[Laparoscopic treatment of an adult gastric duplication cyst]. / Traitement laparoscopique d'une duplication gastrique chez l'adulte.

We hereby report the case of a 24 years old woman with an adult gastric duplication cyst, a very rare congenital disease. Diagnosis was established on preoperative imaging tests. Complete resection of the duplication cyst was undertaken laparoscopically. To the best of our knowledge, this is the first report of laparoscopic resection of an adult gastric duplication cyst.

[Acute appendicitis in kidney transplantation: value of laparoscopy]. / Appendicite aiguë chez le transplanté rénal: intérêt de la voie laparoscopique.

Right iliac fossa pain in renal transplant recipients can raise diagnostic and therapeutic problems. The authors present two cases of acute appendicitis in renal transplant recipients treated by laparoscopy.

Surgery for biliary obstruction by tumour thrombus in primary liver cancer.

Five patients with primary liver cancer presented with obstructive jaundice due to extension of tumour thrombus into the biliary ducts. Three patients had hepatocellular carcinoma, two of whom had alcoholic cirrhosis, and the other two had a peripheral cholangiocarcinoma. Preoperative diagnosis of biliary thrombus was best achieved by ultrasonography and computed tomography which showed peripheral hepatic tumour with dilated bile ducts containing dense material. All patients underwent liver resection associated with biliary exploration, clearance and T-tube drainage. Major hepatectomy was required in four cases. There were no postoperative deaths; one patient developed a subphrenic collection of bile which was drained percutaneously. All patients survived more than a year; median survival was 29 months. There are two long-term survivors without recurrence at 29 and 80 months. Patients with primary liver cancer and jaundice due to migrated tumour fragments in the common bile duct may benefit from surgical resection which can result in long-term resolution of symptoms and occasional cure.

Reuse of a liver graft five days after initial transplantation.

Brain death is a possible complication of orthotopic liver transplantation (OLT). In these cases, if the liver graft continues to function normally it could be resued for another recipient. To our knowledge this is the second reported case of liver graft reuse after brain death of the first recipient.

Intrahepatic cholangiocarcinoma. Results of aggressive surgical management.

OBJECTIVE: To report the results of a deliberately aggressive surgical management in patients with intrahepatic cholangiocarcinoma. DESIGN: A case series of patients with intrahepatic cholangiocarcinoma. SETTING: A tertiary care university hospital in a metropolitan area. PATIENTS: From 1989 to 1993, 19 patients with intrahepatic cholangiocarcinoma underwent laparotomy, with a 74% resectability rate (14 liver resections). In addition, two selected patients with a slow-growing tumor underwent orthotopic liver transplantation after limited recurrence following resection in one case and after exploratory laparotomy in the other. INTERVENTIONS: The 14 liver resections included six right or left hepatectomies and eight extended right or left hepatectomies. Total vascular exclusion of the liver was used in nine cases (64%) and resection of the biliary confluence with reconstruction was used in six cases (43%). RESULTS: There was one postoperative death (7%). There were four postoperative biliary fistulas (28%). Overall actuarial 1- and 2-year survival rates were 58% and 32%, respectively. The 1- and 2-year survival rates were 100% after curative resection (no lymph node invasion, clearance margin of < or = 1 cm, and solitary tumor [five cases]) and 48% and 10% after palliative resection. Median survival was 14 months for the whole series and 27 and 9 months following curative and palliative resections, respectively. The two liver transplant recipients are alive and free of disease at 25 and 31 months. CONCLUSION: These results support aggressive surgical management in patients with intrahepatic cholangiocarcinoma, including complex liver resection procedures and selective use of orthotopic liver transplantation.