Background: Gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours located commonly in the stomach. A complete and radical surgery is needed in most cases. GISTs near the gastro-esophageal junction are more challenging as compared to those situated in the pylorus, because of the complex surgical management. In our case we attempted an organ sparing surgery for a tumour located on the lesser curvature, which was close to cardia, thus avoiding a radical gastrectomy.Methods: A midline laparotomy followed by creation of a sleeve of the greater curvature was done. The cardio-oesophageal junction was divided and the tumour along with stomach adjacent to the lesser curvature resected using gastro-intestinal anastomotic linear staplers. Once vascularity of remnant stomach was confirmed, the greater curvature remnant was anastomosed to the oesophagus, thus restoring anatomic continuity.Results: Post-operative recovery was uneventful. A contrast study done on post-operative day 8 showed no leak. Patient was started on orals and was discharged on day 10 after adequate oral intake. Final histopathology report revealed a spindle cell GIST with resection margins and lymph nodes uninvolved. Immunohistochemistry study was positive for C-Kit and DOG-1 and negative for desmin and S-100. Tablet Imatinib was started and on a six month follow up patient showed no evidence of recurrence.Conclusions: GIST of lesser curvature close to cardia, can be treated with organ sparing surgery in selected patients, provided adequate tumour free resection margins and vascularity of remnant stomach is possible. It avoids a radical surgery and its associated complications.

Background: A choledochal cyst is a cystic dilatation of the biliary tree, also termed a biliary cyst, including an intrahepatic cyst as well. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard investigation of choice for this pathology. Todani classification is most commonly used to classify choledochal cysts.Materials and methods: A total of 30 adult patients with choledochal cysts presenting at our center from December 1, 2009, to October 31, 2019, were studied retrospectively.Results: The mean age was 35.13 years ranging from 18 to 62 years with a male-to-female ratio of 1:3.29. Of the patients, 86.6% presented with abdominal pain. Total serum bilirubin was raised in six patients with a mean of 1.84 mg/dL. MRCP was done in all patients, which had almost 100% sensitivity. Two cases had anomalous pancreaticobiliary duct union. In our study, we found only type I and type IVA cysts according to the Todani classification (type IA = 56.3%, IB = 11%, 1C = 16%, and IVA = 17%). The mean size of the cyst was 2.37 cm. Complete cyst excision with Roux-en-Y hepaticojejunostomy was performed in all patients. Four patients had surgical site infections and two had bile leaks. One patient developed hepatic artery thrombosis. All complications were eventually managed conservatively. Mortality was nil in our study with the mean postoperative stay being 7.97 days.Conclusion: Adult presentation of biliary cysts is not an uncommon entity in the Indian population and should be considered as a differential diagnosis of biliary pathology in adult patients. Complete excision of cysts with bilioenteric anastomosis is the current treatment of choice.