (18%) patients had jaundice and 36 (42%) had a cyst-biliary communication detected at surgery. Biliary complications developed in 14 (16%) patients. Bile leaks and bilio-cutaneous fistulae were observed in 11 (13%) patients; the fistula output was low (< 300 mL/day) in 8 of these. Three patients had localized intra-abdominal bile collections; all 3 underwent percutaneous drainage of biloma (subsequent laparotomy and lavage was required in one patient due to failure of percutaneous drainage), producing controlled low-output bilio-cutaneous fistulae in all. All low-output fistulae closed spontaneously after a mean duration of 4 weeks. Patients with high-output fistulae underwent endoscopic intervention (stenting/naso-biliary drainage), resulting in the conversion of these fistulae to low-output category and eventual closure after a mean duration of 7.5 weeks. CONCLUSION: Postoperative bile leaks lead to significant morbidity after surgical management of hydatid cysts of liver. A majority of them resolve spontaneously. Biliary drainage (endoscopic or surgical) hastens the closure of these bilio-cutaneous fistulae.

Surgical management of corrosive strictures of stomach.

BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.