Ileal pouch-anal anastomosis is a successful and well-tolerated procedure with 94 % of patients opting to have the surgery again. Preliminary results do not show any significant difference in the incidence of pouchitis following laparoscopic surgery.

Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. Ever increasing number of patients with myriad of medical illness is being treated by this technique. However, significant concern prevails among the surgical community regarding its safety in patients with cardiac co-morbidity. Patients with significant cardiac dysfunction and multiple co-morbidities were prospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopic cholecystectomy was performed. Patient demographics, details of peri-operative management and post-operative complications were studied. Between March 2005 and January 2009, 28 patients (M:F= 21:7) with mean age of 60 years (range 26-78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy. Of these, 24 patients were in NYHA class-II, while 4 belonged to class-III. Left ventricular ejection fraction, as recorded by transthoracic echocardiography, was 20-30% in 13 (46%) patients and 30-40% in the rest 15 (54%). In addition, 13 (46%) patients had regional wall motion abnormalities, 11 (39%) patients had cardiomyopathy, 2 (7%) patients had valvular heart disease while 12 (43%) patients had prior cardiac interventions. Following laparoscopic cholecystectomy, hypertension (3), tachyarrhythmia (4) and bradycardia (1) were the commonest events encountered. One patient required laparotomy to deal with peritonitis in the immediate postoperative period and succumbed to myocardial infarction, but all other patients made an uneventful recovery. With appropriate cardiological support, laparoscopic cholecystectomy may be safely performed in patients with significant cardiac dysfunction.

Primary angiosarcoma is an extremely rare and aggressive soft-tissue malignancy of endothelial cell origin that occurs most frequently in the skin and subcutaneous tissues of the extremities. Presence of this disease in the intestine as a primary or metastatic deposit is an extremely uncommon incident, and might causes diagnostic confusion with primary colonic neoplasm. We encountered epithelioid angiosarcoma of the sigmoid colon in a 59-year-old male patient who presented with occasional bleeding per rectum and had also had an angiosarcoma arising from the subcutaneous tissue of the right thigh. Retrospective review of histopathology and immunohistochemistry of the two specimens were helpful in the final diagnosis.

Benign coloesophageal anastomotic stricture in postoperative colon bypass patients suffering from the corrosive stricture of the upper esophagus is a challenging problem. Failure of repeated endoscopic balloon dilatation makes way for revisional operative techniques like free jejunal grafts or interposition skin tube based on radial vessels. The situation arising from the morbidity of such reconstructive procedures, at times, becomes more complex than the stricture itself [1]. This clinical scenario has compelled us to innovate with a much simpler technique using buccal mucosal graft (BMG) to manage these strictures. Currently, the utility of BMG is mostly limited to urethral reconstruction. Overtime, it has become an ideal urethral substitute. Here, we present a case series of five patients who have been subjected to coloesophagoplasty with BMG and have demonstrated excellent results. With a median follow-up of 13 months, all patients have fully recovered and are taking solid and liquid foods satisfactorily. Thus, the option of coloesophagoplasty with BMG should always be kept in consideration while planning a revision surgery for a small-segment benign coloesophageal anastomotic stricture in the corrosive injury of the esophagus, considering the ease and excellent outcome.Keywords Coloesophagoplasty . Anastomotic stricture . Buccal mucosal graft . Corrosive stricture IndicationLong-segment corrosive stricture of the esophagus is the commonest indication for colon bypass surgery in Eastern India. Benign coloesophageal anastomotic stricture is an important complication for these patients. Repeated endoscopic dilatation of anastomotic stricture is usually the first step to manage this complication. In spite of repeated dilatations, a significant percentage of patients suffer from dysphagia. Surgical management by stricturoplasty frequently fails, and about 10-20 % of patients have to undergo complex revisional operative techniques by free jejunal grafts or interposition skin tube based on radial vessels [1]. We describe here a simple new surgical technique by using buccal mucosal graft (BMG) to manage this benign anastomotic stricture. Material and MethodsTwenty-one patients suffering from a long-segment corrosive stricture of the esophagus were managed by colon bypass surgery from April 2010 to September 2013. Patients were between 18 and 45 years of age, and 18 were female (85.7 %). The patients were suffering for a maximum period of 5 years to a minimum of 3 months. Eight patients (38 %) were unable to swallow their saliva due to proximal esophageal and/or pharyngeal inlet obstruction. These patients were operated in stages, initially by esophagostomy or pharyngostomy, followed by different methods of dilatation of the upper gastrointestinal tract. Then, they were trained for swallowing solids and liquids for 3-6 weeks. If swallowing was satisfactory, then patients were taken up for colon bypass surgery. Remaining patients were taken up for single stage colon bypass operation. Following surgery, patie...

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