Epiphrenic esophageal diverticulum (ED) is a rare entity usually associated with a concomitant esophageal motility disorder (EMD). Proper evaluation of ED dictates subsequent management strategy. The best surgical approach, indication, treatment of motility disorder, the addition of an antireflux technique, and the resection of the diverticulum are still debated. The pathophys-iology and the surgical management of this rare disease are reviewed in the present article. Key words: Epiphrenic diverticulum. Esophageal diverticula. Pathophysiology. Surgical treatment. Laparoscopy. Thoracoscopy. Minimally invasive surgery

Objective. This study was conducted to compare the outcome between Laparoscopic Total Extraperitoneal (TEP) and Open Lichenstein Repair (LR) for unilateral uncomplicated inguinal hernia. Methods. This was a Randomized Controlled Trial from March 2012 to September 2012.Data were collected on patient de-mographics, duration of operation, pain scores, length of hospital stay, time to return to work and post operative complications. Results Total of 86 patients were enrolled in this study and randomized to laparoscopic (TEP) and open (LR) groups involving 42 and 44 patients. There was no significant difference in mean operation time in the open group compared to the laparoscopic group ( p=0.949).In laparoscopic TEP group, the mean length of return to work was 6.75 days while in the open LR group was 8.91 days (p=0.012).There was no statistical difference in all postoperative complications except postoperative wound infection (p=0.013) and groin pain at one week postoperatively (0.032) which favors TEP group.

Plasties are treatments without tension, given the low rate of recurrence and chronic pain they cause. The aim of this study is to discuss the techniques and results of two types of plasty surgery in inguinal hernias in adults: the prosthetic plasty and fascial plasty. Patients and methods: this is a double study (Study A and Study B) made the General Surgery Service of the University Hospital Aristide Le Dantec. A The study is a prospective descriptive study of 7 years (March 2009-March 2016), involving 115 cases of treatment of uncomplicated inguinal hernia plasty of fascial oblique. They were 100 men (94.8%) and 6 women (5.2%) with a mean age of 42.7 years. Study B was a retrospective study of 11 years (from December 2003 to December 2013). They were 76 men and 3 women, average age 57.2 years. Results: In study A, the average operative time was 34.8 minutes. Morbidity was 8.5%. Chronic postoperative pain was noted in 11.3% of cases. Two cases of recurrence (1.7%) were observed with a mean of 73.08 months. In study B, morbidity was 12.6%. The rate of chronic pain and recurrence was similar (0.9%), with a mean of 76 months. Conclusion: plasty is in the treatment of inguinal hernias, the best surgical approach. The choice between autoplasty and alloplasty based on the ratio between the results of each techniques. Keywords: inguinal hernia; prosthesis; recurrence; Chronic Pain

Autologous fat grafting (AFG) is an easy and safe surgical procedure performed by plastic surgeons to correct breast contour deformities following breast cancer surgeries. However, conflicting results from clinical reports have led to the lack of consensus regarding the optimal AFG method. AFG can be divided into 3 main procedural steps: harvesting, processing, and grafting, each of which can significantly affect the viable and functional aliquot of adipocytes and thus influence the graft reabsorption rate. Here, we describe the AFG protocol that we routinely perform in our clinical practice to correct contour deformities following breast reconstruction. Our protocol involves the use of an all-in-one, closed circuit device that enhances the ease and standardi-zation of the process, while maximizing its sterility. The harvested adipose tissue is centrifuged at 1260 g for 3 minutes to re-move the oil and serous fractions, and is then retrogradely injected in a multi-layered and multidirectional manner

Background: Neuroendocrine carcinoma (NEC) is a rare entity which accounts less than 2% worldwide. Its non-specific presentation posed a challenge for diagnosis. Case Presentation: We present a 53-year-old Malay lady presented with epigastric pain and constitutional symptoms. Imaging re-vealed a suspicious mass within the gall bladder. She was scheduled for a radical cholecystectomy. The tumour was found to extend beyond the liver and colon. A segmental liver resection and transverse colectomy was performed. Postoperative recovery was une-ventful. Histopathology came back as neuroendocrine tumour of the gall bladder. Conclusion: A high index of suspicion is needed to diagnose a rare entity such as this. An early detection may improve patients? survival.

Cholecysto-colonic fistulas are a rare complication of gallbladder pathology. Presentation may vary from completely asympto-matic to unexplained diarrhea and malabsorption. Due to non-specific symptomatology, these fistulas are usually diagnosed intra-operatively. We present a case of 56 year old female who underwent an elective cholecystectomy for recurrent biliary colic at our unit. Intra-operatively, a fistulous communication was found between the gallbladder and hepatic flexure of colon. This was treated with subtotal cholecystectomy and primary fistula closure. Cholecysto-colonic fistulas are a rare presentation of gallbladder disease and a high index of suspicion is required for pre-operative diagnosis to facilitate early prompt intervention.

Introduction: Ampullary adenomas are rare lesions but in the era of endoscopy their incidence seems to be more often. Although they are benign, they have the potential of becoming malignant and thus their excision is incumbent. Case presentation: We present a case of 72-year old female which was found to have a large (>5cm) papillary tumor that was not possible to be removed endoscopically. A biopsy was carried out which revealed an adenoma with low grade dysplasia. Abdominal CT and MRI imaging, revealed no signs of lymph node or loco-regional metastases. Due to the co-morbidities of the patient, a transduodenal excision was performed and the post-operative course was uneventful. Final pathology of the specimen confirmed the initial diagnosis with clear resection margins. Conclusion: Ampullary adenomas, usually, can be remover by endoscopy, however in case of large tumors; radical excision (i.e. transduodenal excision, pancreatoduodenectomy) is preferred. However, in case of a possible underlining malignancy pancreatoduodenectomy is the treatment of choice. Preoperative staging is crucial, in order to apply the ideal treatment strategy while radical procedures has still higher morbidity and mortality.

Duodenal gangliocytic paraganglioma is an extremely rare benign tumour which commonly located in the second part of duodenum. Patients can either presented with upper gastrointestinal bleeding, abdominal pain or symptomatic anaemia. It is frequently mistaken for gastrointestinal stromal tumour (GIST) or neuroendocrine neoplasm during upper endoscopy and on computed tomography (CT) imaging. The diagnosis is based on histopathological presence of epithelioid, spindle-shaped and ganglion-like cells. It can either be resected surgically or endoscopically with a clear margin. Endoscopic submucosal dissection (ESD) is preferred if the location, depth and lymph nodes status are favourable. Surgical excision is reserved for tumour not amenable for endoscopic resection. Adjuvant therapy is not indicated after complete resection of the tumour. We report a rare case of duodenal gangliocytic paraganglioma and review the latest literatures

Management of MEN2a is conditioned by the mutation of the RET gene. Aim of this study is to discuss the diagnostic and surgical strategy. Case report: seventy-year-old woman is admitted for hyperparathyroidism. Examination found a good general condi-tion and a nodular goiter. Biology found a Medullary Carcinoma of the Thyroid (MTC) and a pheochromocytoma. It was a MEN2a. Left adrenalectomy was performed, followed by right thyroidectomy with lymphadenectomy and parathyroidectomy. Pathological examination of the surgical specimens found a pheochromocytoma, a MTC and a parathyroid hyperplasia. Genetic analysis did not find a mutation in the RET gene. Conclusion: management strategy relies mainly on the existence of MTC, which is the main prognostic factor. Absence of mutation of the RET gene in the index case is a rare situation and can modify the ma-nagement.

Preduodenal portal vein commonly present in neonate and delayed presentation in adulthood is rarely reported. We presented a case of preduodenal portal vein in a man who presented with features of ascending cholangitis. Physical examination was unremark-able. An ultrasound of the biliary system demonstrated gallbladder stone with dilated left intrahepatic ducts. The right hepatic duct and common bile duct were spared. ERCP revealed a small common bile duct and intrahepatic duct with distortion of the ampulla. CT abdomen shows malrotation of the gut with preduodenal portal vein and abnormality of the intrahepatic inferior vena cava. MRCP showed a normal caliber of biliary tree except for a small abrupt tapering at the common channel. Otherwise the anatomical location of pancreatic duct is normal. We are reporting our unique case and the radiographic images are discussed. The literature of PDPV with other visceral organs anomalies are reviewed

Metabolic imaging with Fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT scan has been shown to be more effective than the conventional computed tomography (CT) scan in differentiating benign and malignant focal lesion. However, false positive findings of FDG-PET-CT should always be considered in a patient with an increased FDG uptake lesion as it is not a tumour specific agent and its? uptake can be seen both physiologically in healthy tissue and in benign diseases. Hence, it become a challenge for a nuclear medicine physician in interpreting the FDG-PET-CT result and a dilemma for a surgeon in considering the best treatment modality for a patient. We report a case of necrotising granuloma of pectoralis minor muscle which was initially suspected a metastatic lesion of left parapharyngeal squamous cell carcinoma (SCC) via FDG-PET-CT scan and discuss the factors causing the false positive findings.