Gastroesophageal reflux disease (GERD) is a complex disease with a multifactorial etiology. While most patients are treated with pharmacological agents, a proportion of patients do not respond to this, thereby necessitating the need for surgical intervention. In this article, we describe the pathophysiology of the disease and also discuss some of the issues of this disease pertinent to the Surgeon.

Non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) are the most common liver diseases in the world. The prevalence of NAFLD is up to 30% in many countries. NAFLD (accumulation of hepatic steatosis non due to excess alcohol consumption) is the most common liver disease worldwide. NAFLD may progress to cirrhosis, liver failure and hepatocellular carcinoma. Hepatic steatosis, clinically, is commonly silent and is detected frequently incidentally by blood liver function tests or imaging performed for other reasons. It seems that hepatic steatosis has an important impact in case of liver transplantation, with an increase of primary non function of the steatotic graft and a decrease rate of patient survival. Many studies showed also an amplified postoperative morbidity and mortality rate after liver resection, in patients with hepatic steatosis.

Only rare cases of retained sponge after abdominal surgery or textiloma or gossipyboma have been published. Aim. Our objective was to report cases of textiloma after laparotomy. Patients and method. This is a retrospective study (1995-2006) that compiled 8 files of patients presenting textiloma after 6792 abdominal surgeries. The frequency of textiloma was 0.12%. The average age of our patients was 27.8 years. There were 6 men and 2 women. Five patients were operated in emergency and 3 were within scheduled surgery. Initial indications for scheduled surgery were: 1 case of hydatid cyst of the liver, 1 case of pheochromocytoma and 1 case of adenocarcinoma of the rectum. Among emergency cases, 2 were appendicular abscesses, 1 case of volvulus of the pelvic colon, 1 case of ruptured ectopic preg-nancy and 1 case of iatrogenic rectal fistula. Intraoperative difficulties in hemostasis have been reported in 3 patients. Indica-tions for reoperation were postoperative peritonitis in 1 case, hemoperitoneum in 1 case, a mass of the left hypochondrium in 1 case, a purulent discharge through the opening drain port in 2 cases, a mass of the right iliac fossa in 2 cases and an incidental finding in 1 case. The delay for revision surgery ranged from 3 days to 6 years. The surgical procedure was a simple removal of textiloma in 7 cases and in 1 case ileocecal resection associated with an ileostomy and a colostomy was necessary. Mortality rate was 25% (2 cases). Conclusion. Retained surgical sponge is an incident that may occur after any laparotomy especially if done in emergency. The best treatment is prevention, which recommends a vigilance of the entire surgical team.

Σκοπός: Σκοπός της μελέτης είναι η διερεύνηση της αποτελεσματικότητας της υπέρθερμης δεγχειρητικής ενδοπεριτοναϊκής χημειοθεραπείας (HIPEC) στον καρκίνο του ενδομητρίου. Ασθενείς-Μέθοδοι: Μελετήθηκαν 53 γυναίκες με καρκίνο ενδομητρίου, μέσης ηλικίας 62.7+11.1 (38-85) ετών. Οι 23 από αυτές (43.4%) έλαβαν υπέρθερμη διεγχειρητική ενδοπεριτοναϊκή χημειοθεραπεία, ως συμπληρωματική θεραπεία μετά την υστερε-κτομή (ομάδα Α), ενώ οι υπόλοιπες 30 (56.6%) υποβλήθηκαν σε υστερεκτομή σε συνδυασμό με ή χωρίς συμπληρωματική ακτι-νοθεραπεία (ομάδα Β). Εκτιμήθηκαν η ηλικία, η φυσική δραστηριότητα, το στάδιο ASA, το στάδιο της νόσου, ο βαθμός διαφο-ροποίησης του νεοπλάσματος, ο υπολειμματικός όγκος, η νοσοκομειακή θνητότητα και νοσηρότητα και συσχετίσθηκαν με την επιβίωση και τις υποτροπές της νόσου. Αποτελέσματα: Η νοσοκομειακή θνητότητα και νοσηρότητα ήταν αντίστοιχα 1.9% και 13.2%. Η 5ετής επιβίωση της ομάδας Α ήταν 81.5% και η μέση 36+3 μήνες ενώ της ομάδας Β ήταν 91% και 135+9 μήνες αντίστοιχα (p>0.05). Ο μοναδικός προγνωστι-κός παράγοντας επιβίωσης ήταν η παρουσία μεμακρυσμένων μεταστάσεων. Υποτροπές διαπιστώθηκαν σε 6 ασθενείς (11.4%). Προγνωστικοί παράγοντες υποτροπής ήταν η παρουσία μεμακρυσμένων μεταστάσεων και η συμπληρωματική ακτινοθεραπεία. Συμπεράσματα: Η προφυλακτική χορήγηση υπέρθερμης διεγχειρητικής χημειοθεραπείας είναι μία πολύ καλά ανεκτή μέθοδος και δεν ευθύνεται για μετεγχειρητικές επιπλοκές ή αιματολογική τοξικότητα. Η μέθοδος δεν φαίνεται να βελτιώνει την επιβίω-ση στον καρκίνο του ενδομητρίου, ούτε να έχει επίδραση στην ανάπτυξη υποτροπών της νόσου.

Purpose. A prospective study was performed to evaluate two options for surgical treatment in patients with chronic pancreatitis: duodenum-preserving pancreatic head resection with dissection (Beger`s operation in our clinic modification) and without dis-section (Berne version of Beger`s operation) of the pancreas over the portal vein. Methods. A prospective study of patients with chronic pancreatitis, who had inflammatory mass in the head of the pancreas. Points of the study: duration of surgery, the volume of intraoperative blood transfusion , duration of treatment in the intensive care unit, duration of hospitalization after surgery, frequency and structure of postoperative complications, frequency of repeat-ed surgical interventions in the early and late postoperative period, the level of quality of life in patients within 6-24 months af-ter surgery. Results. 82 patients participated in the study. The time of surgery was significantly lower in the Berne version subgroup (differ-ence - 64 minutes, p <0,05). Intraoperative blood transfusion in the Berne version subgroup was also significantly lower than during Beger`s operation in our clinic modification (difference - 353 ml, p <0,05). The duration of treatment in the intensive care unit in the postoperative period was significantly shorter in the Berne version subgroup (difference - 0.7 days, p <0,05), as well as the duration of hospitalization (difference - 6.8 days, p <0 05). The incidence of early postoperative complications was 28,2% (11 cases) in the subgroup of Beger`s operation in our clinic modification , in the subgroup of Berne version ? 32,5% (14 cases). Qual-ity of life in patients, estimated within 6-24 months by using SF-36 questionnaire was not significantly different in subgroups .

LC has brought many benefits to patients and these benefits have been convincingly demonstrated in controlled trials in the literature. Along with these benefits, it has served to rejuvenate the debate regarding the practice of selective versus routine cholangiography. Recent evidence has emerged evaluating the link between IOC and bile duct injury. The aim of this systematic review was to provide ?evidence-based? answers to the following questions: Could routine IOC pre-vent CB injury? Could routine IOC limit the severity of CBD injury? Could IOC permit the recognition of CBD injury and pro-mote the quality of life? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MED-LINE and the COCHRANE LIBRARY. Key words used for the final search were ?laparoscopic cholecystectomy (LC)?, ?common bile duct injury?, ?Bile duct repair?, ?Bile duct stenosis?, ?LC and bile duct injury?, ?LC and IOC?, ?IOC and laparoscopic biliary injury?, ?LC and meta analysis?, ?LC and randomized prospective study?, ?LC and prospective study?, ?LC and retrospective study?, and we established a cross match from the references of the collected studies. Bibliographic research has permitted to find three meta analysis, nine systematic and collective reviews of non controlled trials, Three studies about cost effectiveness of the IOC, two retrospective populations-based studies, American and Australian includ-ing a big numbers of patients, thirteen prospective (with two comparative studies), and 35 retrospective studies. No randomized trial was found so a little power of the study comparing with the place of the IOC in detecting stones in the common bile duct. Several prospective studies have tried to evaluate the usefulness of IOC in preventing CBD injury. Drawing conclusions about this has been difficult because these reports include relatively small numbers of patients. All these reports have reported an increase in the incidence of CBD injury with the introduction of LC. The incidence of major BDI was initially as high as two to five times that of open cholecystectomy. The majority of studies (two systematic reviews, the two retrospectives populations-based analysis and four prospective studies) had shown that IOC use can decrease both the absolute rate and the seriousness of CBD injuries. However one meta analysis and nine prospective studies have concluded that LC can be performed safely with selective or no use of IOC (Level of evidence III). Three meta analysis, two retrospective nation wade stud-ies and seven prospective studies had concluded that IOC permit the early recognition of biliary injury and this improved the clinical outcome and quality of life for patients, reduces total costs, and shortens the hospital stay (level of evidence III).

Objective. Evisceration after abdominal surgery is a severe complication, associated with high morbidity and mortality. A number of techniques have been described in order to confront with the reclosure of the abdomen in these cases. Prosthetic mesh, ab-sorbable or non-absorbable, is often used. The aim of the present study was to assess the safety of the use of prosthetic mesh for this purpose. Material and methods. All patients who had undergone mesh repair of severe abdominal wound dehiscence between January 2003 and January 2009 were included in a retrospective cohort study. All surviving patients had physical follow-up in July 2009. Results. Seven patients were included in the study with a mean age of 71.2 years and a mean post-operative hospital stay of 26 days. Four of the initial surgical wounds were classified as clean-contaminated, two as contaminated and one as dirty-infected. Operative incisions included four midline incisions, one right subcostal incision and two right paramedian incisions. At the time of the mesh placement operation two of the patients had infected wounds. Meshes used consisted of four Composix? meshes, one Gore-Tex? mesh, one Prolene mesh and one Permacol? mesh. The first five of them were placed intraperitoneally, one was placed with the onlay technique and the last one was placed with the inlay technique. After a mean follow-up time of 45.25 months (23-77 months), three patients (43%) died while being hospitalized after the mesh placement operation, two because of progressive sepsis, not of abdominal origin though and one due to acute pulmonary embolism. Another patient died of his ma-lignant disease 13 months after the mesh placement operation. Another patient developed an enterocutaneous fistula, 6 months after the mesh placement operation, which was treated successfully, but developed an incisional hernia. The remaining two patients still had an uncomplicated post-operative course. Conclusion. Synthetic graft placement for the reclosure of the abdomen after an evisceration, especially in the presence of wound infection, has a high risk of complications and should be avoided if possible.

Background: Acute gastric volvulus is a rare surgical emergency. Mesentero-axial variety accounts for only one-third cases of gastric volvulus. Whole stomach Gangrene is an extremely uncommon sequel of vascular compromise in acute gastric volvulus and that too in the Mesentero-axial type compared to the organo-axial one. Case Presentation: A 16-year old boy of thin built presented with recurrent spasmodic upper abdominal pain and distension along with nausea, retching and occasional vomiting of little non-bilious vomitus for the last five days. Abdominal X-ray did not show the Ryle?s tube in the abdomen and stomach was found grossly distended. Emergency laparotomy revealed mesentero-axial gastric volvulus with gangrene of the whole stomach and Eventration of left diaphragm. Total gastrectomy with Roux-en-y oesophago-jejunostomy was done. Post-operative period was uneventful and patient was discharged on 9th day. Conclusion: Acute gastric volvulus with whole stomach gangrene is an extremely rare and challenging surgical emergency. Prompt surgical intervention and presence of a senior surgeon to perform the resection-anastomosis were found fruitful to-wards smooth post-operative recovery and are highly recommended.

We report the case of a 34 year old female patient who presented initially a palpable mass siting in the abdominal cavity. The patient is a mother of two children (age 7,5 and 5,5 years old) with a history of ectopic pregnancy in 2001. She was hospitalized with the following indications: a. palpable mass, b. abdominal pain, c. enormous cystic morphoma with diaphragms and solid protusions located in the right ovary (as indicated in the abdominal ultrasound). After all the clinical and laboratory examinations it was considered necessary for the patient to undergo an operation. The histo-logical report revealed an enormous mature ovarian teratoma in the right ovary filled with iris, neural, fat, smooth muscular and intestinal type tissue, mature cartilage, mucous, hair follicles and sebum. We must also mention the existence of a gagllion, salivary glands and cerebellum tissue

Background: Desmoid tumors are benign and rare fibroblastic neoplasms which behave in a locally-aggressive manner to infiltrate into the adjacent tissue and have a high incidence of local recurrence after surgical excision. Desmoid tumors may develop during or shortly after pregnancy. Case presentation : We report here a case of abdominal desmoid tumor involving the ileum and its mesentery in a 22-year-old woman after pregnancy. Magnetic resonance imaging (MRI) revealed a well-bordered, well-encapsulated mass with 7x8 cm dimensions on the right side of the abdomen neighboring intestinal loops and the mesentery. The tumor was excised radically along with a part of the ileum with 2 cm tumor-free margins. Histological examination revealed desmoid-type fibromatosis with no immunoreactivity for estrogen and progesterone receptors. The patient had an uneventful postoperative course and was discharged on the 10th postoperative day. Conclusion: We conclude that, intra-abdominal masses other than fetus should raise suspicion of desmoid tumor which requires timely-intervention during obstetric follow-up.

Gastrointestinal duplications are rare congenital malformations that may vary greatly in presentation, size, location, and symp-toms.Duplications can occur anywhere in gastrointestinal tract from mouth to anus. Duplications in proximity of small intestine are the most common enteric duplications and majority of these occurs in the ileum.An enteric duplication cyst in a child is presented. The cyst presented as palpable painless abdominal swelling. No associated congenital anomaly was detected. There were two non communicating ileal duplication cysts lying opposite to each other each other sharing common bowel .Resection of involved segment of gut was performed.

Background. Recently autoimmune pancreatitis has been extensively investigated. Despite thorough diagnostic measures, preoperative verification of autoimmune pancreatitis may be very difficult. Case presentation In the present case a 67-year-old female patient was examined for jaundice and abdominal pain. Diagnostic work-up revealed stenosis of the common bile duct without pancreatic mass formation and gallstone disease. Brush cytology raised the suspicion of malignancy, therefore a pylorus-preserving pancreatoduodenectomy was carried out without any complication. Final histological examination proved autoimmune pancreatitis, which was not presumed from the pre- and intraoperative findings. Conclusion It can be concluded that pancreatic resection is the method of choice in uncertain cases, when malignancy can?t be excluded.

Skin necrosis caused by heparins is a rare complication. We report a case of a 71-year-old woman who developed the unusual complication of focal necrotizing skin lesions in the injection site after undergoing thromboprophylaxis with enoxaparin after right knee arthroplasty. Laboratory investigations for heparine-induced thrombocytopenia (HIT), disseminated intravascular coagulation, protein C, protein S, factor V, factor VIII, antithrombin III, and homocysteine deficiency were negative. Fortunately, despite aggressive management, the postoperative evolution was uneventfully

Σημαντικός αριθμός κλινικών δεδομένων υποστηρίζει ότι η ποιότητα διενέργειας ογκολογικών χειρουργικών επεμβάσεων σχε-τίζεται άμεσα με την ευνοϊκότερη μετεγχειρητική πορεία των ασθενών. Σύμφωνα με αυτό το δεδομένο και λαμβάνοντας υπό-ψη την πολυπλοκότητα της χειρουργικής ανατομικής των στοιχείων που εντοπίζονται στο ύψος της προπαγκρεατικοδωδεκαδα-κτυλικής περιτονίας του Fredet, η άρτια γνώση της χειρουργικής ανατομικής των εύτρωτων φλεβικών συνιστωσών της άνω μεσεντερίου φλέβας στο κάτω χείλος της κεφαλής και αγκιστροειδούς απόφυσης του παγκρέατος, είναι εξαιρετικά σημαντική για την ασφαλή και άρτια διενέργεια ριζικών χειρουργικών εκτομών για τη θεραπεία κακοηθών νόσων του παγκρέατος, του παχέος εντέρου και του στομάχου. Σκοπός της παρούσας ανασκόπησης είναι η αναλυτική περιγραφή της χειρουργικής ανατο-μικής των φλεβικών συνιστωσών της άνω μεσεντερίου φλέβας στο ύψος του κάτω χείλους του παγκρέατος, με βάση δεδομένα κλινικών και ανατομικών μελετών και η περιγραφή της χειρουργικής τεχνικής για την ασφαλή και ακριβή παρασκευή τους.