Treatment of post-cholecystectomy bile duct strictures--push or sidestep?

Management of post-cholecystectomy bile duct strictures can be complex.Traditional treatment has been surgical reconstruction. In recent years endoscopic stenting has been successful in a selected subgroup of patients with iatrogenic bile duct strictures. Adequate information about long-term results of endoscopic stenting as definite treatment for such strictures is still awaited. Surgery is a reliable and time-tested method and results of numerous studies show its long-term success in relieving biliary obstruction with minimal morbidity.

Squamous cell carcinoma of stomach.

Squamous cell carcinomas in the gastrointestinal tract are known to occur in oro-pharynx, esophagus and anal canal. Gastric squamous cell carcinoma is a rare epithelial tumour. Surgical treatment is the same as that for an adenocarcinoma, though prognosis is probably worse.

Median pancreatectomy: a report of three cases.

Conventional pancreatic resections may be unnecessary for tumors of the pancreas that are benign or of low malignant potential and can place the patient at increased risk of developing postoperative exocrine and endocrine complications. Median pancreatectomy is an option that has been investigated in the management of such tumors located in the body of the pancreas. We present our experience with three women who underwent this procedure successfully for neuroendocrine tumors (2) and cystadenoma (1).

Surgical management of obstructive gastroduodenal tuberculosis.

BACKGROUND: Gastroduodenal tuberculosis is a rare but potentially curable condition. The aim of the present study was to evaluate the clinical presentation, pre-operative status, management and outcome in patients with histologically proven diagnosis of gastroduodenal obstruction due to tuberculosis. METHODS: We retrospectively reviewed the records of 17 patients managed surgically for gastroduodenal obstruction due to tuberculosis. RESULTS: The site of obstruction was the pyloroduodenal canal in 53% of patients, second part of the duodenum in 24%, third part of the duodenum in 12% and duodenjojejunal flexure in 12%. The obstruction was caused by fibrotic stricture formation in 59% of patients and extrinsic compression by a lymph nodal mass in 41%. Endoscopic biopsy was diagnostic in only 29% of the patients in whom it was performed. Overall, a pre-operative diagnosis of gastroduodenal tuberculosis was suspected in only 35% of patients. All the patients underwent surgical drainage procedures and the diagnosis was confirmed by histopathological examination of biopsies taken at the time of laparotomy. CONCLUSIONS: In view of its rarity and non-specific findings on clinical, radiological and endoscopic evaluation, tuberculosis as a cause of gastroduodenal obstruction is seldom diagnosed pre-operatively. Hence, a high index of suspicion is required in young patients residing in endemic areas. Surgical intervention helps not only in relieving obstruction but also in confirming the diagnosis.