Background: Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery. Methods: Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury. Results: Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome. Conclusion: Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.

TNF-α-308 G/A polymorphism is significantly associated with the development of postoperative sepsis and with increased expression of cytokines TNF-α, IL-6, and IL-8.

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

No abstract

Compared with open cholecystectomy, biliary injuries sustained during laparoscopic cholecystectomy are more likely to present earlier, are more often associated with persistent bile leaks, and are usually high injuries. However, the results of surgical repair do not appear to be different in these two groups.

BackgroundThe wound healing properties of the human omentum are well known and have extensively been exploited clinically. However, the underlying mechanisms of these effects are not well understood. We hypothesize that the omentum tissue promotes wound healing via modulation of anti-inflammatory pathways, and because the omentum is rich in adipocytes, the adipocytes may modulate the anti-inflammatory response. Factors released by human omentum may affect healing, inflammation and immune defense.MethodologySix human omentum tissues (non obese, free from malignancy, and any other systemic disorder) were obtained during diagnostic laparoscopies having a negative outcome. Healthy oral mucosa (obtained from routine oral biopsies) was used as control. Cultured adipocytes derived from human omentum were exposed to lipopolysaccharide (LPS) (1–50 ng/mL) for 12–72 hours to identify the non-cytotoxic doses. Levels of expression (mRNA and protein) were carried out for genes associated with pro- and anti-inflammatory cytokine responses and antibacterial/antimicrobial activity using qRT-PCR, western blotting, and cell-based ELISA assays.ResultsThe study shows significant higher levels of expression (mRNA and protein) of several specific cytokines, and antibacterial peptides in the omentum tissues when compared to oral sub-mucosal tissues. In the validation studies, primary cultures of adipocytes, derived from human omentum were exposed to LPS (5 and 10 ng/mL) for 24 and 48 h. The altered expressions were more pronounced in cultured adipocytes cells when exposed to LPS as compared to the omentum tissue.Conclusions/SignificancePerhaps, this is the first report that provides evidence of expressional changes in pro- and anti-inflammatory cytokines and antibacterial peptides in the normal human omentum tissue as well as adipocytes cultured from this tissue. The study provides new insights on the molecular and cellular mechanisms of healing and defense by the omentum, and suggests the potential applicability of cultured adipocytes derived from the omentum for future therapeutic applications.

Duplication of the extrahepatic bile duct is an extremely rare anomaly. There are five types of this anomaly, with type V being the least common variant. Only two cases of type V (one each of type Va and type Vb) have been reported. Here we report the second case of type Va duplication of the common bile duct presenting with choledocholithiasis. The patient underwent open choledocholithotomy and T-tube choledochostomy after failed endoscopic stone clearance. Duplication of the bile duct was detected on T-tube cholangiogram, which was confirmed by magnetic resonance cholangiopancreaticography (MRCP). No associated pancreaticobiliary maljunction was found on the imaging.

Increased SAT resistin mRNA expression probably leads to inducing insulin resistance and thus may be associated with obesity-related disorders in postmenopausal obese women.