Background:Although pancreatic trauma is infrequent, it can lead to substantial morbidity and occasional mortality. Fair amount of controversy exists about the optimum management of these patients. The aim of this study was to analyse the clinical presentation, operative management and outcomes in patients with high grade (AAST >/= 3) pancreatic trauma. Materials and methods: Over a four year period from Jan 2016 to October 2020, eight patients with pancreatic trauma were treated at the Department of Surgical Gastroenterology, GCS Medical College and Research Institute, Ahmedabad. The grade of pancreatic injury, clinical presentation, surgical management, outcomes including complications were studied. Results: Each of the eight patients had blunt abdominal injury. Six presented early (within a week of injury) and two presented late. Six patients had grade III pancreatic trauma, one each had grade IV andV . Overall, seven out of eight patients underwent surgery (operative management-OM). Three patients had associated other organ injury. Out of these, Three patients underwent spleen-preserving distal pancreatectomy (DP), two underwent Roux-en-Y pancreaticojejunostomy(PJ), one underwent open necrosectomy 5 weeks after the injury for infected pancreatic necrosis. There were no deaths. Four out of seven operated patients developed complications but out of these, only one was grade III a, rest three were Clavien grade I Conclusion: Early OM of high pancreatic trauma, potentially leads to favourable outcomes, perhaps with fewer complications.

Background: Gallstone ileus is a surgical urgency exceptionally rare. It represents about 1-4% of all cases of intestinal obstruction and 25% of cases in subjects > 65 years. Patients and Methods: We reported the outcomes of urgent surgical treatments on 13 patients with gallstone ileus observed in the year 2007-2019. All patients presented an urgent clinical situation and underwent surgery within 48 hours of hospital admission. Results: The laparoscopic enterolithotomy has been the chosen treatment in 5 cases out of 13 patients, in one case the enterolithotomy with cholecystectomy, in 2 cases a duodenotomy has been privileged, in 2 cases a resection of small intestine (ileus), in one case a right colectomy. In another case, after executing a surgery for a strangulated incisional hernia because of the persistence of the intestinal stoppage, a further surgical operation was executed. During exploratory laparotomy was evident a perforation of small intestine at the level of the gallstone. In one case there was the spontaneous elimination of the gallstone. In one case the patient died for an intestinal perforation. No patient, subjected to enterolithotomy presented pathologies connected with the surgery. Conclusion: The laparoscopic enterolithotomy represents for us the privileged treatment of gallstones ileus because of the advanced age of the patients under observation and the concomitant presence of other pathologies. Consequently, the treatment in one stage was reserved only for patients at low risk.

Aims: Primary aim of the study was to evaluate effect of prolonged hospital stay on Surgical site infections. We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less days of hospital stay vs patients who had 5 or more days of hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (> 4 days) was significantly associated with surgical site infections (p0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

Background and purpose of the study: Anal fissure is a common benign anal condition, the gold standard treatment is lateral internal sphincterotomy (LIS), this procedure carry a risk of incontinence. The aim of this study is to determine the long-term risk of sphincter dysfunction after LIS using a questionnaire. Method: All patients who had LIS for chronic anal fissure between the years 2004 till 2010 were interviewed by phone and assessment of Sphincter function (incontinence) using Wexner fecal incontinence score (WIS). Results: 59 patients (34 females, 57.6%) with mean follow-up duration 10.6 years (range 8 – 15 years) were interviewed. Twelve patients (20.3 %) had WIS score of one or more. The majority of the patient noticed the change in sphincter function years after the operation. Conclusion: This long-term risk of abnormal sphincter function after LIS could be higher than expected especially in the presence of multiple vaginal deliveries or systemic disease such as Diabetes mellitus. Larger prospective studies are required before LIF is offered routinely to these patients.

Background: Performing a laparoscopic-assisted dissection of the pelvic lymph node in low advanced cancer rectum patients is a complicated surgical procedure with a high liability of surgical morbidity. Its safety needed further clarification. Objective: This study aims to compare the open pelvic lymph nodes dissection and the laparoscopic-assisted approach in the low advanced rectal cancer patients with clinically suspected nodal metastases in the term of safety, technical feasibility, and patients oncological outcomes. Patients and methods: Sixty patients of low advanced cancer rectum had reviewed. (30 cases) were underwent laparoscopic total mesorectal excision. The other 30 patients had operated by open procedure) in addition to lateral pelvic dissection. Results: The duration of operation in the laparoscopically assisted procedure was longer than the open one(p=0.003). The postoperative hospital stay was longer in the open group than in the laparoscopic group (P=0.043). No significant differences between both groups regarding the number of excised lymph nodes, disease recurrence, RFS, or OS rate. Conclusions: performing laparoscopic total mesorectal resection in addition to excision of the lateral pelvic lymph nodes is technically easy with less morbidity, accurate dissection, and faster recovery than the open approach in addition to comparable oncological results and similar patient survival.

Backround: Pancreatic cancer is one of the most challenging tumour worldwide, associated with a poor prognosis even in developed countries. To the best of our knowledge, there is no recent data available on pancreatic cancer in our country, Cameroon. Methods: We conducted a retrospective descriptive multicentre study in the city of Yaoundé, the capital city of Cameroon. Patients with a diagnosis of pancreatic head cancer, over a 6 year period from January 2012 to December 2017, were included. Results: We recorded 105 patients with a mean age of 55.61 years. There were 57 men (54.3%) and 48 women (45.7%). The commonest risk factor found in our patients was heavy alcohol use (n=46, 43.8%). The mean time from symptoms onset to diagnosis was 3 months. Jaundice was present in 91.4% of patients. At the time of diagnosis, the pancreatic head cancer was locally advanced or metastatic in 19% (n=20) and 47.6% (n=50) of cases respectively. Metastases were hepatic in 70% of cases. Histological type was obtained in 35 patients (33.3%) and it was a ductal adenocarcinoma in 33 of them. Only two patients out of the 105 identified (1.9%) were able to have a curative treatment (cephalic duodenopancreatectomy). All patients died during the 15 months following the diagnosis with a mean survival time of 2.5 months. Conclusion: Pancreatic head cancer is diagnosed at advanced stages in our environment and its prognosis is grim. Emphasis should therefore be placed on prevention and early detection.

Background: There is ongoing debate regarding the usefulness of laparoscopic pancreaticoduodenectomy. This study aimed to analyze all the randomized control trials published including the most recent one. Material and methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2. The random-effects models were used to summarise the relative risks, odds ratios, and mean differences as appropriate. Results: 4 RCTs were included consisting of 818 patients. 411 patients were in the laparoscopic group and 407 in the open pancreaticoduodenectomy group. Weighted baseline patient characteristics were similar except more patients with pancreatic adenocarcinoma and more males were there in the open pancreaticoduodenectomy group. There was no difference in-hospital stay,90 days complications rate, 90 days mortality, R1 resection, postoperative pancreatic fistula, delayed gastric emptying, post pancreatectomy hemorrhage, bile leak between the two groups. Operative time was more in the laparoscopic group. Blood loss [mean difference -132.12 ml (-172.60,-91.65)] and surgical site infection [Risk ratio 0.41 ( 0.17-1.0)] were significantly lesser in laparoscopic group. Conclusion: There was no benefit in-hospital stay or clinical outcomes after laparoscopic pancreaticoduodenectomy. Blood loss and surgical site infection were lesser in laparoscopic pancreaticoduodenectomy.

Introduction: Mini-invasive surgery in its various modifications is widely used for the surgical treatment of Hirschsprungs disease (HD) in children. The authors from different clinics joined the discussion on mini-invasive techniques with emphasis on the positive and problematic issues of this area of surgical treatment of HD. Aim: to evaluate the positive and problematic technical features of mini-invasive surgery in the treatment of Hirschsprungs disease in children. Material and Methods. Between October 2011 and January 2021, we treated 221 children with HD using a mini-invasive technique. Among them - 156 (70.59%) patients underwent TEPT without laparoscopic assistance and 65 (29.41%) children underwent laparoscopic-assisted TEPT. The results of general clinical and specific research methods were used for diagnosis. Results and Discussion: All children were operated on in one step, without conversion, no intraoperative complications took place. Coloanal anastomosis failure in the early postoperative period was noted in 2 (0.95%) patients. This complication was eliminated conservatively in one patient, and in case of another child this complication was corrected by stepwise open treatment. The postoperative intestinal problems in the remote period occurred in 55 (24.89%) children and were represented by: moderate stenosis of the coloanal anastomosis without delayed fecal discharge - 4 cases (1.81%), constipation - 9 (4.07%), partial fecal incontinence – 20 cases (9.05%) and enterocolitis - 22 (9.96%). Conclusions: Mini-invasive surgery is a modern effective method of surgical treatment of HD in children of all ages. Mini-invasive methods of surgical treatment of HD in children lead to 0.95% of early and 24.89% of late postoperative complications. The type of complications in the early and remote periods after HD correction depends on a wide range of factors.

Background: The flaps closure including natal cleft obliteration and eccentric closure are becoming more popular due to their lower rate of recurrence including both the lateral advancement adipo-fascio-cutaneous flap and the classic limberg flap. Objective: This study aimed to compare the results of the surgery for non-complicated pilonidal sinus with the lateral advancement adipo-fascio-cutaneous flap versus the classic Limberg flap. Patients and methods: This study was a prospective randomized controlled trial, and was conducted on patients with non- complicated pilonidal sinus attending Zagazig University Hospitals, Egypt during the period from February 2017 to August 2019. Patients were randomly assigned to undergo either lateral advancement flap (group A) or classic Limberg flap (group B). The follow-up period ranged from 12 to 36 months. Demographic characteristics, operative duration, hospital stay duration, patient satisfaction, complications and recurrence rates were analyzed and compared. Results: 101 (85 men and 16 women) patients (out of total 137 patients) were finally completed the study. Age of patients ranged from 18 to 42 years with a median age of 27.5 years in group (A), while in group (B) the age of patients ranged from 19 to 41 years with a median age of 27 years. There were no significant differences between the two groups in terms of length of hospital stay, complications rate, patient satisfaction, or recurrence rate. Conclusion: The lateral advancement adipo-fascio-cutaneous flap is as effective as the classic Limberg flap in the treatment of non-complicated pilonidal sinus with significant lower operative duration of the lateral advancement flap.

Background: The association between thyroid disorders and the risk of breast cancer is controversial. Estrogen levels affect thyroid function, resulting in thyroid disorders. Breast cancer is sensitive to estrogen. This study aimed to determine the role of thyroid disorders in patients with breast cancer as compared to the general female population. Methodology: A total of 69 breast cancer patients and 69 matched controls were included in the study. All the subjects diagnosed with breast cancer and the controls were examined for thyroid disorders by ultrasonography of the neck, fine needle aspiration tests, and thyroid function tests (TFT). Association between the variables was tested using Chi-square test and a P value of 0.05 was considered significant for the differences between two observations. Results: Ultrasonography of the neck and fine needle aspiration cytology showed positive cases (5.8% and 2.9%, respectively) as compared to controls which did not report any positive cases. The total prevalence of thyroid abnormality among the breast cancer cases was 18.84%. With respect to the TFT findings, abnormal test findings were commonly associated with breast cancer cases as compared to control (p=0.00624), and the odds of breast cancer were 7.6776 times more likely in patients with positive TFT results as compared to patients with negative results. Conclusion: Increased number of abnormal TFT results was significantly associated with breast cancer.

Introduction: To compare Submental Island flap versus pectoralis major myocutaneous flap as reconstruction options for large oral cavity defects after resection of malignant tumors. Patients and methods: This study is a retrospective observational cohort that included 44 patients from March 2009 to March 2018. In this study, we evaluated two options for oral cavity reconstruction: submental island flap (28 patients) and pectoralis major myocutaneous flap (PMMF) (16 patients), as regards the functional, aesthetic, and oncologic outcomes. Results: The mean operative time was 4.71 +- 1.88 hours, and the mean operative blood loss was 512 +- 186.42 ml. The mean hospital stay was 16.72 +- 10.77 days. The mean time to start of oral fluids intake was 14.1 +- 6.62 days. There were two postoperative deaths. Reconstruction related complications occurred in 21.4% in the submental island flap group and 6.2% in the PMMF group. Total flap loss was reported in 4 of our patients (9.1%) [3 submental 1 PMMF], while partial flap loss was reported in 3 submental flaps (6.8%). There was no statistical significance in functional outcomes except in feeding function. There was no statistical significance in aesthetic outcomes between the 2 groups. Conclusion: Pedicled flaps for oral cavity reconstruction especially submental island flap and PMMF are considered simple, timesaving, relatively safe, with minimal donor site morbidity.

Aims and objectives: The primary aim of our analysis was to do a systematic review and updated meta-analysis of literature published in the last 10 years and look for the association of neoadjuvant chemoradiation and risk of subsequent clinically significant pancreatic fistula. Methods: EMBASE, MEDLINE, and the Cochrane Database were searched for Studies comparing outcomes in patients receiving neoadjuvant chemoradiotherapy first with those patients who received surgery first in case of pancreatic cancer. A systemic review and Metanalysis were done according to MOOSE and PRISMA guidelines. Heterogeneity was measured using Q tests and I2, and p 0.10 was determined as significant. The Odds ratios (OR) and Risk Ratios (RR) were calculated for dichotomous data as per the requirement, and weighted mean differences (WMD) were used for continuous variables. Results: Twenty-six studies including 17021 patients finally included in the analysis. 339 patients out of a total of 3386 developed clinically significant pancreatic fistula in the neoadjuvant first group. 2342 patients out of 13335 patients developed clinically significant pancreatic fistula in the surgery first group. Neoadjuvant treatment significantly reduced the risk of subsequent clinically significant pancreatic fistula. (p= 0.0001). The number of patients with soft pancreas was significantly higher in the surgery first group. (p 0.0001). Pancreatic duct diameter mentioned in only two studies but there was no significant difference between both groups. [p=1].Blood loss was significantly more in the surgery first group.[ p 0.0001]. There was no difference in pancreaticoduodenectomy or distal pancreatectomy performed between both groups. (p=0.82). There was no difference in the number of borderline resectable pancreatic tumors between both groups. (p= 0.34). There was no difference in overall grade 3/grade 4 complications rate between both groups. (p= 0.39). Conclusion: Neoadjuvant treatments may be responsible for the lower rates of clinically significant pancreatic fistula after subsequent surgery.

Obturator hernia is a very rare form of abdominal hernia also known as e concluded that obturator hernia is rare, difficult to diagnose yet potentially fatal cause of intestinal obstruction in elderly patients. The surgical intervention is fairly safe obstruction in elderly patient. It is extremely difficult to diagnose in the absence of specific signs symptoms and frequently required small bowel (SB) resection. We presented three cases of obturator hernia in old lady patients, whom presented with intestinal obstruction. The diagnosis achieved with the aid of CT (computed tomography) imaging. All patients underwent little old lady's hernia, often presents as acute intestinal successful surgical intervention with good postoperative recovery. In conclusion, w with good postoperative outcome.

Background: Strangulated internal hernias are rare. They are defined by a protrusion of small bowel or other abdominal organs through a normal or abnormal orifice in the peritoneum or mesentery into the abdominal cavity that may lead to strangulation. Internal hernias may be congenital or acquired postoperatively (bypass surgery or liver transplantation). They are often asymptomatic and are often discovered during acute intestinal obstruction. CT scan has a key place for the preoperative diagnosis. Otherwise, internal hernias are often discovered during surgical exploration. Cases presentation: We report 3 cases of internal hernias revealed by acute intestinal obstruction to discuss diagnostic and therapeutic aspects. These were internal hernias through an abnormal orifice including 2 trans-mesenteric with necrotic small bowel and 1 trans-mesocolic without necrosis. A closure of the orifice were performed with and Bowel resection and anastomosis in case of necrosis. The post-operative course was uneventful in all cases. Conclusion: Strangulated internal hernia is infrequent. The preoperative diagnosis without CT scan is difficult. Exploratory laparotomy can confirm the diagnosis and its topography. The treatment consists of the reduction of the contents followed by a closure of the defect.

Papillary thyroid cancer (PTC) is the commonest thyroid cancer. It accounts for 85% of thyroid malignancy yet still highly curable. It carries only 5% of disease recurrence with appropriate surgery and nodal dissection. Disease relapse can occur as lymph node metastasis, true soft tissue local recurrence or systemically as a distant metastasis. High resolution neck ultrasound (US) and highly sensitive serum thyroglobulin (Tg) are being used as the standard surveillance tool. There were only a few documented granuloma mimicking recurrences of a well differentiated thyroid cancer in the literature, with positive uptake on FDG PET scan. A 40 year old lady presented with right neck swelling which developed two years after total thyroidectomy and bilateral lymph node dissection for papillary thyroid cancer. She was treated with radioactive iodide ablation once and subsequently showed no uptake on diagnostic WBS. She was asymptomatic throughout surveillance until serum anti thyroglobulin(anti-Tg) was detected to be elevated with normal serum thyroglobulin(Tg). Neck ultrasound identified a lesion at the right thyroid bed with atypical cell seen on ultrasound-guided fine needle aspiration cytology. Whole body scan was negative. Further FDG-PET scan showed positive uptake only in the right thyroid bed. She underwent excision of the lesion using continuous intraoperative nerve monitoring (c- IONM) but complicated with right recurrent laryngeal nerve palsy as detected by reduction of the amplitude. However, histopathology revealed the presence of only granuloma tissue without malignancy cell. Fortunately, her vocal cord function recovers after three months and subsequent serum Tg still normal with persistent slightly elevated anti Tg. Neck ultrasound showed no new lesion detected. Granuloma may mimic the recurrence of papillary thyroid cancer with a positive anti thyroglobulin and false positive FDG-PET scan. The diagnosis of granuloma instead of well differentiated thyroid cancer recurrence might be challenging in the absence of adequate tissue diagnosis. This is important as the need for redo surgery and the risk of unnecessary morbidity is avoidable. It is challenging to differentiate a granuloma from a well differentiated thyroid cancer recurrence in the presence of raised anti Tg and positive PDG-PET scan. Thorough investigation need to be done to avoid unnecessary morbidity of re-do surgery.

Abstract: The incidence of colorectal cancer during pregnancy is rare and often associated with management dilemma. Herein, we report a case of rectal cancer in pregnancy and review of literature. A 36 years old multiparous, pregnant lady, in her 31st week of gestation, presented with rectal bleeding progressing to spasmodic abdominal pain. Sigmoidoscopy revealed fungating mass 5cm from anal verge. Imaging studies and biopsy proved to be locally advanced rectal adenocarcinoma with no distant metastasis. She delivered her baby at 34th week of gestation and given neoadjuvant therapy followed by curative surgery. This case suggests that colorectal cancer can mimic pregnancy related symptoms and often present at advanced stage.

A separate group in the variety of non-epithelial tumors of the gastrointestinal tract are gastrointestinal stromal tumors (GIST), which have individual histological, immunohistochemical, and genetic characteristics. They also do not have pronounced features of clinical manifestations, diagnosis and prognosis and require a special approach to the choice of treatment tactics. The moment of prehospital diagnosis and obtaining histological samples of such tumors is very important in order to develop optimal treatment tactics. The article presents a clinical case of a giant extragastrointestinal stromal tumor localized in the leaves of the greater omentum, undiagnosed at the prehospital stage and causing the clinic of peritonitis. The established diagnosis required urgent surgical intervention and removal of the malignant tumor. Subsequent histological examination revealed signs of a stromal tumor, which determined further treatment tactics.

Typhoid fever is common in developing countries.Majority of these diseases are caused by Salmonella Typhi. Pancreatitis is one of the rare complications. It is being postulated that this organism transmits via haematogenous, lymphatic, or direct invasion into the biliary system. Just like other pancreatitis, it can evolve into acute necrotizing pancreatitis or pancreatic abscess, which carry high mortality and morbidity to the patient. From 2018-2021, we encountered two cases of Salmonella Typhi induced peripancreatic abscess and emphysematous necrotizing pancreatitis. The first case was treated with antibiotic as well as imaging-guided percutaneous drainage. The second case was treated with antibiotic alone. Both our patients recovered well without any complication and need for major pancreatic surgery. The average length of hospital stay and intravenous antibiotic was ten days. Salmonella Typhi pancreatitis and its complication are rare. Major pancreatic surgery can be avoided with prompt diagnosis and commencement of appropriate antibiotic treatment with or without minimal invasive drainage.

19 years old male presented with a case of acute abdominal and was subsequently diagnosed as a recurrent embryonal liver sarcoma. Surgical intervention was done and patient was well to be discharged without developing any complications. We believe this is the first case of recurrent embryonal liver sarcoma to be recorded. This case report is to bring about a new perspective regarding embryonal liver sarcoma as the outcome does not lie on recovery or mortality but, the possibility of recurrence and the potential impact to the patient, especially of the younger age group.