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Summary The variations of the cystic duct are so common that only 30% of all humans present the classical anatomical arrangement between the common bile duct (CBD), the cystic duct, and adjacent arteries. Thus, it could be considered that anomalies of the biliary tree are a rule rather than an exception. Duplication of the cystic duct, however, is a very uncommon anatomical finding. In the Department of General and Digestive Surgery of the University Hospital Complex Albacete, a 73-year-old patient was admitted with symptoms of cholangitis. He underwent emergency surgery that found exacerbated chronic cholecystitis and dilation of the CBD. Cholecystectomy was performed with identification of a double cystic duct that drained separately in the CBD and exploration of the last revealed cholangitis without choledocholithiasis. The postoperative period progressed favourably, proceeding to discharge from the hospital with Kehr drainage closed. In conclusion, we consider that the routine use of intraoperative cholangiography when there is suspicion of anatomical variations of the biliary tree is mandatory to rule out lesions or alterations thereof.

Summary Introduction: Bariatric surgery has amply demonstrated its benefit in the treatment of morbidly obese patients. After surgery, there is a progressive and significant decrease in weight in a high percentage of patients. Most comorbidities resolve, improving quality of life and increasing life expectancy. Methods and Objective: The literature review is based on a 10-year or longer follow-up of patients who underwent various bariatric surgery procedures. The long-term weight loss results and the clinical impact were evaluated. Results: The applied surgical techniques, including Rouxen-Y gastric Bypass (RYBG), Biliopancreatic Diversion, Scopinaro type (BPD), and Duodenal Switch (DS), have contributed to achieving very satisfactory long-term and sustainable weight loss results. According to the reviewed literature, the percentage of excessive BMI Loss (%EBMIL) for the various techniques was 67.9%, 70.7%, and 71.5% for RYGB, BPD, and DS, respectively. Patients undergoing BGYR have lost much more weight than non-surgical patients and can maintain long-term weight loss, reaching a Percentage of Excessive Weight Loss (%EWL) as high as 56.4% in 10 years. Patients who underwent Adjustable Gastric Band (AGB) presented with a %EWL of 45.9% in 10 years, but with very high re-operation rate range (8-78%). There are few studies in the literature on Laparoscopic Sleeve Gastrectomy, reporting weight loss results over ten years. According to the study carried out by Arman G. A., Himpens J., et al. isolated Laparoscopic Sleeve Gastrectomy (LGS) produced a satisfactory weight loss over ten years, reachingEBMIL of 62.5%. Amending LSG with a new surgical design with malabsorbtive component (in 25% of patients) increased the weight loss, achieving %EBMIL of 81.7%.The Vertical Band Gastroplasty technique resulted in EWL of 38.1 ± 28.8%, as shown by a mean follow-up of 17.3 years, with a high rate of re-operations and conversions.

Summary Biliopancreatic derivation with duodenal switch (BPDDS) as an operative technique in the management of morbid obesity was created as an alternative to BPD (Scopinaro's operation), because of BPD-DS's fewer malabsorption side effects, better restrictive effect to the stomach remnant, fewer peptic ulcers and dumping syndromes, as well as lower morbidity and mortality rate. Between January 2003 and June 2012 in the University Hospital Center of Albacete, 141 patients with morbid obesity underwent BPD-DS. The patients were divided in groups according to four criteria: length of the common channel, age, gender and initial Body Mass Index. On the 6th postoperative year in our study the percent of excessive body weight loss was 67.6% and the percentage of excessive BMI loss was 73%. According to the evaluation announced by Hess D.S. & Hess D.W, our results could be assessed as successful after 6 months, good on the first year, excellent on the second, and good from 3rd to 9th postoperative years. Our results confirm the hypothesis that the biliopancreatic derivation with duodenal switch is a bariatric intervention, which leads to a significant weight loss, well preserved in time.

Acute appendicitis due to Enterobius vermicularis, usually known as pinworm, is very rare and affects mostly children. According to different authors, it is controversial whether pinworms cause inflammation of the appendix or appendiceal colic only. We present a case of a 14-year-old female with three subsequent hospitalizations in 1 month due to abdominal pain in the right lower abdomen, with rebound tenderness, normal CT scan and laboratory findings. During the last hospitalization, laparoscopic appendectomy was performed. Intraoperatively multiple pinworms were found in the appendix. These were trapped by a stercolith in the appendicular base in a noninflamed and histologically normal appendix. Two oral doses of mebendazole were administered postoperatively. Uneventful postoperative period and postoperative follow-up showed lack of symptoms six months after the operation. Despite the widespread idea that acute appendicitis due to is very rare, it Enterobius vermicularis should always be considered in young female patients with repeated abdominal pain in the right lower abdomen with normal laboratory and radiologic findings.