Post-cholecystectomy syndrome: A cohort study from a single private tertiary center.

Objectives: Although post-cholecystectomy syndrome (PCS) is a well-recognized complication, there are few reports arising from KSA. The effect of sleeve gastrectomy or endoscopic retrograde cholangiopancreatography (ERCP) stenting on the development of PCS is unknown. We aimed to measure the possible factors affecting the development of PCS, such as symptom duration, comorbidities, previous bariatric surgery, ERCP stent insertion, surgical intervention, conversion to open surgery and complication rate. Methods: This was a prospective cohort and observational study conducted at a single, private tertiary center. We included 167 patients who underwent surgery for gallbladder disease between October 2019 and June 2020. The patients were classified into two groups according to their PCS status (PCS+ vs. PCS-). Results: Thirty-nine patients were PCS+ (23.3%). There was no significant difference between the two groups with regards to age, gender, BMI, ASA score, smoking, comorbidities, duration of symptoms, previous bariatric surgery, ERCP, stent insertion or sphincterotomy. Chronic cholecystitis was the predominant histopathology in 83% (139/167) of patients. The most frequent causes of PCS included biliary system dysfunction, bile salt-induced diarrhea, gastritis, gastroesophageal reflux disease, and retained stones. Overall, 71.8% (28/39) of patients had incident PCS; the remaining patients had persistent PCS. Conclusions: PCS is a neglected complication that was observed in 25% of patients mainly in the first year. Surgeon awareness can assist with patient diagnosis, preoperative selection and education. Furthermore, the history of ERCP stenting, sphincterotomy, or sleeve gastrectomy seems to be unrelated to PCS development.

Omental infarction present with right upper quadrant pain, case report.

Omental infarction is a rare cause of pain and must be considered in the differential diagnosis of acute abdomen. It arises in any quadrant that contains omentum when a compromised blood supply takes place. We report a morbid obese 45-year-old male with Diabetes mellitus, dyslipidemia and coronavirus-disease-related pneumonia 2 months prior to his emergency presentation with acute epigastric and right upper quadrant pain. The patient was investigated by computed tomography (CT), and the provisional diagnosis was biliary colic from gallbladder stone. The patient's pain was severe and not compatible with biliary colic. Diagnostic laparoscopy approached and an incidental finding of omental necrotic area. Excision of the infarcted omentum in addition to cholecystectomy was done. The patient's postoperative course was uneventful, and he was discharged home after 2 days. In our case, the CT image did not discover mental changes that may help us to make a preoperative diagnosis.

Analysis of 190 Female Patients after Appendectomy.

This study is a retrospective cohort review carried out at a single, private tertiary center. We included 190 female patients who underwent surgery for acute appendicitis between January 2016 and December 2018. Two groups of patients were analyzed based on the pregnancy. The main outcome measures were complication rate and risk of abortion during or after surgery. Out of 190 female patients, eight of them were pregnant (4.2%). The pregnant group more significantly underwent ultrasound investigation compared to the nonpregnant group. Complicated appendicitis present in two pregnant patients at advanced gestational age was not statistically significant from nonpregnant. Laparoscopic appendectomy was performed in 6/8 (75%) of pregnant compared to 158/182 (87%) in nonpregnant (p = 0.415). Compared to the nonpregnant, the pregnant group has a more fecolith, positive peritoneal fluid culture, and wound infection, with E. coli more frequently isolated in 25%. None of the pregnant patients had an abortion, preterm labor, or mortality during or after surgery. In conclusion, laparoscopic appendectomy is a low-risk operation for pregnant with acute appendicitis.

Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy.

BACKGROUND Ectopic liver (EL) is liver tissue that is not attached to the mother liver, and is also known as choristoma and hepar succenturiatum. According to Watanabe's 1060-patient series, it has an incidence rate of less than 1% (0.47%). The absence of an anatomical attachment to the hepatic proper is a rare congenital departure from the norm, known as EL. EL is thought to be caused by abnormal hepatic tissue growth from the foregut diverticulum, particularly at cystic structures. CASE REPORT We report the successful management of a 47-year-old male patient, not known to have any medical illness, who was referred to the surgical team with a clinical picture of biliary colic. An ultrasound (US) abdomen was performed, and cholecystitis was confirmed. During a laparoscopic cholecystectomy, ET was identified by chance. He tolerated the operation well. Gallbladder histological examination revealed significant mucosal and wall ulcers, chronic inflammation, many black stones, no dysplasia or malignancy, and connected liver tissue measuring 12×5 mm. As a result, chronic calcular cholecystitis was confirmed, as was normal EL architecture and no evidence of malignancy. CONCLUSIONS We conclude that EL is a rare condition, but there have been cases reported in the literature. Imaging modalities such as US and computed tomography scans are recommended to rule out other underlying diagnoses and should be tailored to each individual when necessary. Because the presence of EL attached to the vesicle is a rare occurrence in the literature, a histological examination is required due to the elevated risk of hepatocellular carcinoma. Keeping such an abnormality in mind can help surgeons demarcate the embryological plane of dissection during cholecystitis to avoid tumor cell spillages if present.

Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients.

BACKGROUND: There have been few studies describing the use of indocyanine green (ICG) fluorescent imaging during robot-assisted (RA) sphincter-saving operations (SSOs) and assessing its potential role in reducing anastomotic leak (AL). METHODS: A consecutive cohort of 436 rectal cancer patients who underwent curative RA SSOs were prospectively enrolled during 2010-2014, including 123 patients with ICG imaging (ICG+ group) and 313 patients without ICG imaging (ICG- group). RESULTS: ICG imaging appeared to be helpful in identifying competent perfusion of the bowel adjacent to the anastomosis in 13 patients (10.6%) who might be susceptible to bowel ischaemia, including restrictive mesocolon. AL was remarkably greater in the ICG- group compared with the ICG+ group (5.4% vs 0.8%; p = 0.031). CONCLUSIONS: ICG imaging during RA SSO provides accurate real-time knowledge of the perfusion status at or near the anastomosis, specifically reducing AL in patients who may incur bowel ischaemia. Copyright © 2015 John Wiley & Sons, Ltd.