Congenital absence of the common bile duct: A rare anomaly of extrahepatic biliary tract.

Congenital absence of the common bile duct (CBD) is an extremely rare developmental anomaly with right and left hepatic ducts draining directly into the gallbladder (GB). Other synonyms for this clinical condition are "cholecystohepatic ducts", "transverse lie of the GB" or "interposition of the GB". The potential for iatrogenic injury is high, because of either inadvertent division or ligation of the ducts. Diagnosis is mostly made intraoperatively, and needs some form of biliary reconstruction. Herein, we are reporting a case of congenital absence of the CBD in a 36-year-old lady that was detected intraoperatively.

Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility.

INTRODUCTION: Eventration of the diaphragm results in impaired respiratory mechanics, which leads to symptoms of dyspnea. Robotic diaphragmatic plication is a recently reported technique that has had good immediate outcomes. The aim of this study was to describe our transthoracic and transabdominal plication techniques and to analyze the safety, efficacy, and feasibility of robotic diaphragmatic plication in an Indian setting. METHODS: This retrospective study was conducted at a large tertiary care center in a dedicated thoracic surgery unit. To measure the efficacy of plication, we administered a pulmonary function test to each patient at baseline and 6 months postoperatively and then compared the results. RESULTS: Eighteen patients underwent robotic diaphragmatic plication during the study period. Of these 18 patients, 12 underwent surgery via a transabdominal approach, and 6 underwent surgery via a transthoracic approach. Surgery was completed robotically in 17 patients. The comparison of the preoperative and postoperative pulmonary function test results showed that the mean ± SD increase in forced expiratory volume in 1 second (FEV1 ) was 19.9 ± 22.0% (P = .002) and the mean increase in FEV1 /forced vital capacity was 5.7 ± 2.5 % (P = .225), indicating a significant improvement in FEV1 after surgery. CONCLUSION: Robotic diaphragmatic plication can be performed transthoracically or transabdominally with good surgical outcomes. It is safe, effective, and feasible.

Thoracoscopic Decortication of Stage III Tuberculous Empyema Is Effective and Safe in Selected Cases.

BACKGROUND: Open decortication of advanced tuberculous empyema remains standard of care. As with other aspects of thoracic surgery, minimally invasive approaches are making inroads into procedures traditionally performed open. In this retrospective analysis, we sought to examine feasibility, efficacy, and outcomes of thoracoscopic decortication of stage III tuberculous empyema in our experience. METHODS: The records of all patients in whom thoracoscopic decortication of stage III tuberculous empyema was performed between March 2012 and December 2015 were examined. Demographic and perioperative data were analyzed to assess the surgical outcomes of this study group. To assess long-term efficacy, patients were followed for a minimum of 6 months. RESULTS: One hundred patients fit the study criteria, of these 67 were men. Ninety cases were successfully completed thoracoscopically. Mean operative time was 204 ± 34.2 minutes with mean blood loss of 384 ± 28 mL. Median chest drain duration and hospital stay was 7 days. There was no perioperative deaths. Morbidity rate was 33%, composed mostly of prolonged air leak (29%). Six-month follow-up revealed completely expanded lung in all patients except one with small apical asymptomatic air space. Intraoperative cultures were positive for mycobacteria in 25% patients. Six (6%) of these patients had multidrug-resistant tuberculosis and required a modification in their antituberculous therapy. CONCLUSIONS: Thoracoscopic decortication of advanced tuberculous empyema is feasible, safe, and effective with good short- and long-term results in selected patients. In a substantial portion of patients, operative cultures required modifying drug treatment to treat underlying tuberculosis.