Single-Stage Laparoscopic Common Bile Duct Exploration and Cholecystectomy Versus Two-Stage Endoscopic Stone Extraction Followed by Laparoscopic Cholecystectomy for Patients With Cholelithiasis and Choledocholithiasis: A Systematic Review.

Gallbladder stones with common bile duct (CBD) stones can be managed by a single-stage laparoscopic approach with transcystic or transcholedochal CBD exploration and cholecystectomy or a two-stage approach with endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction followed by laparoscopic cholecystectomy. Comparative outcomes between these approaches remain controversial. The objective was to compare single-stage laparoscopic CBD exploration and cholecystectomy versus two-stage ERCP stone removal followed by laparoscopic cholecystectomy for clearance of CBD stones, complications, length of stay, and costs. We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized trials and observational studies comparing outcomes of interest between single and two-stage approaches. Meta-analyses using random effects models were conducted. Seven studies with 382 patients were included. The single-stage approach achieved higher stone clearance rates (OR: 1.53, 95% CI: 1.12-2.08) with a shorter length of stay (mean duration: 3.5 days, 95% CI: -5.1 to -1.9 days) compared to the two-stage method. No significant difference was seen in complication rates (45% vs 40%, p=0.43) or costs ($19,000 vs $18,000, p=0.34). For patients with gallbladder and CBD stones, single-stage laparoscopic CBD exploration with cholecystectomy appears superior for stone clearance while comparable in safety and cost to a two-stage approach. Further randomized trials are warranted.

Compound Volvulus: A Rare Case of Intestinal Obstruction.

Compound volvulus or ileosigmoid knotting is an uncommon surgical emergency that causes intestinal obstruction. The sigmoid and ileum are mostly involved in this closed-loop intestinal obstruction. It is regarded as a rather uncommon cause of intestinal obstruction. It's important to distinguish between an ileosigmoid knot and a simple sigmoid volvulus since the management of the two is different. CT and MRI are more helpful in the diagnosis than abdominal X-ray findings, which are not pathognomonic. After resuscitation, a patient with ileosigmoid knotting typically needs an emergency laparotomy. Different resectional and non-resectional surgical procedures may be employed depending on the viability of the ileum and sigmoid colon.

Urachal Adenocarcinoma: a Case Report and Review of the Literature.

Urachal adenocarcinoma is one of the rare and aggressive neoplasms that often presents at an advanced stage and has a poor prognosis. Urachal adenocarcinoma makes up 0.17 to 0.34% of all bladder carcinomas. Patients commonly present with hematuria. Wide local excision of urachal mass with umbilicus and surrounding soft tissue en bloc combined with partial or radical cystectomy and bilateral pelvic lymphadenectomy is considered to be the primary surgical management. However, many publications in literature report that en bloc removal of tumor with umbilicus, entire urachal ligament, and bladder dome alone has long-term survival and disease-free period. Here, we present a case of a 50-year-old post-menopausal female patient with a fungating mass in the umbilical region of size approximately 10 cm in maximum diameter with mucopurulent discharge from the mass. The patient had no history of any hematuria, mucinuria, burning micturition, or any particles in urine. A laparotomy was performed, and tumor mass along with the cuff of the bladder dome was removed as en bloc along with umbilectomy. This case report highlights a rare case of urachal adenocarcinoma with a fungating mass of large size in a female patient which is otherwise more commonly seen in males. A review of published literature is also presented.