The survival rates of gastric cancer patients with cytology-positive peritoneal lavage fluid without macroscopic dissemination (CY+/P-) is the same as that of patients with overt peritoneal metastasis.The 5-year survival rate of such patients is only 2%. The current study aims to highlight its significance in the staging of gastrointestinal malignancies and its implications for patient care. Prospective nonrandom analysis of peritoneal wash cytology in patients with gastrointestinal malignancies was conducted in the department of Surgical Gastroenterology, Nizams Institute of Medical Sciences, Hyderabad from January 2012 to June 2013. Descriptive statistics and ANOVA variance analysis was performed to estimate incidence, risk factors and the effect of surgery in causing peritoneal dissemination of malignancy. A total of 60 patients with operable gastric cancer underwent peritoneal lavage for evaluation of malignant cells. The incidence of Positive peritoneal lavage cytology was 8.3% (5/60).Four patients with positive lavage fluid belong to T3 stage (11.7%, p-0.309).Poorly differentiating and mucinous tumors had a higher incidence of positive cytology (18.1% and 25%).None of the patients with positive cytology had positive resection margin. Tumors with advanced T stage, lymph nodal involvement, lympho-vascular and perineural invasion have higher incidence of positive peritoneal cytology. Surgical handling has a negligible effect in peritoneal dissemination of tumor. Large scale studies are warranted to validate the findings and define it's role in management of gastric cancer.

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.

post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in median OS (32 vs 48 months, p = 0.86), median RFS(16 vs 36 months, p = 0.17), or patterns of recurrence (local, regional, or distant) between MD and PD tumors. Conclusions: Poorly differentiated PDAC is characterized by more frequent or persistent perineural invasion relative to moderately differentiated tumors following preoperative therapy. However, tumor differentiation has no impact on postoperative patterns of local or distant tumor recurrence or the incidence or severity of post-operative complications.

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.