Improve the results of resection of the pancreas in chronic pancreatitis. Methods: The clinic resection of the pancreas in 86 patients. Male-70 (82%) , women-16 (18%). The average age of 50,47 4 years. One month after surgery, with the presence of inflammatory infiltrate in parapankreal tissue, conducted Regional intra-arterial infusion of the celiac artery or gastroduodenal hydrocortisone 50 mg or 5-ftoruracil at a dose of 0.5 grams per day in order to arrest the inflammatory process in the pancreas and tissues for parapankreal tissue 5e7 days. Results: The first group included patients with PDR-12, distal resection-17 and intraparenchymal resection-48. The second group included patients with intraparenchymal resection using a sealing seam pankreatoenteroanastomosis loop or stomach-9, including 5 patients received intraarterial infusion of hydrocortisone or 5-fluorouracil. Mortality in the first group was 4%. Complications occurred in 28% of patients, mainly in the first group. When analyzing the reasons for the formation of complications, it turned out that they include patients with a loose structure of the pancreas, as well as in cases of inflammatory infiltration parapankreal fiber and the presence of cold abscess.Suture failure PEA is found in 2 patients, abscesses in the area of PEA and subhepatic space in 9 patients, a violation of evacuation after pPDR in 8 patients, and bleeding from the branches of GDSs and splenic artery aneurysm in 3 patients. Conclusions: 1) The use of intraparenchymal pancreatic resection produces fewer complications than gastropankreatoduodenalnoy resection ; 2) Complications arise in cases where there is inflammation in the papapankreal tissue 3) The use of complicated cases of chronic pancreatitis sealing the free end of the intestinal loop is not accompanied by the emergence of insolvency pancreatic and intestinal anastomosis.

Introduction Lymphorrhea or seroma formation after modified radical mastectomy (MRM) is a serious and disabling complication of axillary lymphadenectomy. Octreotide is a hormone with general anti-secretory effects. The potential role of octreotide in the treatment of lymphorrhea after axillary lymph node dissection in patients undergoing MRM is being investigated in this study. The purpose of this research is to study the effect of octreotide on the magnitude and duration of lymphorrhea in patients after MRM for carcinoma breast. Methods This clinical trial was registered in the Clinical Trials Registry India (CTRI/2017/11/010653). It was conducted in the Department of General Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from September 2015 to March 2017. This study is a parallel randomized controlled trial with a 1:1 allocation ratio. Thirty patients were enrolled and allocated equally into two groups. The intervention group received standard medical care plus injection octreotide 100 micrograms eight hourly intravenously post-operatively for five days and the control group received only standard medical care. The primary outcomes were lymphorrhea volume from 24 hours post-surgery till five days post-operatively and the number of days till the suction drain was removed. Secondary outcomes were surgical site infection, the incidence of seroma formation, complications of octreotide, duration of hospital stay, and the number of lymph nodes isolated. All the patients were followed up twice a week for the first six weeks after discharge followed by three monthly visits. Results A total of 30 patients were included in the study. The mean age was 46.2 years. The mean operative time in the control group was 137.87 ± 23.28 minutes and in the octreotide group was 128.13 ± 12.29 (p = 0.163). The volume of lymphorrhea in the control group was 354.67 ± 346.28 ml and in the octreotide group was 194.00 ± 240.62 ml (p = 0.081). Seroma occurred in 9% of patients in the control group and 2 % of patients in the octreotide group (p = 0.010). The duration of lymphorrhea was 4.93 ± 2.49 days in the control group and 3.13 ± 1.36 days in the octreotide group (p = 0.029). The duration of stay was 7.07 ± 2.40 days in the control group and 5.13 ± 1.06 days in the octreotide and was found to be statistically significant (p = 0.010). No obvious adverse reactions related to injection octreotide, namely, nausea, vomiting, abdominal discomfort, hypotension, bradycardia, and dysglycemia, were seen in any of our patients. Conclusion The duration of lymphorrhea, incidence of seroma formation, and duration of hospital stay were lesser in the octreotide group, and the difference was statistically significant. The wound infection rates were similar in both groups. Thus injection octreotide can be used safely and effectively.

A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.

Background Perforation peritonitis is associated with a high rate of morbidity and mortality in spite of advances in antibiotics and surgical techniques. The Omega-3 fatty acid is an immune-enhancing essential fatty acid that has been found to have anti-inflammatory properties, which help in quicker recovery. The present study examined the role of Omega-3 fatty acid infusion in the surgical outcome of perforation peritonitis. Methods Three hundred consecutive patients in the age group of 18-70 years operated for perforation peritonitis were included in this study. Patients in the study group received Omega-3 fatty acid emulsion postoperatively while those in the control group received a placebo. The groups were compared with respect to clinical and biochemical parameters. Results The Omega-3 fatty acid helped in reducing postoperative complications. The incidence of postoperative pyrexia (22.67% versus 82.67%), chest infection (6% versus 31.33%), and complete wound dehiscence (12% versus 34%) was significantly less in the study group compared to the control group. There was a 4.5-day difference in overall length of stay, favoring the study group who were on Omega-3 fatty acids (LOS 8.06 vs. 12.65 days). There was no mortality in the study group compared with 17 deaths (11.3%) in the control group. Conclusion Postoperative perforation peritonitis patients receiving Omega-3 fatty acids are at a lower risk of developing postoperative complications, have a shorter duration of hospital stay, and have lower morbidity and mortality.

Aims: Modern chemotherapy has improved the prognosis of stage IV colorectal cancer (CRC). However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis. We report our experience in this context. Methods: Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from a prospectively collected database. We assessed response to neoadjuvant chemotherapy (NACT), postoperative outcome, progression free survival (PFS), and overall survival (OS). Survival was estimated using Kaplan Meier analysis. Results: 21 patients were treated between 2007 and 2014. In sixteen patients (76%), NACT with a biological was administered and tumor response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence and resectability of the disease. Median peritoneal cancer index was 5 (range: 3e10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 42 hepatic lesions with a median of 2 per patient (range: 1e2) and a median size of 1.5 cm (range: 0.8e2.8). Tumor necrosis >50% was recorded in 7 (33%) patients. Median hospital stay was 17 days (range: 14e24); severe morbidity (Dindo-Clavien grade III-IV) occurred in 24% and no perioperative mortality (0e90 days) was recorded. The median OS was 49 months (95% confidence interval, 31.5e66.5) while the median PFS was 7 months (95% confidence interval, 5e9). Conclusions: Combined parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy may be warranted in a selected group of patients with LM and PC from colorectal cancer allowing low morbidity and a good mid-term overall survival. Aims: Acute-on-chronic liver failure (AoCLF) is defined as acute deterioration of liver function in cirrhotic patients, following variceal bleeding, infection, binge drinking or surgery. It carries poor prognosis, with in-hospital mortality 50%e66%. Several extracorporeal liver support systems have been developed and in recent meta-analyses there was shown the decrease of mortality in AoCLF as compared with standard medical treatment (SMT).Aim: to present the results of treatment of patients with AoCLF with the use of Prometheus FPSA device, compared to STM group. Methods: From 2003 to 2012 103 patients with AoCLF underwent all together 257 FPSA procedures. This group was compared to the historical group AoCLF patients (n = 31), treated in the period 2000e2003, with SMT. There were no differences in: gender (45F/58M vs 16/15, p = 0,5), age (45 vs 43, p = 0,09), MELD (3510 vs 2914, p = 0,04), Child-Pugh score (122 vs 122), creatinine 2,612,03 vs 2,241,94, p = 0,2), INR (2,631,53 vs 2,241,69, p = 0,8), albumin (2,610,68 vs 2,540,79, p = 0,7), grade of encephalopathy (p = 0,99); the only difference was bilirubin (30,016,88 vs 16,0913,01, p < 0,05) -for FPSA and SMT groups respectively. The most common indication to FPS...