Preoperative PCT and CRP levels done 48 h before surgery are sensitive, specific, easily available, and cost-effective predictors of infective complications after PD.

Transduodenal ampullectomy (TDA) is indicated for large ampullary tumors, for presence of dysplasia on endoscopic biopsy, for poor surgical candidates for pancreaticoduodenectomy, and in cases not indicated for endoscopic ampullectomy. Retrospective review of data from 2009 to 2015 revealed 11 patients who underwent TDA. Magnetic resonance imaging cholangiopancreatography (MRI-MRCP), contrast-enhanced computed tomography (CECT) scan, side-viewing endoscopy, and endoscopic ultrasound (EUS) were used for investigating the patients as required. Preoperative biopsy was done in all. Out of the 11 patients, only one had recurrence. Two patients had adenocarcinoma and were treated with pancreaticoduodenectomy. TDA is a safe surgical procedure for treatment of well-selected benign ampullary pathologies. It is also a treatment option for the cases of ampullary adenomas not amenable to endoscopic resection.

IgG4-sclerosing cholangitis (IgG4-SC) commonly presents with type 1 autoimmune pancreatitis. Isolated IgG4-SC is rare. Differentiating IgG4-SC from cholangiocarcinoma preoperatively is challenging due to overlapping radio-clinical manifestations and difficult preoperative histology. We present three cases preoperatively diagnosed and surgically treated as hilar cholangiocarcinoma. First and second cases presented with cholangiocarcinoma with portal vein involvement and third with a malignant-appearing hilar stricture. On histopathology, IgG4-SC was diagnosed in the first two cases. Third patient had raised serum IgG4, and histopathology was inconclusive for IgG4-SC and negative for malignancy. However, she responded to steroid therapy.

large lesions can be laparoscopic management of left sided lesions. This aim of this study is to assess the impact of size on the feasibility and safety of lesions in the left pancreas. Methods: A retrospective collected database of patient undergoing LLP between June 2007 and June 2015 was reviewed. Data was divided into 2 groups according the size of the lesion, group A lesions >5 cm and group B lesions >5 cm. Results: A total of 105 LDP were performed. There were 73 patients (69.5%) in group A (mean size: 26.9 mm) and 32 patients (30.5%) in group B (mean size: 76.42 mm).The two groups were similar in Operation time (p = 0.662), blood loss (p = 0.728), length of stay (p = 0.586), length of specimen (p = 0.77) and post operative complications (p = 0.53). Large tumours showed higher conversion rate 0% vs 6.2% (p = 0.009). Conclusion: LDP for Large lesions is feasible and safe. However a higher conversion rate should be expected.

Background and rationale: Laparoscopic common bile duct exploration (LCBDE) is an established option for treating CBDS. The aim of this paper was to look at the feasibility of LCBDE and choledochoduodenostomy as a salvage procedure after failed endoscopic bile duct stone extraction, complicated bile duct stones and primary CBD strictures. Method: We retrospectively reviewed a prospective database, to study the feasibility of LCBDE with choledochoduodenostomy as salvage procedure for failed ERCP and complicated bile duct stones. Result: In our Institution from period of Jan 2013 to June 2015 total number of ERCP done for CBD stones was (n1) = 516 out of which failed ERCP account to (n2) = 24.24 patients who failed endoscopic stone extraction due to multiple large CBD calculi (12), recurrent stones (5), lower CBD stricture (4), impacted primary CBD stone (2), periampullary diverticulum (1). These patients underwent LCBDE and choledochoduodenostomy, of which 24 achieved successful stone clearance. Average operating time was 130 minutes and average blood loss was 50 ml. Stone clearance was done using direct choledochotomy in 6 patients, Dormia basket was used in 5 patients and balloon extraction was done in 3 patients. Stone clearance was confirmed with either choledochoscope or intraoperative cholangiogram in all patients. One patient developed bile leak which resolved spontaneously. The median length of stay for these 16 patients was five days. Conclusion: Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be safe and effective method for treating complex CBDS with failed ERCP procedures.