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Telemedicine, Virtual visits, Carbon emissions, Sustainability, General surgery clinic Keywords: Telemedicine; Virtual visits; Carbon emissions; Sustainability; General surgery clinic EN Telemedicine Virtual visits Carbon emissions Sustainability General surgery clinic 2199 2201 3 10/18/23 20231001 NES 231001 Meeting Information: This project was presented at the Americas Hepato-Pancreato-Biliary Association (AHPBA) meeting on March 9-12, 2023, in Miami, Florida. [Extracted from the article]

Background: The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease.Results: Sixty-seven patients were identified including 15 children and 52 adults; 76.1 % were females. The median age at diagnosis was 3 [inter-quartile range (IQR) = 6.0-0.7] years for children, and 46 [IQR = 55.6-34.3] years for adults. Forty-eight patients (72 %) were symptomatic. Types of choledochal cyst included: I (n = 49, 73.1 %), II (n = 1, 1.5 %), IV (n = 9, 13.4 %), and V (n = 8, 12 %). The median diameter of the type I choledochal cyst was 35 [IQR = 47-25] mm. All 48 patients underwent excision of cyst with Roux-en-Y hepaticojejunostomy, and eight underwent resection with hepaticoduodenostomy. Six patients underwent liver resection, and five patients underwent orthotopic liver transplantation. Malignancy was concomitant in five adult patients, being identified on preoperative imaging in three cases; and atypia was seen in three additional patients. Early morbidity included Clavien-Dindo classification grades III (n = 7) and II (n = 5), while long-term complications consisted of Clavien-Dindo grades V (n = 5), IV (n = 2), III (n = 18), and II (n = 1).Conclusions: Presentation and management of choledochal cyst is varied. Malignant transformation is often detected incidentally, and so should be the driving source for resection when a choledochal cyst is diagnosed. [ABSTRACT FROM AUTHOR]

An unusual case of variceal bleeding at the site of a biliary enteric anastomosis is presented. This entity can occur when a high-to-low pressure gradient forms in a variceal field. In this case the anastomotic site was the location of the pressure gradient from the high-pressure small bowel varices to the low-pressure biliary tract. This was successfully treated by disconnection of the anastomosis. The resulting biliary defect was patched with small intestinal submucosa, which functioned successfully as a scaffold for biliary epithelial ingrowth. [Copyright &y& Elsevier]