Introduction: Mortality rates after pancreaticoduodenectomy have decreased dramatically during the last two decades in high volume centers. However, despite a low mortality rate and improvements in perioperative care, morbidity rate is still high after pancreaticoduodenectomy. Studies defining the role of potential risk factors for the development of postoperative complications are few, and sometimes with conflicting results. There is need to identify potential risk factors for predicting complications after pancreatic resections. Aim: The aim of the present study was to assess the risk factors for morbidity after pancreatic resections, by utilizing a simple grading system and identify the factors affecting them. Material and Methods: This was a prospective study done in the Department of Surgical Gastroenterology between Feb 2007 to Jun 2009. All patients who underwent elective pancreatic surgeries were included in this study. Major Morbidity was defined as patients having grade III and above complications. The risk factors assessed were patient factors, disease factors, operative factors and postoperative factors. Risk factors were analyzed for morbidity and major morbidity separately. Results: One Hundred and Seven patients underwent elective pancreatic surgeries between Feb 2007 to Jun 2009. Pancreaticoduodenectomy was the commonest procedure. Three patients died after pancreatic surgeries. Mortality rate after pancreatic surgery was 2.8% (3/107) and that after Whipple's procedure was 4.68% (3/64).In our study a total of 58 of 107 (54.2%) patients developed complications after pancreatic surgery. Major morbidity defined as Grade III or more complication was seen in 24.2% (26/107). Complications after Whipple's procedure was seen in 49 of 64 (76%) patients. Major morbidity (Grade III and more) was seen in 22 of 64 patients (34.3%). All complications following pancreatic surgeries were graded. The mean postoperative duration was 12.4 days (6 -47 days).The significant risk factors for morbidity after pancreatic surgery were soft pancreas (OR 5.988; p=.007), SGPT > 73 U/L (OR 3.623; p = .054), age > 50yrs (OR 3.254; p = .053), and absence of chronic pancreatitis (OR 4.363, p = .016).The significant factors for major morbidity were soft pancreas (OR 6.557, p = .005), hypertension (OR 5.803, p = .037) and BMI >25(OR 4.052, p = .05). Conclusions 1. Independent factors predicting morbidity after pancreatic surgery were soft pancreas, age > 50yrs, SGPT > 73 U/L and absence of chronic pancreatitis. 2. Independent factors predicting major morbidity after pancreatic surgery were soft pancreas, hypertension and BMI > 25.

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

Backgrounds/Aims: Central pancreatectomy (CP) is associated with a higher rate of postoperative pancreatic fistula (POPF), and it is less preferred over distal pancreatectomy (DP). We compared the short-and long-term outcomes between CP and DP for low-grade pancreatic neck and body tumors. Methods: This was a propensity score-matched case-control study of patients who underwent either CP or DP for low-grade pancreatic neck and body tumors from 2003 to 2020 in a tertiary care unit in southern India. Patients with a tumor >10 cm or a distal residual stump length of <4 cm were excluded. Demographics, clinical profile, intraoperative and postoperative parameters, and the long-term postoperative outcomes for exocrine and endocrine insufficiency, weight gain, and the 36-Item Short Form Survey (SF-36) quality of life questionnaire were compared. Results: Eighty-eight patients (CP: n=37 [cases], DP: n=51 [control]) were included in the unmatched group after excluding 21 patients (meeting exclusion criteria). After matching, both groups had 37 patients. The clinical and demographic profiles were comparable between the two groups. Blood loss and POPF rates were significantly higher in the CP group. However, Clavien-Dindo grades of complications were similar between the two groups (p = 0.27). At a median follow-up of 38 months (range = 187 months), exocrine sufficiency was similar between the two groups. Endocrine sufficiency, weight gain, SF-36 pain control score, and general health score were significantly better in the CP group. Conclusions: Despite equivalent clinically significant morbidities, long-term outcomes are better after CP compared to DP in lowgrade pancreatic body tumors.

Primary ciliary dyskinesia (PCD) is a rare disorder with impaired ciliary function resulting in a spectrum of clinical manifestations of varying severity. PCD affects approximately one in every 20,000 individuals with a reported prevalence between 1:4000 and 1:50,000. Due to its nonspecific clinical features, the condition is usually diagnosed late in its course, unless situs inversus (SI) or organ laterality defects are discovered at imaging. A small subset of patients with PCD display associated organ laterality defects, different from the classical SI totalis. We present here, the clinical and imaging findings in a young female with PCD along with left-sided isomerism, a variant of heterotaxy syndromes.