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AIMTo evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors.METHODSThis is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017).RESULTSThe frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.CONCLUSIONSurgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.

We report the first case series from Africa and the Middle East on choledochal cyst, a disease which shows significant geographical distribution with high incidence in the Asian population. In this study, the epidemiological data of the patients are presented and analyzed. Attention was paid to diagnostic imaging and its accuracy in the diagnosis and classification of choledochal cyst. Most cases of choledochal cyst disease have type I and IV-A cysts according to the Todani classification system, which support the etiological theories of choledochal cyst, especially Babbitt's theory of the anomalous pancreaticobiliary duct junction, which are clearly stated. The difficulties and hazards of surgical management and methods used to avoid operative complications are clarified. Early and late postoperative complications are also included. This study should be followed by multicenter studies throughout Egypt to help assess the incidence of choledochal cysts in one of the largest populations in Africa and the Middle East.

LLR for HCC is feasible in patients with LC. Cirrhotic patients showed comparable perioperative and long-term outcomes to non-cirrhotic patients.

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This paper aims to identify the challenges faced by Pakistani students during online learning environment, to determine whether a difference exist between males and females students regarding challenges faced during online learning, and to evaluate the effectiveness of online learning in Pakistan from students' perspectives. The population of the present study was consisted of students who were taking online classes in Lahore Pakistan. The study design was cross sectional and analytic study. A sample of 550 students was drawn. The technique of simple random sampling was used for this purpose. Google form questionnaire was used as a tool for data collection. Frequency table were used to represent the findings. One Sample t-test applied regarding problem faced by students in online learning, Independent Sample t-test regarding difference between male and female students responses about challenges faced during online education and One way ANOVA for significant difference between qualification level of students responses about challenges faced during online education. Results revealed that all the students were facing same issues either they were school level or university level. Male and female students were facing same challenges in online classes. Online learning cannot produce good results in developing countries like Pakistan, where a huge majority of students are not able to access the good internet facility due to technical as well as financial issues. This study addressed the effectiveness of online and challenges faced by students who are taking online classes. As per this study, 88% of students had not proper internet facility and they faced lots of internet issues and 65% students were not satisfied with online learning 85% students complaining about eye sight issue by taking online classes on devices 50% students were unable to manage the university affairs. As a result, we found that all the students were facing same issues either they were school level or university level. We also obtained that male and female students were facing same challenges in online classes.

PD is associated with an increased risk of postoperative morbidity in overweight patient. Overweight patients must not be precluded from undergoing PD. However, operative techniques and pharmacological prophylaxis to decrease POPF should be considered in overweight patients.

Background/AimsWith improvements in the survival of liver transplantation (LT) recipients, the focus is shifting to patient quality of life (QOL), and employment is an important factor in aiding the social reintegration of LT patients. This study aims to evaluate the current employment status of liver graft recipients and various factors that may hinder reemployment.MethodsFifty patients above age 18 who underwent either living or deceased donor LT at a single center from March 2009 to July 2016 were interviewed during their visit to the outpatient clinic. The internally developed questionnaire consisted of 10 items. The Karnofsky Performance Scale and EQ-5D were used to evaluate patient function and QOL.ResultsA total of 25 (50%) patients returned to work after transplantation (the working group), and 21 (84%) patients in the working group returned to work within the first year after transplantation. In the non-working group (n=25), 17 (68%) answered that their health was the reason for unemployment. Fatigue and weakness were the most frequent symptoms.ConclusionsThe data shows that as many as 50% of total patients returned to work after receiving LT. Fatigue and weakness were the most common complaints of the unemployed group, and resolving the causes of these symptoms may help to increase the employment rate.