Background: There is currently limited data to reassure the technical efficacy, particularly in attaining clear margins, through a transgastric laparo-endoscopic approach to resecting tumours located near the gastroesophageal junction (GOJ) or the pylorus. Methods: Single institution retrospective analysis of all cases from 1 April 2008 to 31 Dec 2019. Results: Overall, 34 patients (38 tumours) underwent transgastric laparo-endoscopic resection. Of these, 27 (71.1%) and 5 (14.7%) cases were located close to the GOJ and pylorus respectively. Three (8.0%) cases were converted to conventional laparoscopic excision. No anatomical gastric resection was required. The mean (SD) operative time was 167.5 (64.2) minutes and reduced with increasing experience. The median (IQR) length-of-stay was 3.0 (3.0-4.5) days. Major post-operative complication (Clavian-Dindo ≥3) occurred in 1 (2.9%) patient, which required surgical control of staple line bleeding. The most common pathology was gastrointestinal stromal tumour (71.1%), followed by leiomyoma (10.5%), schwannoma (5.2%), dysplastic polyp (5.2%), and neuroendocrine tumour (2.6%). The mean (SD) tumour diameter was 3.9 (2.1) cm (largest 10.1 cm, 10 cases >5 cm). Resection margins were clear in all cases. We found no evidence of tumour recurrence or gastric stenosis at a median follow-up of 88 months. Conclusion: Transgastric laparo-endoscopic resection of junctional and pyloric tumours with low metastatic potential is technically feasible. This approach achieved clear resection margins in all our cases, with acceptable perioperative and longer-term outcomes.

CS group. Among them, the cognitive function score difference (-21.43, 95% CI-30.50À-12.36, p< 0.001) was was the highest parameter and fatigue was the most severe symptom with a difference of 22.36 (95% CI 12.87-31.85, p< 0.001). There is no difference in terms of postoperative complication rate, and survival rate in both groups. Conclusion: Even not affecting on cancer survival, negative stigma against cancer is an important, negatively affecting factor on the QoL in HBP cancer patients. Proper selection and management of these patients could be important to improve QoL after surgery.

Background: Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease that commonly affects renal and carotid arteries but involvement of virtually any vascular territory has been observed. Research Design/ Study sample: This is a case report of a ruptured left gastric artery aneurysm as the first presentation of fibromuscular dysplasia. Data collection: After written consent from the patient, relevant clinical notes and imaging were retrospectively reviewed and critically analysed. Purpose: This case reiterates the importance of considering fibromuscular dysplasia as an uncommon cause of visceral artery aneurysms. In addition, this case shows that the impact of visceral artery vasospasm on endovascular access should not be underestimated and subsequent attempts can be successful after a period of resuscitation. Results: After initial difficulty in endovascular treatment due to visceral vasospasm, the case was successfully managed with with staged open ligation and endovascular embolization after a period of resuscitation. Conclusions: FMD is an important differential diagnosis to consider in cases of visceral aneurysms.

Introduction: Iliopsoas abscess is a rare condition that carries a risk of mortality when not treated appropriately. There is a paucity of high-level evidence concerning the management of this abscess and very sparse data is available in the literature regarding treatment options. This article discusses the treatments for iliopsoas abscess and reports a case effectively drained laparoscopically through an extraperitoneal approach.

No abstract