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Lebanon is a relatively low Tuberculosis burden country but has a high proportion of extrapulmonary tuberculosis. Tuberculosis involving the chest wall is found in around 1% of all skeletal tuberculosis cases. We present the case of an 81-year-old immunocompetent patient who presented with 3 months history of a painful lump in the anterior chest wall. PCR for MTB (mycobacterium tuberculosis) was positive and a diagnosis of the tubercular abscess of the chest wall was made mimicking a pyogenic abscess.

Hepatic cavernous hemangiomas are the most common benign tumors of the liver. They can be found incidentally in the general population in up to 20% of the cases. On the other hand, gastric hemangioma is a very rare entity. These tumors account for only 0.05% of all gastrointestinal (GI) neoplasms. Hemangiomas have no malignant transformation potential. They are detected using CT-scan or MRI. Endoscopy can play a role in the differentiation of gastric from hepatic hemangiomas. Hepatic hemangioma can be associated with portal vein thrombosis as a mass effect resultant. Surgery is recommended for the treatment of symptomatic hemangiomas or giant ones (above 10cm). Laparoscopy is recommended for symptomatic hemangiomas less than 4cm or those who harbor a vascular pedicle. Here we present a case of a 50-year-old male presenting with a history of 1 month duration of epigastric pain and 5 kilograms of weight loss diagnosed on imaging studies with gastric hemangioma and partial portal vein thrombosis. Laparoscopic approach was adopted to deal with his condition. Intra-operatively, he was found to have hepatic hemangioma of around 10cm associated with complete atrophy of the left liver lobe. Decision was taken intra-operatively to carry a laparoscopic left hepatectomy regardless of all the challenges that pose laparoscopy in general for any hepatectomy. This decision was taken due to the presence of a vascular pedicle, which was clipped for hemostatic control.

Adrenal myelolipoma is a rare condition. Although benign in nature, these tumors can increase in size and cause a mass effect to nearby structures presenting as abdominal distension and pain. In 90% of cases, adrenal myelolipomas are unilateral. However, the real challenge in management is when bilateral adrenal myelolipoma is present. Herein, we present a case of a 51-year-old male Caucasian patient with bilateral adrenal myelolipoma. The patient had a large left adrenal myelolipoma (23 × 13 cm) and a small one on the right (4.4 × 4 cm). We opted for an open left adrenalectomy due to classical features on computed tomography scan and the mass effect of the tumor.

Objective: Surgical resection of hilar cholangiocarcinoma carries significant morbidity and mortality, particularly if postoperative bile leak occurs. Prognostic factors and scoring tools have been described for overall morbidity and mortality but none are specific for postoperative bile leak. In this study, we investigate the prognostic utility of various factors in predicting overall morbidity, mortality and risk of biliary leak in Bismuth Type III tumors with the hopes of developing a scoring tool in future research. Materials and Methods: A retrospective sample of 23 patients with Bismuth Type III tumors exclusively who underwent surgery between 2010 and 2017 were selected for this study. Demographic, surgical, pathologic and biochemical data were collected from the patients’ medical records. Results: 11 patients underwent a right hepatectomy for type IIIa tumors and 10 patients underwent a left hepatectomy for type IIIb tumors. 2 patients were lost to follow up and were excluded. R0 resection was achieved in 20 patients. Overall survival at 1, 3 and 5 years was 78.3%, 61.9% and 38.1%, respectively. A BMI >24kg/m2 was associated with a worse prognosis, increased overall morbidity and decreased survival at 1, 3 and 5 years (p0.74 was associated with decreased 5-year survival (p24kg/m2 and a preoperative creatinine >0.74 are associated with a poor prognosis in Bismuth Type III Klatskin tumors. Furthermore, Age, sex, preoperative hemoglobin, tumor size, use of CUSA and type IIIb tumors demonstrate a borderline significant association with the occurrence of postoperative bile leak.

Introduction: Pilonidal disease is a chronic inflammatory process resulting from impaction of natal cleft hair into the subcutaneous tissues creating an abscess or a draining sinus over the sacrococcygeal area. Malignant transformation occurs in around 0.1%, mainly into squamous cell carcinoma (SCC) type. Wide excision with tumor-free margins remains the treatment of choice. Multiple closure techniques were settled and the best one ought to be chosen in a context malignancy and future radiological treatment. Case Presentation: We describe the management of a case of a 69-year-old male with chronic pilonidal disease, recurrent after 25 years found on final pathology to undergo malignant transformation into SCC. Wide and aggressive excision were performed with new margins and with periosteal excision of the sacrum and coccyx. rotational myocutaneous gluteal flap was done for closure of the wound in order to ensure better satisfactory esthetic results without a delay in future treatment. Conclusion: The progression of a chronic pilonidal disease into SCC is a rare but serious complication. The diagnosis is confirmed by biopsies. Workup for metastasis should be made before aggressive surgical excision. Oncoplastic surgeries is recommended for satisfactory results. Routine follow-up postoperatively should be considered due to high rate of recurrence by physical examination and imaging.

International audience; No abstract available

Introduction: The lymphocytic population, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are prognostic tools predictive of adverse outcomes for several solid tumors and oncologic surgeries, one of which is esophageal adenocarcinoma. Furthermore, delayed resumption of oral feeding postoperatively is associated with significant morbidity. Given the controversies regarding post-op nutritional support in these patients, this study investigates the prognostic role of the lymphocytic percentage, the NLR, and the PLR in predicting prolonged length of hospital stay (LOHS) and ICU stay (LOICUS) as well as delayed oral feeding following transhiatal esophagectomy (THE) for adenocarcinoma of the esophagogastric junction (AEG). Methods: Forty consecutive patients who underwent transhiatal esophagectomy performed by a single surgeon for Siewert type II and type III adenocarcinoma of the esophagogastric junction at a tertiary referral center were selected. Retrospective data collection was performed from the patients’ medical records, and statistical analysis was performed using Pearson correlation and Student’s t test and Chi-square testing. Results: An increased LOHS was correlated with a lower preoperative lymphocyte percentage (p = 0.043), higher NLR (p = 0.010) and PLR (p = 0.015), and an increased number of packed red blood cell (PRBC) transfusions perioperatively (p = 0.030). An increased LOICUS was correlated with a lower preoperative lymphocyte percentage (p = 0.033), higher NLR (p = 0.018) and PLR (p = 0.044), an increased number of PRBC transfusions (p = 0.001), and patients’ comorbidities (p < 0.05). A delay in feeding resumption was correlated with a lower preoperative lymphocyte percentage (p = 0.022), higher NLR (p = 0.004) and PLR (p = 0.001), an increased PRBC transfusions (p = 0.001), and diabetes mellitus (p = 0.033). Multivariate analysis with automatic linear modeling showed that only the preoperative PLR was a powerful predictor for the delay of feeding resumption (p < 0.01). Conclusion: The lymphocyte percentage, PLR, and NLR are found to be associated with prolonged hospitalization and ICU stay and delayed oral feeding following THE for Siewert types II and III AEG. We hope by this series, to have set, at least one preliminary cornerstone, in the creation of a prognostic model, capable of assessing the need for an intraoperative jejunostomy placement, in patients undergoing esophagectomy for distal esophageal carcinoma., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Laparoscopy has become the standard of care in many surgical interventions over the last two decades. Gaining access to the intraperitoneal space and establishing pneumoperitoneum remains a crucial step to be safely achieved during these procedures..

Anastomotic leaks and gastric fistulas are recognized complications after sleeve gastrectomy and Roux-en-Y gastric bypass. They are, however, almost unheard of following a one-anastomosis gastric bypass. A gastrobronchial fistula, an exceedingly rare complication after bariatric surgery, has to date never been described following a one-anastomosis gastric bypass. Furthermore, there is no consensus regarding the management of this challenging complication. In our case, we present a patient who was discovered to have a gastrobronchial fistula 5 years after a one anastomosis gastric bypass. After 2 failed attempts at endoscopic stent placement, the patient was successfully managed with a laparoscopic Roux-en-Y gastrojejunostomy over the fistula.

Hydatid disease is caused by Echinococci parasite. The disease is considered endemic in the Mediterranean region with an incidence of 50 in 100000 inhabitants. The disease can occur in various organs such as the lungs, liver, and bones, in isolated and disseminated forms, however 75% of these cases involve the liver. Unusual location of cyst can be reported in disseminated disease such as in the spleen and retroperitoneal space. Isolated cases in unusual locations, however, are rarely reported. The adrenal gland is a remarkably rare location for isolated hydatid cyst to occur with less than 10 cases reported in the literature. We report the case of an isolated hydatid cyst in the right adrenal gland of a 38 years old female who was successfully managed with a medical and surgical manner. Albendazole was used pre-operatively for 1-month followed by a laparoscopic en bloc resection of the hydatid cyst and right adrenal gland due to absence of cleavage plan. The patient was then discharged on Albendazole for 1-month post-operatively.

A randomized case control prospective method was adopted in this study in order to assess the health benefit associated with the Darfiyeh cheese, a traditional Lebanese raw goat milk cheese ripened in goat skin. 21 participants were recruited and divided into 2 groups: test group (n = 10) and control group (n = 11). Venous blood and stools were collected at day 14, 21 and day 0 and 21 respectively. Flow cytometry was performed on blood sample. Fecal samples were plated on Plate Count Agar (PCA) and de Man, Rogosa and Sharpe Agar (MRS) agar in order to monitor any alteration in the gastrointestinal tract (GIT). At day 24, a significant increase by 27.67% (p = 0.043) in the bacterial count was seen on the MRS agar for the test group in comparison to no change in the total bacterial count. At day 14 a significant drop (p = 0.026) in CD3+/CD4+ population in the test group (35.67 vs 42.87), and a non-significant drop (p = 0.818) in CD8+ (24.76 vs 28.28) is seen when compared to control group. At day 24, no significant change (p = 0.20) in the CD3+/CD4+ population in comparison between both groups and no change in CD8+ or Geo means in both groups. In conclusion, an alteration in the GIT microflora could be hinted at by the lactobacilli bacterium, which was not reflected on the total bacterial count.

Background and aims Inflammatory bowel diseases (IBDs) and colorectal cancer have an increased impact on the Lebanese population’s morbidity and mortality. This study evaluated the situation of IBD and colorectal cancer at a tertiary hospital centre in Lebanon. Methods 1007 patients underwent colonoscopy over a period of 12 months by qualified physicians. 91 patients were excluded from the study. Biopsy results were divided into normal versus abnormal colonic tissue. The abnormal section was further subdivided into number of polyps, IBD, dysplasia and cancer. Results Out of 916 individuals included, 61 cases of Crohn’s colitis (CC) (6.7%) and 24 cases of ulcerative colitis (UC) (2.7%) were identified. A total of 92 cases of colorectal cancer (10.04%) were also identified. There was a slight male predominance in both groups of IBD without any statistical significance. One statistical significance was reported in favour to age50 years and male gender significantly correlate with an increased incidence of precancerous and cancerous polyps in the colon. They significantly correlate with adenocarcinoma. The estimated incidence of colorectal cancer, CC and UC was 54.1, 35.8 and 14.1 per 100 000, respectively, with a denominator of 169 959 patients per year. Conclusion Within the limitations of this study, the incidence of colorectal cancer and IBD falls in the high range compared with similar European and American studies. Our data are biased because of the tertiary centre setting but they can be considered as base for further investigations.