Suprahepatic gallbladder with hypoplasia of the right lobe of the liver.

One of the rarest congenital anomalies of the gallbladder is the suprahepatic variant of this organ. Three cases of this ectopia were seen in a ten-year period, all of which associated with hypoplasia of the right lobe of the liver and upward displacement of the hepatic flexure of the colon, which overlapped the liver border. All patients complained of recurrent pain in the right upper quadrant of the abdomen, suggestive of biliary disease, but only one case had calculi in the gallbladder that was acute cholecystitis. Two patients underwent cholecystectomy, and operative findings confirmed the preoperative diagnosis. It is speculated that the primary defect in this modality of suprahepatic gallbladder might be hypoplasia or atrophy of the right lobe of the liver of a congenital nature, with subsequent vicious orientation of the gallbladder and upward displacement of the colon.

New technique of pancreaticojejunal anastomosis after partial pancreaticoduodenectomy.

The authors propose a new technique of pancreaticojejunal anastomosis after pancreatoduodenectomy with the aim of reducing the incidence of anastomotic disruption and late stenosis of the duct. Basically the technique consists of end-to-end pancreaticojejunal anastomosis with invagination of the pancreas into the intestinal loop and mucosal juxtaposition of the pancreatic duct and jejunum.

Anthropometric assessment of nutritional depletion after surgery injury.

Triceps skinfold (TS), arm muscle circumference (AMC) and body weight (BW) were studied prospectively in 20 adults, admitted to elective operations on the digestive tract, in order to evaluate these anthropometric parameters in planned surgical procedures performed in non-critically ill, non-stressed patients. Mean duration of the preoperative period was 19.2 days (range 1--38), and of the postoperative period, 14.1 days (range 6--31). Mean changes for BW were, respectively, -0.2% and -2.5%, AMC decreased -0.5% before operation and -3.4% afterwards, and TS was reduced to -1.9% in the preoperative phase, and to -8.4% postoperatively. These results are consistent with minimal anthropometric changes during the presurgical stay, with more striking decreases after operative injury. Postoperative findings were further examined in relationship to degree of surgical trauma and length of postoperative hospitalization. After the arbitrary selection of a 10% reduction as the limit for significant decrease in any of the analysed parameters, the percentage of impaired measurements was determined in the sub-groups of medium and large operations, two consecutive procedures, as well as postoperative stay of 6 to 14 days, 15 to 21 days, and over 3 wks. Decreased parameters comprised 6.0% (2/33) of the observations after moderate surgical manipulation, 27.7% (5/18) after serious trauma, and 66.6% (6/9) after two operations. Simarilarly they represented 2.7% (1/36) of the findings in patients discharged within 2 weeks, 33.3% (4/12) in those staying between 2--3 weeks, and 66.6% (8/12) in the cases remaining for longer periods. Despite the limited sensitivity of anthropometric parameters in the detection of acute moderate changes in body constitution, they were useful in separating the patients undergoing medium surgical injury from those subjected to more severe metabolic stress, when only changes greater than 10% of initial value were considered.