We report the first case series from Africa and the Middle East on choledochal cyst, a disease which shows significant geographical distribution with high incidence in the Asian population. In this study, the epidemiological data of the patients are presented and analyzed. Attention was paid to diagnostic imaging and its accuracy in the diagnosis and classification of choledochal cyst. Most cases of choledochal cyst disease have type I and IV-A cysts according to the Todani classification system, which support the etiological theories of choledochal cyst, especially Babbitt's theory of the anomalous pancreaticobiliary duct junction, which are clearly stated. The difficulties and hazards of surgical management and methods used to avoid operative complications are clarified. Early and late postoperative complications are also included. This study should be followed by multicenter studies throughout Egypt to help assess the incidence of choledochal cysts in one of the largest populations in Africa and the Middle East.

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Background: Laparoscopic gastric plication (LGP) is a restrictive bariatric procedure which was found to be safe, effective and economic as well. However, it hasn't a good reputation among some bariatric surgeons due to some reasons; the most important of them is lack of standardization.  Objective of the present stud was to study propose a standardized technique for LGP aiming at a better outcome.  Setting. Settings: University-affiliated hospital.Methods: This is a retrospective analysis of patients who underwent LGP by the proposed technique., using seromuscular bites with non-absorbable thread, adoption of the four-bite technique, and calibration using bougie.Results: Eighty-eight consecutive morbidly obese patients had been operated by the proposed standardized technique of LGP between March 2010 and September 2014. There were 19 men and 69 women, with a mean age of 30.3 years and a mean BMI of 36.7kg/m2 (range 32-51kg/m2). The most frequently reported complication was prolonged early postoperative nausea/vomiting occurred in 5 of 88 (5.7%) patients. Weight regain was reported in one patient who was treated with conversion of LGP to laparoscopic mini-gastric bypass. Hospital stay was prolonged for a mean of 6.0 (3 -10 days). Postoperative follow-up period ranged from 2 to 38 months with a mean of 15 months. Percentage of excess weight loss was 38.2%, 52.0%, and 63.1% at 3, 6, and 12 months, respectively.Conclusions: The proposed technique of LGP would help in standardization of the procedure in order to improve the outcome; however, the clinical application of this proposed standardized technique should be tested by future studies.