Background:Laparoscopic choledochal cyst excision (LCCE) in adult patients is not common.Aims:The aim is to report our experience of LCCE in adult patients.Patients and Methods:This study includes a retrospective review of twenty adult patients (age >18 years) with choledochal cyst (CC) who underwent LCCE by a single surgical team from February 2011 to April 2016.Results:The mean age was 45.5 years. Nineteen (95%) patients had Type-I CC, and one patient (5%) had Type-IV CC (Todani's classification). Fifteen patients (75%) presented with pain in the abdomen, and five patients (25%) presented with jaundice and/or cholangitis. LCCE was successful in 16 (80%) patients, whereas four patients (20%) required conversion to open method. The reason for conversion was technical difficulty due to the initial learning curve, adhesion and inflammation. The mean blood loss, operation time and post-operative stay were 117.5 ml, 299.5 min and 8.15 days, respectively. Bilioenteric anastomosis leak and formation of pseudoaneurysm occurred in one patient (5%); this patient later died due to uncontrolled intra-abdominal haemorrhage. There were no remote complications during a mean follow-up of 17.2 months.Conclusion:LCCE in adult patients is safe and feasible, but bilioenteric anastomosis leak may have fatal consequences.

Introduction: Intraductal papillary mucinous neoplasms (IPMN) are considered precursor lesions to pancreatic adenocarcinoma. The risk of malignancy is increased in main duct/mixed type IPMNs but even with modern imaging it may be challenging to accurately diagnose main pancreatic duct involvement. The objective of this study was to determine how well radiological findings correlate with pathological features of IPMNs. Methods: Consecutive cases of IPMN undergoing pancreatic resection at our unit were reviewed. All patients' radiological images and histological slides were retrieved and re-evaluated. Radiologists and pathologists performed independent blinded assessments of the tumors. Results: Twenty-two cases of IPMN were identified with a median age was 65 years. Male to female ratio was 10:12. The diagnosis of IPMN was preoperatively suspected in 82% of cases based on radiological evaluation. The surgical procedures performed included pancreaticoduodenectomy (n = 20), total pancreatectomy (n = 1) and distal pancreatectomy (n = 1). An invasive IPMN component was seen in 55% of the specimens on histopathological evaluation. Radiological accuracy was 45% for detecting involvement of the main pancreatic duct. Seven of the patients (32%) had a second malignancy within the tumor specimen, including ampullary adenocarcinoma in 3 patients, duodenal adenocarcinoma in 2 patients, cholangiocarcinoma in 1 patient and anaplastic pancreatic cancer in 1 patient. Conclusion: Preoperative radiological assessment is fairly accurate in diagnosing IPMN, however it frequently underestimates main pancreatic duct involvement, which may question the validity of basing surgical decisions on radiological assessment of duct engagement. IPMN is often associated with a secondary periampullary malignancy.

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Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Methods: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis. Results: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis. Conclusions: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.

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