Background: Intrabiliary rupture is one of the most serious complications of liver hydatid cysts (LHC). The kind of surgery for these patients is still controversial. T-tube drainage and choledochoduodenostomy (CD) are used by most of the surgeons. But there is no comparative study in the literature. Methods: Eighty patients with symptomatic intrabiliary rupture were treated between 1980 and 1995. All patients had jaundice. In addition to treatment of the cyst cavity, T-tube drainage of the common bile duct (CBD) was performed in 53 patients, 25 patients underwent a CD for biliary drainage and two patients were treated by a T-tube placed in the CBD without treating the cyst. The T-tube drainage and CD groups were compared in regard to morbidity, mortality, duration of the operation, rate of relaparatomy and duration of postoperative hospital stay. Results: The morbidity rate was 40% (10/25) after CD and 18.1% (10/55) after T-tube drainage. Relaparatomy was necessary in 8% (2/25) and 1.8% (1/55) of patients treated with CD and T-tube drainage, respectively. T-tube drainage was performed much more rapidly than CD (p < 0.05). The length of hospital stay for both groups was the same. One patient who was treated with CD died postoperatively. Conclusion: Our results suggest that T-tube drainage is superior to CD for intrabiliary rupture of LHC in most cases.

Objective: The aim of this study was to present a case of hepar lobatum resulting from metastatic rectal carcinoma. Clinical Presentation and Intervention: A 50-year-old man presented with a 2-year history of bleeding per anum, tenesmus, malaise and weakness. Initially, the patient received neoadjuvant chemoradiotherapy followed by abdominoperineal resection of the rectum. Abdominal computed tomography showed lobar enlargement and lobulated contour, mainly in the left lobe of the liver, but no primary or metastatic lesions were detected. Laparotomy revealed an irregularly lobulated hepatic deformity. Liver biopsy showed a necrotic tumor growth from adenocarcinoma of the rectum in subcapsular localizationof the liver. Conclusion: This case showed a patient with hepar lobatum carcinomatosum caused by metastatic rectal carcinoma. The report further highlights the need for clinicians and surgeons to keep in mind the possibility of hepar lobatum carcinomatosum while caring for rectal carcinoma patients, especially when the lobulated contour of the liver is detected at preoperative imaging studies or when the coarsely lobated liver is encountered during surgery for carcinoma of the rectum.

Extralevator abdominoperineal excision versus conventional surgery for low rectal cancer: a single surgeon experience INTRODUCTIONAs originally described by Miles (1), abdominoperineal excision (APE) has long been the standard treatment for tumors of the middle and lower rectum. It achieves the greatest possible distal margin of resection by removing the anus in continuity with the rectum. Total mesorectal excision (TME), recommended by Heald et al. (2), has led to a decrease in perineal amputation numbers and has become the oncologic standard in the last 30 years. However, the rates of circumferential resection margin (CRM) positivity and of intraoperative perforation (IOP) is higher in abdominoperineal excision as compared to anterior excision. Recently, Holm's studies have generated a renewed interest on the abdominoperineal excision technique (3). In this operation, the levator muscles are excised from their origins on the pelvic side walls and removed en bloc with the tumor. The aim of this approach is to reduce both the rate of CRM positivity and IOP, which are associated with high rates of local recurrence and poor survival outcomes in patients with rectal cancer (4-8). Although there are many similarities between what Miles has previously described and what Holm recently defined, there are major differences that should be recognized e.g. Miles did not use the prone position and did not undertake a total mesorectal excision. This study was designed to compare the results of extralevator abdominoperineal excision (ELAPE) with the conventional APE approach. MATERIAL AND METHODS PatientsBetween November 2008 and December 2011, 25 patients with low rectal cancer underwent ELAPE in the prone jack-knife position. Nine patients (36.0%) received neoadjuvant long-term chemoradiotherapy. A consecutive series of 56 patients that were treated by conventional APE in the lithotomy position between 2003 and 2008 were selected from our prospectively collected rectal cancer database for comparison as a historical cohort. Eight of these patients (14.3%) had received neoadjuvant chemoradiotherapy. Chemoradiation indication was defined as T3-4/N+ tumors for both group of patients. Surgeries were performed at 6 to 8 weeks after neoadjuvant therapy. Low rectal cancer was defined as tumors in the lower third of the rectum. Digital rectal examination, plain chest x-ray, colonoscopy, abdominal ultrasonography, and computerized tomography were used for staging both before and after chemoradiotherapy. All operations were performed by the same consultant surgeon who had undergone additional training on the extralevator technique. All patients were followed up prospectively. Patient informed consent was obtained for the operation presented in the study. Our study has been Objective: Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates and poor survival outcomes for rectal...

Benign anastomotic stricture after hepaticojejunostomy is one of the serious complications of biliary surgery. If left untreated, jaundice, cholangitis, or cirrhosis may develop. A 58-year-old male patient was admitted with benign hepaticojejunostomy stricture. The patient initially underwent an endoscopic retrograde cholangiography using double-balloon enteroscope, which was unsuccessful due to the sharp angle between the jejunal limb and the biliary tree. It was decided to perform surgery. During the operation, we performed Heineke-Mikulicz strictureplasty to the narrowed anastomosis. Patient's postoperative course was uneventful. At the end of followup, for 18 months, his liver enzymes were within normal ranges, and the ultrasound examination showed a patent hepaticojejunostomy anastomosis. The simplicity of the technique and the promising result support the applicability of the Heineke-Mikulicz principle in suitable cases as an alternative treatment approach for hepaticojejunostomy strictures.

Gallbladder stone disease developing after orthotopic cardiac transplantation: is laparoscopic cholecystectomy a safe procedure? A case report Cardiao transplant surgery is being performed with increasing frequency as a treatment for end-stage heart diseases. In addition to the vtfell-known post-surgical problems of rejection and infection, these patients may present at a future date with other medical problems which require surgical treatment, including biliary stone disease. Patients undergoing heart transplantation may be prone to general surgical complications. Biliary tract diseases are among the most frequently reported complications and may be associated with significant morbidity and mortality, especially in the early period after transplantation. The spectrum of problems ranges from asymptomatic cholelithiasis to fulminant cholecystitis, cholangitis, and gallstone pancreatitis. We herein report a 36-year-old immunosuppressed heart transplant patient who underwent successful laparoscopic cholecystectomy for gallbladder stones.