the Hannover classification. The pre-operative MELD score was obtained and correlated with the following: patient characteristics, perioperative variables and postoperative outcomes, including mortality rates. Results: Out of 25 patients, 13 (52%) had open and 12 (48%) had laparoscopic cholecystectomy. 17 patients (68%) were referred to our center within 6 weeks from the time of injury. 14 (56%) were managed by endoscopic stenting, while 7 (28%) had definitive surgical reconstruction. There were no mortalities for patients with MELD score < 20. However, for those patients with MELD scores of 20-29 and 30, the mortality rate was 50% and 100%, respectively. Conclusion: MELD score is a potential prognostic tool for patients with iatrogenic bile duct injury sustained during cholecystectomy.

patients with gastrinoma have multiple endocrine neoplasia type 1 (MEN-1). We experienced two cases of gastrinomas associated with MEN-1 syndrome. 42 and 56-year-old man was admitted for abdominal pain and diarrhea. The endoscopic findings revealed severe reflux esophagitis and multiple ulcers at the bulb and second portion of the duodenum. They were diagnosed as ZES based on typical clinical features such as markedly elevated fasting gastrin level (1,000 pg/mL) and findings from a CT scan and somatostatin receptor scan. Pathologic findings after the operation revealed malignant gastrinoma. He was confirmed to have parathyroid adenoma and MEN-1. We diagnosed this patient using immunohistochemical studies and treated the patients by tumor resection with distal pancreatectomy. The patients are alive and in a good condition without recurrence for 10 months and 9 years. MEN-1 syndrome should always be considered in pts with ZES. A precise preoperative localization of all pancreaticoduodenal lesions, in combination with a surgical exploration and management by experienced surgeons, seems to be curative in patients.

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and 2 Apollo hospitals, India Introduction: High grade pancreatic injuries after Blunt Abdominal Trauma (BAT) were associated with significant morbidity and mortality even in experienced hands. Two stage approach may be beneficial in sick patients. Method and results: We present a case report of 28 year gentle man with grade IV (AAST) pancreatic injury with bile duct injury. He presented to us four days after BAT with haemodynamic instability.After resuscitation initial Damage control surgery was done in the form of debridement ,repair of bile duct ,closure of proximal pancreatic duct and exteriorization of distal pancreatic duct along with cholecystostomy. A second stage surgery (Pancretico jejunostomy to distal pancreas) was done three months after primary surgery with good outcome. Conclusions: Staged surgery can be considered in high grde pancreatic injuries. Pancreas Preserving surgeries (by avoiding Distal Pancreatectomy) in Grade IV injuries will result in better functional outcomes.

Introduction: Stereotactic navigation has been proposed to enhance precision in tumor targeting for local ablation of HCC, however reports of large patient series remain scarce. We report therapeutic efficacy of percutaneous stereotactic image-guided microwave ablation (SIMWA) for HCC. Methods: All patients treated with SIMWA for HCC at our institution between January 2015 and December 2017 were included for this retrospective analysis. Interventions were performed in a team of surgeons and radiologists, using a CT-based navigation system allowing trajectory planning, stereotactic tumor targeting and immediate treatment validation. Therapeutic efficacy was measured as local recurrence and overall survival survival. Results: Ninety-two patients underwent 163 SIMWA procedures, most patients being CHILD A (74.2%). A median of 1 (range 1-4) tumors were ablated per treatment session with mean tumor size of 16mm (5-43mm). Fourtythree patients (44.3%) had one or more previous HCC treatments and 14 (14.4%) were transplanted afterwards. No major or liver-specific complications occurred. Of the 77 patients with a minimum follow-up of 6 months, mean OS was 13.9 months after SIMWA and 23.7 months after initial diagnosis. Local recurrence occurred in 20/131 (15.2%) lesions, which were successfully re-ablated in 14 and operated in 2 cases (12.2%). Fifteen (11.5%) of these recurrent patients had simultaneous disease progression. Tumor size 3 cm was significantly correlated with local recurrence (p=0.005). Conclusion: SIMWA is safe and effective for the treatment of HCC and might offer a curative treatment approach for patients with inoperable and conventionally not ablatable lesions due to more precise minimal invasive ablation.