FON can be an alternative method to conventional open necrosectomy in patients with infected necrosis and unresolved sepsis.

and maintained database. Development of long-term biliary complications, mortality and the costs of treatment were compared across each of the injury grades. Results: Amongst 120 patients, the majority of injuries were Strasberg grade A (41%), with 11%, 17% and 32% at grades B, C and D, respectively. Rates of surgical repair differed significantly by grade (p<0.001), with 8-20% of grade A-C injuries being repaired surgically, compared to 74% of grade D injuries. A total of 31 patients developed complications of BDI, which gave estimated complication rates of 19%, 23% and 31% at 1, 5 and 10 years respectively. A significant difference in complication rates was detected (p=0.022), with estimated rates at five years of 40% vs. 15% in grade D vs. A injuries (p=0.010). When all treatment costs were combined a significant difference across the BDI grades was detected (p<0.001). Costs were highest in grade D injuries at a mean of £11,048 per patient, but this was closely followed by the grade B group, at £10,612 per patient. Comparisons across the grades of BDI found no evidence of a significant difference in patient survival (p=0.830). Conclusions: Strasberg A-D injuries lead to considerable long-term morbidity and cost. Grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.

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Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable topical agent for gallstone dissolution after having been proven its effectiveness and safety through the worldwide studies. Although generally safe, the widespread use of MTBE is limited by the drawbacks of MTBE, most which is attributed to relatively low boiling point of MTBE and resulting higher evaporation. Method: 2-Methoxy-6-methylpyridine (MMP) is a compound wherein the bulky aliphatic tert-butyl group of MTBE is replaced with an aromatic group, thereby having higher boiling point (156 C). In this study, we were intended to determine the safety and gallstone-dissolving potential of MMP. Results: In the in vitro dissolution test, MMP showed significantly better gallstone-dissolving potential than MTBE, especially at 8 h and 24 h after reaction, respectively (P< 0.05). 24-h incubation with MMP has resulted in 88.2%, 61.5%, and 39.3% dissolubility of cholesterol, mixed, and pigmented gallstones, respectively. The treatment with MTBE did not reduce the viability of human gallbladder epithelial cells nor did increase or decrease the expression of pro-apoptotic marker (Mcl-1) or proliferation marker (PCNA), respectively. In the in vivo dissolution test, MMP exhibited the significantly higher gallstonedissolving potential than MTBE in the both hamster models of cholesterol and pigmented gallstones (P< 0.05). Compared to MTBE. Conclusions: If a clinical trial supports these conclusion, contact litholysis by MMP is expected to be an attractive alternative to laparoscopic cholecystectomy in managing a proportion of patient population with gallstones.