The use of Lichtenstein "tension-free" technique in emergency treatment of strangulated inguinal hernia is safe, effective with an acceptably low rate of postoperative complications and without recurrence.

Surgical internal sphincterotomy has a higher healing rate and a lower recurrence rate than intrasphincteric injection of botulinum toxin in the treatment of uncomplicated chronic anal fissure. Injection of botulinum toxin, however, is a simple noninvasive technique that avoids the greater risk of incontinence. It could be used as the first therapeutic approach in patients without clinical risk factors of recurrence.

What is called "idiopathic biliary duct system dilatation" or better to name it "un-explained biliary dilatation" is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fi elds; the technical and the clinical ones. This clinical review is trying to fi ll this gap and introduce a comprehensive discussion of the subject. Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really diffi cult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to fi nd a correlation rationale. At some point verifi cation of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.

Laparoscopic cholecystectomy is the "gold standard" in the treatment of symptomatic gallbladder lithiasis. Nevertheless, some pitfalls are associated with the use of the monopolar hook, such as the risk of thermal injuries and biliary complications. The present study assessed the efficacy of the Liga-Sure Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy.The laparoscopic cholecystectomy was done beginning with visualization of Calot's triangle, and dissection of Calot's triangle was achieved using a monopolar cautery device. Once the cystic duct was exposed, sealing was performed and divided using the LVSS. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period.The results showed that during the study period, 218 laparoscopic cholecystectomies were performed; 82 of these were performed with the Liga-Sure. The work was experienced a single case of bile leakage from the cystic duct due to missed stone in the common bile duct that was managed using ERCP.