Introduction: Percutaneous Biliary drainage (PTBD) is required as palliation and optimization for surgery or chemotherapy in carcinoma gallbladder (GBC) but may be associated with complications. We aimed to study the outcomes, complications and changes in quality of life in patients with GBC undergoing PTBD.Methods: A prospective study from July 2018 to December 2019 in patients of GBC presenting with obstructive jaundice was done. Patients planned for PTBD were included in the study. The progression of disease, complications of PTBD, re-interventions, effects on initiation or completion of chemotherapy, surgical resection or intervention, overall survival was recorded. Quality of life (QoL) was assessed using SF-36 questionnaire before and after 4-6 weeks of intervention.Results: Of 160 patients assessed for inclusion, 60 (mean age: 53.7 ± 10.95 years, 27 (45 %) males) were eventually included. Eleven patients (18.3%) had metastatic disease at presentation. Of 60 patients undergoing PTBD, none had immediate procedure related complications, 41(68 %) patients had at-least one and 18 (30%) patients had more than one complication. The most common complication was pericatheter bile leak (41.6%) followed by catheter dislodgement (30 %), blockage (23.3 %) and bleeding (10 %). Re-intervention was required in 32 (53 %) of patients. There was a signi cant decrease in QoL after PTBD (P<0.0001). Median survival after PTBD was 12 weeks. Conclusion:The high technical success of PTBD does not translate into the improvement of QoL, survival, and curative surgical treatment.

Background Incidental carcinoma gall bladder and benign disease in radical cholecystectomy specimen is the cause of concern. We attempted to find out the incidence and reasons thereof in the present study. Methods Present study is a retrospective analysis of a prospectively maintained database between July 2002 and July 2019. All patients with a diagnosis of carcinoma gall bladder admitted for surgery were included. Results Out of 148 patients, 110 patients had carcinoma gall bladder (CAGB), while 38 patients (25.7%) had incidental carcinoma (under-diagnosis). Radical resection was done in 61/110 (55.4%) patients with clinical CAGB, where 15 (24.6%) patients had benign pathology (“over-diagnosis”). Overdiagnosis was due to xanthogranulomatous cholecystitis (n = 9), chronic cholecystitis (n = 2), tuberculosis (n = 2) and IgG4 related cholecystitis (n = 2). Among 61 patients, a history of weight loss and anorexia were significantly associated with malignancy. Asymmetrical wall thickness was significantly more common in benign mimickers. Among patients with incidental carcinoma, preoperative ultrasonography reported normal wall thickness of gall bladder in 28 (73.7%), thickened gall bladder wall in 6, and polyp in 3 patients. The resectability rate among incidental carcinoma was 27/38 (71.05%). Conclusion Over-diagnosis of the carcinoma gall bladder was present in 24.6%. On the other hand, incidental carcinoma comprised 25.7% of all admissions for carcinoma gall bladder with resectability of 71%.

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between the results of culture and postoperative outcomes in bile duct resection operation. Methods: The data was prospectively collected from 235 patients who underwent bile duct resection at Samsung Medical Center for one year from October 2018 to September 2019. The diseases included in the data are periampullary cancer, gallbladder cancer, hilar cholangiocarcionoma, and intrahepatic cholangiocarcinoma. Intraoperative bile smear test was performed in operation, and the included operation was pancreaticoduodenectomy and liver resection surgery with bile duct resection. Specimens were obtained from culture swab of bile drained during bile duct resection. Results: Of the 235 patients, microorganism was isolated in 141 patients (60%). The predominant microorganisms grown from the intraoperative bile cultures were Enterococcus faecalis (38 cultures, 27.0%), Enterococcus faecium (32 cultures, 22.7%), Klebsiella pneumoniae and Enterobacter cloacae (28 cultures, 19.9%). In postoperative complication, the positive results of intraoperative bile cultures was related with Clavien-Dindo ClassificationIII (OR3.117, 95%CI:1.498-6.485, p=0.002). Also, it was a risk factors for occurrence of surgical site infection (OR3.266, 95%CI:1.237-8.621, p=0.013) and intraabdominal abscess (OR1.145, 95%CI:1.057-1.240, p=0.003). In addition, the incidence of postoperative pancreatic fistula was increased in patients with microorganisms grown in bile (OR1.974, 95%CI:1.098-3.549, p=0.022). Conclusions: Smear positivity of intraoperative bile fluid is associated with occurrence of major complication. It was risk factor for surgical site infection and intra-abdominal abscess.