Outcomes of our surgical team compared to the published data of some other centers. Preoperative ERCP seems to make difficulty in bile duct dissection during PD.

Background  Laparoscopic cholecystectomy is a one of main surgical procedures that used widely for the treatment of symptomatic gallstones throughout the world. Although laparoscopic cholecystectomy has its own advantages, but bile duct injuries occur more frequently compared to the open cholecystectomy. In this study, critical view of safety (CVS) technique is compared to conventional infundibular technique (IT). Objectives  The aim is to compare critical view of safety with infundibular technique in laparoscopic cholecystectomy, in term of duration of the surgery and bile duct injuries (BDI). Methods Laparoscopic cholecystectomy was performed for 245 patients at Sulaimani city within a period from April 13th 2015 to April 13th 2016. The patients were divided into two groups; critical view of safety was used for the first group and infundibular technique for the second. Comparison performed between the both groups for operation time and bile duct injury. Results The operative time was significantly reduced in CVS technique as the mean time of the operations was (33.04 min) for CVS, and (38.58 min) for IT, with significant P-value (0.013). Seventeen cases (6.93%) converted to open cholecystectomy; the conversion found more in IT group, with significant P-value (< 0.001). Conclusion The “critical view of safety” although needs more patience in dissections with comparison to infundibular technique, but it is found to be faster and regard as a safe technique in laparoscopic cholecystectomy.

Introduction: Glomus tumor (GT) mainly occurs in the extremities. Its appearance elsewhere has rarely been reported. This study aims to report an incidental finding of gastric GT in a patient with biliary colic. Case presentation: A 45-year-old female presents with moderate to severe upper abdominal pain. Physical examination was performed, the abdomen was soft, nontender, and no mass felt. Transabdominal ultrasound showed a single stone in the gallbladder, normal wall thickness, and no biliary dilatation. The diagnosis of biliary colic was achieved based on the clinical presentation, examination findings, and test results. Wedge resection of the stomach with open cholecystectomy was performed. Histopathology result was compatible with gastric GT. Clinical discussion: The clinical examination of GT is much similar to other tumors like hemangioma, lipoma, gastrointestinal stromal tumor, and leiomyoma. Concerning diagnosis, GT is mostly intersecting with gastrointestinal stromal tumors, mainly in small biopsy screening. For this reason, most of the gastric GT can be identified preoperatively as gastrointestinal stromal tumors. Conclusion: Gastric GT is an uncommon benign tumor that can be found incidentally during the diagnosis of other diseases or tumors because of its clinical and radiologic similarities.

Background  Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy, mainly because of technical difficulty.  Objectives  To identify the prediction of difficult laparoscopic cholecystectomy. Materials and Methods Preoperative clinical, laboratory, and radiologic parameters of 249 patients, who underwent laparoscopic cholecystectomy, were analyzed for their technical difficulty. Parameters (male sex, abdominal tenderness, previous upper abdominal operation, sonographically thickened gallbladder wall, age over 65 years, preoperative diagnosis of acute cholecystitis, history of ERCP) were found to have significant effect in multivariate analysis. Results Overall 54 operations (21.7%) were difficult; 36 operations (14.5%) took long time and 18 patients (7.2%) required conversion to open cholecystectomy.  Conclusions Conversion risk can be predicted to some extent. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.

Background and objectives: Iatrogenic bile duct injury (IBDI) is a serious complication during cholecystectomy caused by a surgeon in apparently healthy patients and is associated with a significant rate of morbidity and a low rate of mortality. Our aim was to review the surgical repair of IBDI and post-operative outcomes regarding morbidity and mortality. Methods: We retrospectively analyzed the surgical management and outcome of biliary injuries during cholecystectomy in 52 patients diagnosed intraoperatively during cholecystectomy or referred postoperatively to Sulaymaniyah digestive and liver surgery center between May 2014 and May 2017. Results: During these three years; we managed 52 patients of which 41 patients (78.8%) were females. Forty-seven bile duct injuries happened during laparoscopic cholecystectomy and in 5 patients during open-type surgery. Eight patients were diagnosed intraoperatively the remaining 44 were diagnosed post-operatively. The most common type of injury was Strasbourg type E2 (33 patients, 63.5%). The mean age of patients was 32 years in females and 36 years in males. Roux-en- Y hepati- cojejunostomy was the surgical treatment in 47 patients (90.4%). Post-operative morbidity within three years was 34.6% and mortality was 3.8%. Patients were followed for one month on their regular visit to our center or private clinic post-operatively then followed by their irregular visits once they had complains within the period of our study. Conclusions: Hepaticojejunostomy was the best surgical procedure for repair of IBDI with less postoperative morbidity and mortality in our study, IBDI type E4 according to Strasberg classification associated with more morbidity and mortality than other types.