Surgical outcome of extrahepatic portal venous obstruction: Audit from a tertiary referral centre in Eastern India.

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

Surgical outcomes after re-operation for excision of choledochal cyst with delayed biliary complications: A retrospective study on 40 patients.

PURPOSE: The purpose of this study is to review our experience in patients who underwent re-operation for delayed biliary complications after choledochal cyst (CDC) excision. METHODS: All the patients who underwent re-operation. for delayed biliary complications after CDC excision between August 2007 and July 2020 were included in this retrospective study. The outcomes of these patients were compared with those who underwent primary surgery (CDC excision) at our institution. RESULTS: Of the total 40 patients with delayed biliary complications, 25 (62.5%) were female. Thirty-seven (92.5%) patients had a history of cholangitis. The median interval between CDC excision and the reoperation was 70 (4-216) months. The median duration of symptoms before reoperation was 12 (2.5-84) months. Re-do hepaticojejunostomy and direct hepaticojejunostomy were performed in 34 and in 6 patients respectively. Median operative time and blood losses were 219 min and 150 ml respectively. The median postoperative stay was 9 days. Postoperative complications developed in 10 (25%) patients. There was no operative mortality. Over a median follow-up of 71 months, a satisfactory outcome was achieved in 86% of patients. Restricture and intrahepatic stones developed in three and two patients respectively. Incidence of type IV cyst, cholangitis before operation, and operative blood loss were significantly more in the re-operative group. Clinical outcomes like the incidence of recurrent cholangitis, re-stricture, and postoperative hospital stay were comparable between the two groups. CONCLUSION: Surgery affords excellent results for majority of the patients with delayed biliary complications after CDC excision. Type IV cysts are more commonly associated with the development of delayed biliary complications.

Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis.

BACKGROUND: The literature on predictors for postoperative complications after Frey procedure (FP) is sparse. The aim of this study is to report our experience with 90-day complications of FP and predictors for complications. METHODS: All patients with chronic pancreatitis (CP), who underwent a FP between August 2007 and July 2021, were retrospectively reviewed. Univariate and multivariate analysis were used to identify predictors of 90-day morbidity and mortality. RESULTS: Of the total 270 patients, 84 (31%) patients developed at least one postoperative complication. Major complications occurred in 32 (12%) patients. Most common complication was wound infection and it was significantly more common in stented patients (p = 0.017). Pancreatic fistula and post pancreatectomy hemorrhage (PPH) developed in 7.4% of patients. Thirteen patients (4.8%) required early re-operation and the most common cause of re-exploration was PPH. 90-day mortality was 1% (n = 3) and all 3 patients required re-exploration for PPH. Median postoperative hospital stay was 9 (5-51) days. Perioperative blood transfusions was the only independent predictor of postoperative complications after FP. CONCLUSIONS: Frey procedure is an acceptable treatment modality with low rates of mortality and reasonable perioperative morbidities. Minimizing blood transfusions may further improve 90-day outcomes.

Clinical Profile of Hepatoblastoma: Experience From a Tertiary Care Centre in a Resource-Limited Setting.

Background Hepatoblastoma (HB) is a rare neoplasm of the liver, accounting for about 1% of all pediatric cancers. The aim of the present study is to report our experience with HBs over a period of five years from a tertiary center in Eastern India. Methodology This is a retrospective observational study. The data of all patients who were diagnosed with HB between August 2015 and December 2020 was reviewed. Results Twenty-three patients who were diagnosed and treated for HB at our center were included in the study. Sixteen (69.5%) of them were male. The median age of presentation was 14 (range, 3-58) months. An abdominal lump (n=23, 100%) and abdominal pain (n=11, 47.8%) were the most common presenting symptoms. The median level of serum alpha-fetoprotein at the time of initial evaluation was 8000 (878-1,280,000) ng/dL. The mean size of the largest focus in its largest dimension was 12.03±3.77 cm. The epithelial variant (n=22, 95.7%) was the most common histological subtype. One (4.3%), 10 (43.4%), 11 (47.8%), and one (4.3%) patient were found to have pre-treatment extent of tumor (PRETEXT) stages 1, 2, 3, and 4, respectively. Fifteen (65.2%) children were classified as standard risk and seven (34.7%) children as high risk. All the patients received neoadjuvant chemotherapy (NACT). The most commonly performed surgery was right hepatectomy (n=12, 52.1%). There were three (13%) cases of perioperative mortality. Four postoperative complications developed in three (13%) patients. Four (17.3%) patients developed chemotherapy-related complications. The median duration of follow-up was 31 (range, 0-58) months. Three (13%) patients developed relapses of the disease. Overall, five-year survival in our series was 73.9%. Conclusion This study shows that the overall outcomes of HB in a resource-limited setting such as ours are good with the adoption of multi-modality treatment. Managing chemotherapy-induced complications and making liver transplantation more feasible will improve the results further.

Clinical profile and outcome of solid pseudopapillary neoplasm of the pancreas: A retrospective study on 28 patients.

BACKGROUND: Solid pseudopapillary neoplasms (SPN) of the pancreas are rare tumors accounting for 0.9-2.7% of all exocrine pancreatic tumors. Very few studies comprising of more than 10 patients have been published. The aim of the present study is to report on our experience with SPNs over a period of 14 years from a tertiary center of Eastern India. METHODOLOGY: Data of all patients whose histopathology reports of surgically resected specimen confirmed SPN were retrospectively reviewed in the present study. RESULTS: Twenty-eight patients had a pathologically confirmed diagnosis of SPN. Twenty-five (89.3%) patients were females with a median age of 26 (15-45) years. Abdominal pain (89.2%) was the most common presenting symptom. Abdominal mass was palpable in 12 (42.8%) patients. The mean size of the tumor was 9.03 cm (range, 4-25 cm). The most common location of the tumor was in the body and tail of pancreas (35.7%). The most commonly performed operation was distal pancreaticosplenectomy (n = 17, 60.7%), followed by Whipple's procedure (n = 8, 28.5%). Thirty postoperative complications developed in 23 (82.1%) patients. The operative mortality was 3.5% (n = 1). The median hospital stay was 10 (5-25) days. Over a median follow-up period of 36 months (range), no patient developed recurrence. CONCLUSION: Although the size of tumor was quite large at the time of initial presentation, complete surgical resection was possible in all the patients. In experienced hand, surgery can be performed with acceptable perioperative mortality and excellent long-term outcomes.

Outcome of surgery for chronic pancreatitis related pancreatic ascites and pancreatic pleural effusion.

BACKGROUND: An internal pancreatic fistula involves an abnormality in the way that the pancreas communicates with organs and spaces within the body. This is usually due to a disrupted pancreatic duct or psuedocyst leakage (Ascitic or pleural fluid amylase level >1000 S units/dl and fluid protein level >3 g/dl). The study aims to report our experience with surgery for chronic pancreatitis-related pancreatic ascites and pancreatic pleural effusions. METHODS: All the patients, who underwent surgical intervention for pancreatic ascites and pancreatic pleural effusion between August 2007 and December 2020 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed. RESULTS: Of the total 14 patients, 10 (71.4%) were men with a median age of 40 (4-49) years. The median interval between onset of symptoms of CP and diagnosis of IPF was 27 (3-60) months. All patients had a history of chronic abdominal pain and 5 (35.7%) had a prior history of hospitalization for pain. Eleven patients (78.5%) presented with abdominal distension and 3 (21.4%) patients had respiratory distress. Six (42.8%) patients had undergone endotherapy before surgery. Contrast-enhanced computed tomography detected pancreatic pseudocyst in 10 (71.42%) patients. The most commonly performed operation was lateral pancreaticojejunostomy (n = 11, 78.5%). Seven postoperative complications developed in 4 (28.5%) patients. After a median follow-up of 60 (6-86) months, no patient developed recurrence of pancreatic ascites or pleural effusion. CONCLUSION: In the experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.

Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience.

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n = 2), ganglioneuroma ( n = 1), adenoma ( n = 10), and adenocarcinoma ( n = 4) were excluded. Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24-61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4-180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n = 7, 77.7%), or extramural extension of the tumor ( n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.

Peripancreatic arterial pseudoaneurysm in the background of chronic pancreatitis: clinical profile, management, and outcome.

BACKGROUND: Bleeding pseudoaneurysm (PSA) is a rare but potentially lethal complication of chronic pancreatitis (CP). It requires expeditious management by a multidisciplinary team. The study aims to report our experience with PSA in the background of CP. METHODS: All the patients, who underwent intervention for CP-related PSA between August 2007 and December 2020 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed. RESULTS: Of the total 26 patients, 25 (96%) were men with a median age of 38 (11-63) years. The most commonly involved vessel was the splenic artery (n = 18, 69%). The interval between onset of GI bleed and intervention was 7 (0-120) days. Embolization was attempted in 11(42%) patients and was successful in six patients. Surgery was performed in 20 (77%) patients including five patients after failed embolization. The most commonly performed operation was distal pancreatectomy with splenectomy. The median operating time was 216 (115-313) minutes. The median intraoperative blood loss was 325 (100-1000) ml. Seventeen (85%) patients' required intraoperative blood transfusion. Four patients in the embolization group and five patients in the surgical group developed procedure-related complications. The most common postoperative complication was wound infection followed by pancreatic fistula. There was no procedure-related death. Over a median follow-up of 24 (6-122) months, no patient developed recurrent hemorrhage. CONCLUSIONS: Both embolization and surgery play an important role in the management of PSA. The choice of procedure depends upon the local availability and feasibility of a particular technique.

Pattern of uropathogens and antibiotic sensitivity in diabetes patients attending to out - Patient department and diabetes clinic of a teaching hospital: A cross-sectional study.

INTRODUCTION: Diabetes mellitus is the most common endocrinological disease associated with different life-threatening infections. Urinary Tract Infection is one of them which may lead to Intensive care Unit admission and even death. In this study, we would like to find out the spectrum of uropathogen and its antibiotic sensitivity, so that we can choose empirical antibiotics early to save lives. AIM AND OBJECTIVES: To find out spectrum of uropathogens in Diabetic patients attending to Diabetes Clinic of a tertiary hospital and to find out the Antibiotic sensitivity pattern in isolated bacteria. MATERIAL AND METHODS: In this cross-sectional observational hospital-based study, consecutive patients of any age and gender having Diabetes mellitus and symptoms of Urinary Tract Infection, who attended Out-patient Department and Diabetes Clinic of General Medicine Department from August 2020 to October 2020, were included. After taking consent and brief history, mid-stream clean catch urine sample was collected in sterile container and sent to a Microbiology laboratory for culture of micro-organism and sensitivity to antibiotics. RESULTS: Among 202 diabetic patients recruited in our study, 138 (68.31%) were female and 64 (31.69%) were male. The mean age of all participants was 50.23 ± 11.45 years. Culture confirmed UTI was 24.3% and patients showing classic UTI symptoms were 32.7%. Compared to male, most of the culture-positive and symptomatic patients were female (26.0% and 37% respectively). Culture-positive patients who showed classic UTI symptoms were 42.42%; however, we found 15.44% asymptomatic patients who showed culture positivity. The mean HbA1c level was 7.5 ± 1.6%. Subgroup analysis revealed that patients with HbA1c >7.5% were at a significantly higher risk of developing culture-positive UTI (P < 0.00001, Odds ratio 21.71). Prevalence of gram-negative and gram-positive bacteria were 65.3% (32 out of 49) and 28.57% (14 out of 49), respectively. The major organism isolated were Escherichia coli (39%), Klebsiella spp. (19%), Enterococcus spp. (12%), Staphylococcus aureus (12%), and Candida spp. (6%). The sensitivity pattern of the gram-negative bacilli showed the presence of Extended-spectrum betalactamases (ESBLs) in 36.84% (11 out of 32 isolates). The bacteria grown were most sensitive to Piperacillin-tazobactam (100%), Cefoperazone-sulbactam (100%) and Meropenem (100%) whereas Fluoroquinolone and Co-Amoxyclav showed least sensitivity (43.8% and 37.5% respectively). The Staphylococcus spp. showed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid whereas Penicillin-G and Ampicillin showed 12.5% sensitivity. The Enterococcus spp. revealed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid, and Fosfomycin. Drug resistance is emerging in clinical isolates. Prevalence of ESBL in Enterobacteriacea was found to be 34%. CONCLUSION: All patients with diabetes must be searched for urinary tract bacterial colonization by simple routine urinary culture even though they are asymptomatic. Resistance to common antibiotics, particularly to oral formulations (especially Fluoroquinolones and Ampicillin) is increasing day by day due to indiscriminate use of antibiotics. This study highlighted that the policy makers should formulate antibiotic policy for rational use of antibiotics, which could help clinicians to prescribe proper antibiotics. However, regular monitoring of susceptibility pattern of urinary pathogens is essential.

ALCOHOLIC VS. NON-ALCOHOLIC CHRONIC PANCREATITIS: SURGEONS' PERSPECTIVE FROM A TERTIARY CENTRE IN INDIA.

BACKGROUND: Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. AIM: To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. METHOD: All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. RESULTS: From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. CONCLUSION: Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

Perioperative outcome of Whipple's procedure with special attention to the impact of preoperative biliary drainage: a real-life scenario.

The aim of the present study is to report the overall perioperative outcome of Whipple's procedure (WP) with particular attention to the impact of preoperative biliary drainage (PBD) on postoperative clinical outcome. All the patients who underwent WP at our institution between August 2007 and December 2019 were retrospectively reviewed. Impact of PBD and the stent-surgery interval on the postoperative clinical outcome of WP were analyzed. Of the total 404 patients, 254 (63%) were male. The median age at operation was 50 years. The overall morbidity was 57.7%. The most common complication was surgical site infection (SSI) (28.7%). POPF developed in 57 (14.1%) patients. Delayed gastric emptying, intra-abdominal collection, and postpancreatectomy hemorrhage developed in 82 (20%), 23 (5.7%), and 18 (4.5%) patients, respectively. PBD was performed in 175 (43%) patients. The median stent-surgery interval was 59 days. Postoperative overall complications and SSI were significantly more common in PBD patients. No significant difference in postoperative major complications or mortality was observed between PBD and no-PBD patients. Stent-surgery interval more than 6 weeks was not associated with increased postoperative complications or hospital stay. Similarly, PBD solely based on serum bilirubin ≥ 15 mg/dl has no beneficial effect on surgical outcome. The operative mortality was 4.2% (n = 17). The median postoperative hospital stay was 13 (7-68) days. PBD is associated with increased incidence of postoperative overall complications and SSI, but does not affect major complications or mortality. PBD-surgery interval greater than 6 weeks does not have a negative impact on postoperative clinical outcomes.

Alcoholic vs. non-alcoholic chronic pancreatitis: surgeons' perspective from a tertiary centre in india / Perspectiva dos cirurgiões sobre pancreatite crônica alcoólica vs. não-alcoólica de um centro terciário na índia

ABSTRACT Background: Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. Aim: To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. Method: All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. Results: From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. Conclusion: Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

RESUMO Racional: Embora o álcool seja a causa mais comum de pancreatite crônica em todo o mundo, a forma idiopática é prevalente na Índia. A história natural e a progressão da doença são diferentes entre esses dois grupos. Há escassez de dados comparando o resultado cirúrgico e a qualidade de vida entre eles. Objetivo: Avaliar as características clínicas, o resultado cirúrgico e a qualidade de vida entre esses dois grupos de pacientes. Método: Todos os pacientes com pancreatite crônica operados foram revisados ​​retrospectivamente. Resultados: Do total de 98 pacientes, 42 eram alcoolistas. O número de homens e a idade média no momento da operação foi significativamente maior nos alcoolistas. Tabagismo, taxa de internação pré-operatória e prevalência de complicações locais como massa inflamatória da cabeça do pâncreas, estenose biliar e hipertensão portal do lado esquerdo foram distintamente mais comuns no grupo de alcoolistas e o procedimento de Frey foi exigido mais comumente neste grupo. A média de internação pós-operatória e a taxa geral de complicações pós-operatórias foram comparáveis ​​entre os dois grupos. Ao longo de acompanhamento médio de 18 meses houve melhora significativa na qualidade de vida e pontuação de dor em ambos os grupos. A melhora no escore de funcionamento físico foi significativamente maior no grupo de alcoolistas, mas a necessidade de medicamentos analgésicos foi significativamente maior nos alcoolistas. No entanto, a perda de apetite foi mais percebida pelo grupo não alcoólico. Conclusão: A pancreatite crônica alcoólica se apresenta com mais complicações locais associadas à pancreatite crônica. O procedimento de Frey é operação segura e bem aceita neste grupo. Embora exigissem mais necessidade de analgésicos no acompanhamento em curto prazo, outros aspectos da qualidade de vida são semelhantes ao grupo não alcoólico.

Parietal Wall Abscess Perforating to Transverse Colon: A Rare Presentation.

Extrapulmonary tuberculosis affects an isolated organ or presents secondary to pulmonary involvement. Lymph nodes are the common sites for extrapulmonary tuberculosis. Primary extrapulmonary tuberculosis involving parietal wall is an unusual presentation. Tubercular abscess of the abdominal wall perforating to large bowel has not been reported. Here, we are reporting a very rare case of anterior abdominal wall abscess of tubercular origin in a 57-year-old female patient who presented with complaints of pain in upper abdomen for four months. CT scan and intraoperative findings revealed perforation of the abscess into transverse colon. Histopathology report confirmed the aetiology and origin of the abscess.

Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time.

BACKGROUND: Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). METHODS: A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. RESULTS: From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. CONCLUSION: Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Outcome of surgery for recurrent pyogenic cholangitis: a single center experience.

BACKGROUND: Although, recurrent pyogenic cholangitis (RPC) is prevalent in several parts of India, there is paucity of published literature from India. The aim of this study was to report on the short and long-term outcomes of surgery for RPC. METHODS: All the patients, who underwent surgery for RPC between August 2007 and February 2016 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed. RESULTS: Of the total 94 patients, 66 (70%) were women. The median age at presentation was 40 years. Left lobe was solely involved in 49% of patients. Left hepatectomy was performed in 23/44 (52%) patients who underwent liver resection. Thirty two postoperative complications developed in 27 patients (29%). Complete stone clearance was possible in 83% of patients after primary surgery. Over a median follow up of 36 months, seventy one of 87 patients (81%) remained free of stones. Recurrent cholangitis occurred 10 of 87 patients (11%). CONCLUSIONS: Surgery plays an important role in the management of RPC achieving excellent short and long-term outcomes.

Short-stay daycare laparoscopic cholecystectomy at a dedicated daycare centre: Feasible or futile.

BACKGROUND: In the last decade, laparoscopic cholecystectomy (LC) has become a regular daycare surgery at many centres across the world. However, only a few centres in India have a dedicated daycare surgery centre, and very few of them have reported their experience. Concerns remain regarding the feasibility, safety and acceptability of the introduction of daycare laparoscopic cholecystectomy (DCLC) in India. There is a need to assess the safety and acceptability of the implementation of short-stay DCLC service at a centre completely dedicated to daycare surgery. PATIENTS AND METHODS: Comprehensive care and operative data were retrospectively collected from a daycare centre of our hospital. Postoperative recovery was monitored by telephone questionnaire on days 0, 1 and 5 postoperatively, including adverse outcomes. RESULTS: A total of 211 patients were admitted for DCLC during the period from November 2011 till November 2014, of whom 211 were discharged on the day of surgery. Two hundred and two patients could be discharged within 6 h of surgery. Mean operation time was 72 min. No patient required admission. No patient needed conversion to open surgery. Only 1 patient was re-admitted due to bilioma formation and was managed with minimal intervention. CONCLUSION: The introduction of short-stay DCLC in India is feasible and acceptable to patients. High body mass index (BMI) in otherwise healthy patients and selective additional procedures are not contraindications for DCLC.

Asymptomatic Traumatic Hepatothorax, Symptomatic Gall Stone Disease - A Rare Coincidence.

Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management. We report a case of acute cholecystitis which revealed a rare association of traumatic right diaphragmatic hernia and hepatothorax.

The effect of citicoline on stroke: A comparative study from the Eastern part of India.

BACKGROUND: Citicoline is a novel neuroprotective agent used in acute stroke with a significantly favorable outcome. MATERIALS AND METHODS: A hundred patients who suffered from either an ischemic and hemorrhagic stroke and who presented to the hospital within 48 h of stroke onset were enrolled for the study. Of these 100 patients (age- and sex-matched), 50 patients were treated with citicoline along with the standard stroke management and considered as 'cases'. The other 50 patients who were administered the standard stroke treatment were considered as 'controls.' The baseline parameters of the patients was assessed using the National Institute of Health Stroke Scale. The patients were reassessed at follow up at the end of the 1st and 3rd month of the commencement of the therapy and their outcome was evaluated by the Barthel Index score (BI). RESULTS: The mean BI scores of all categories at the 1st and 3rd month were significantly higher in the citicoline treatment group (P < 0.001 at the 1st month and P = 0.002 at the 3rd month). An analysis of the categorized BI score showed that there was a significant difference in the number of patients in the categorized BI score (85-100) (at the 1st month follow-up: 0% in control vs. 7% in case group [P < 0.05]; and, at the 3rd month follow-up: 10% in control vs. 36% in citicoline case group [P < 0.05]). In the subgroup analysis, both patients suffering from either ischemic and hemorrhagic stroke (including all categories of BI score) in the citicoline treatment group showed a significantly higher mean BI score at the 1st month (ischemic: P = 0.003, hemorrhagic: P =0.04) and also at the end of the 3rd month (ischemic: P = 0.03, hemorrhagic: P = 0.03). An analysis of the categorized BI score (85-100) at the end of the 3rd month in both the hemorrhagic as well as the ischemic subgroups showed a significant incidence of improvement in the citicoline group compared with the control group (hemorrhagic-- control: 6.66% vs. CASE: 31.81%, P < 0.05 and ischemic-- control: 11.41% vs. CASE: 35.71%, P < 0.05). CONCLUSION: In patients suffering from stroke and presenting within 48 h of onset, treatment with citicholine increases the probability of complete recovery and a favorable outcome at the 1st month and at the end of the 3rd month in all the stroke groups.