There is an increasing PLA incidence with increasing ESBL resistance. Percutaneous drainage should be considered early for elderly patients (≥55-years-old), with multiple abscesses, malignancy as etiology or who required endoscopic intervention. We should have a low threshold for surgical intervention for patients with ECOG performance status ≥2, co-morbidity of hypertension or hyperbilirubinaemia.

Background. In recent years, inflammation-based scoring systems have been reported to predict survival in Hepatocellular Carcinoma (HCC). The aim of our study was to validate combined preoperative Neutrophil-to-Lymphocyte ratio (NLR)-Platelet-to-Lymphocyte ratio (PLR) in predicting overall survival (OS) and recurrence free survival (RFS) in patients who underwent curative resection for HCC. Methods. We conducted a retrospective study of HCC patients underwent liver resection with curative intent from January 2010 to December 2013. Receiver-operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for NLR and PLR. Patients with both NLR and PLR elevated were allocated a score of 2; patients showing one or neither of these indices elevated were accorded a score of 1 or 0, respectively. Results. 132 patients with a median age of 66 years (range 18-87) underwent curative resection for HCC. Overall morbidity was 30.3%, 30-day mortality was 2.3%, and 90-day mortality was 6.8%. At a median follow-up of 24 months (range 1-88), 25% patients died, and 40.9% had recurrence. On multivariate analysis, elevated preoperative NLR-PLR was predictive of both OS (HR 2.496; CI 1.156-5.389; p=0.020) and RFS (HR 1.917; CI 1.161-3.166; p=0.011). The 5-year OS was 76% for NLR-PLR=0 group, 21.7% for the NLR-PLR=1 group, and 61.1% for the NLR-PLR=2 group, respectively. The 5-year RFS was 39.3% for the NLR-PLR=0 group, 18.4% for the NLR-PLR=1 group, and 21.1% for the NLR-PLR=2 group, respectively. Conclusion. The preoperative NLR-PLR is predictive of both OS and RFS in patients with HCC undergoing curative liver resection.

LLLS. LLLS performed during and after LC period had similar outcome (in terms of morbidity, mortality, blood loss, length of stay). Conclusions: LLLS is a standardized procedure and has been performed with reproducible features in 4 independent HPB centres. LLLS was feasible with low morbidity, mortality and conversion rate. LC in LLLS is shorter compared to minor liver resections. Furthermore, it was proved to be reproducible and safe since it does not affect clinical outcome.

cholecystectomy, operated between 2012 and 2020, was conducted. Demographics, co-morbidities, presenting symptoms, details of index surgery, type of lesion, preoperative and post-operative workup and therapeutic interventions were recorded. The biliary strictures were staged according to the Bismuth-Strasberg classification. A side to side anastomoses with Roux-en-Y reconstruction was performed in all cases. Complications, mortality, and long-term follow-up were recorded. Results: Eleven patients with benign biliary strictures were operated. the female to male ratio was 3:2. The mean age of the population under study was 30 years. All eleven cases operated were E3 according to the Strasberg classification. The operative time recorded was ranged between 240 -480 mins. The median value of bleeding was 200 mL (range 50-1100 mL). Oral intake was started in the first 48 hrs. No bile leak was noted in any of our patients. No patients have underwent re-intervention till date. No mortality was recorded. The maximum follow-up was 48 months (Range 2-48 months). Conclusion:The benefits of minimal access techniques may be utilized successfully in the management of benign biliary strictures with acceptable morbidity.

was greater than 10mm in 8 patients. Histologically 46.2% were T1 tumours, 34.6% were T2, 7.7% were T3 and 11.5% were T4. The liver capsule was intact in 20 patients, only 2 patients had direct involvement of adjacent organs and one demonstrated vascular invasion at histopathological analysis. No associated surgical complications were documented in this group. Average disease free survival was 24.5 months, and the average overall survival was 31.6 months. Conclusions: HCC is an increasing diagnosis, with many treatment options. Given the background of cirrhosis, a small proportion of patients are deemed suitable for surgical resection. However when appropriate, it remains a safe and effective treatment option, which may positively impact on survival. Further larger studies are required to validate this.