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Objective: Dilated common bile duct (CBD) (8–15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years. Methods: Seventy-eight such patients were managed from 2009 to 2017 and categorized as: Group A—dilated CBD with post-cholecystectomy status (n = 15); B—dilated CBD with cholelithiasis (n = 34); C—dilated CBD without cholelithiasis (n = 16); D—dilated CBD with no cause identified and underwent CBD excision (n = 13). Causes for CBD dilatation were evaluated. The outcome of patients in Group B + C without any cause (n = 33) was compared with Group D. Result: Median age, CBD diameter, bilirubin and alkaline phosphatase were 51 years (13–79), 10 mm (8–20), 0.6 mg/dl (0.2–2.5) and 126 IU (60–214), respectively. Group-A patients who did not manifest any cause of CBD dilatation were managed conservatively. The aetiology was identified in 17/50 patients in Group B & C [acute pancreatitis (n = 6), passed CBD calculi (n = 3), perivaterian diverticulum (n = 3), viral aetiology (n = 4) and tumour (n-1)]. In Group-C, 7 patients with no obvious cause underwent endoscopic sphincterotomy, pancreatoduodenectomy (n = 1), and the rest were managed conservatively (n = 8). There was no significant difference in the complication between Group B + C (without any cause) and Group D (3/33 vs. 1/13; p = 0.58) at a median follow-up of 72 months (30–90). Conclusion: Dilated CBD with normal LFT's without apparent cause is mostly benign and of no consequence. Excision of the CBD is not required for most of these patients. [ABSTRACT FROM AUTHOR]

Variations in SMV anatomy where two trunks- Jejunal and ileal trunk form a single trunk can occur in 10%-20% of cases, can lead to misinterpretation of anatomy and subsequent vascular injury. Laparoscopic right hemicolectomy (LRH) with complete mesocolic excision with central vascular ligation (CME-CVL) is preferred for right colon cancer due to its superior oncological outcomes, higher lymph node yield and accurate staging. Axial cuts of contrast CT abdomen of the patient show the presence of two trunks of SMV - jejunal and ileal trunk on either side of SMA. [Extracted from the article]

Background: Corrosive stricture of esophagus may be associated with variable involvement of stomach. We analyzed the outcome of gastric conduit used in the management of corrosive esophageal stricture with concomitant antro-pyloric stricture. Study design: Among 101 esophageal replacements performed, 53 patients had combined esophagus and stomach strictures. Colon was used as a conduit in 43 patients, while stomach was used in ten patients. Indications, perioperative complications and early/late outcomes of patients with gastric pull-up were reviewed and compared with those undergone colon pull-up. Results: The indications of using gastric conduit were impromptu in four patients [colonic conduit ischemia ( n = 2) and an oversight of antro-pyloric stricture after forming the gastric conduit ( n = 2)]. Six patients had preconceived gastric conduit (distal antro-pyloric stricture with distended stomach). The median age was 29 years (range 16-50), and median BMI was 15.4 kg/m (range 14.5-20.1). The stomach was drained using loop gastrojejunostomy ( n = 7) or Roux-en-Y gastrojejunostomy ( n = 3). One patient died due to sepsis secondary to anastomotic leak. Median hospital stay was 9 days (range 7-22). At median follow-up of 25 months (range 14-80), the remaining nine patients are able to have solid diet and have gained weight. The level of esophageal stricture was low ( p = 0.01), and duration of surgery ( p = 0.02) and median hospital stay ( p = 0.04) were significantly less in patients with gastric conduit plus drainage as compared to patients undergone colonic pull-up. Conclusion: Gastric conduit in a subject with distal antro-pyloric stricture can be used safely along with gastrojejunostomy in selected patients of corrosive esophageal stricture. [ABSTRACT FROM AUTHOR]

A 31-year-old man with steroid-refractory severe ulcerative colitis was planned for a two-stage robotic total proctocolectomy with ileal pouch-anal anastomosis using the da Vinci Xi system (see Supplementary file Video S1). The proctocolectomy specimen was retrieved using a Pfannenstiel incision, an ileal J-pouch was created, the anvil was secured to the pouch, the pouch was placed inside the abdomen and the incision was closed. Robotic total proctocolectomy with ileal pouch-anal anastomosis using indocyanine green fluorescence imaging in a case of medically refractory ulcerative colitis - a video correspondence. [Extracted from the article]

Background: Pharyngoesophageal stricture (PES) is an Achilles' heel in the management of corrosive injury. Advances in endoscopic techniques were utilized in its management. We classified the stricture as per its dilatability and then planned their treatment. Methods: PES was sub-categorized based on endoscopic dilatation and availability of cervical oesophagus: group-1 stricture with available cervical oesophagus; group-2 stricture with some part of upper oesophagus made available after endoscopic dilatation and anastomosis in cervico-pharyngeal area; group-3 stricture not amenable for dilatation, anastomosis done at the pharynx. Endoscopic dilatation was performed using through-the-scope pyloric balloon. Number and duration of dilatation sessions before surgery, incidence of tracheostomy, time and incidence for re-stricture and present status of swallowing were evaluated. Results: Of 226 patients managed, 46 underwent oesophageal replacement for PES. Group 1, 2 and 3 had 12, 14 and 20 patients, respectively. An average 3 (2-4) preoperative balloon dilatation sessions were performed over 6-8 weeks. Tracheostomy was required in 1, 0, 8 patients ( p = 0.010), and median hospital stay was 10, 9 and 13 days ( p = 0.09) in group 1, 2, 3, respectively. Re-stricture developed in 4/12, 4/14, 9/20 patients with average sessions of dilatation required in post-operative period was 4, 3.5 and 8 in group 1, 2, 3, respectively. >90% of patients are taking normal diet in each group. Conclusion: We attempted to avoid the high anastomosis by dilating the PES and step down the level of anastomosis in two-third patients. We thereby avoided tracheostomy, aspiration and swallowing problems related to high strictures. [ABSTRACT FROM AUTHOR]