Background: The aim of this study was to evaluate the risk factors of wound dehiscence and determine which of them can be reverted.

IntroductionPatients with resection of stomach and especially with Billroth II reconstruction (gastro jejunal anastomosis), are more likely to develop afferent loop syndrome which is a rare complication. When the afferent part is obstructed, biliary and pancreatic secretions accumulate and cause the distention of this part. In the case of a complete obstruction (rare), there is a high risk developing necrosis and perforation. This complication has been reported once in the literature.Case presentationA 54-year-old Greek male had undergone a pancreato-duodenectomy (Whipple procedure) one year earlier due to a pancreatic adenocarcinoma. Approximately 10 months after the initial operation, the patient started having episodes of cholangitis (fever, jaundice) and abdominal pain. This condition progressively worsened and the suspicion of local recurrence or stenosis of the biliary-jejunal anastomosis was discussed. A few days before his admission the patient developed signs of septic cholangitis.ConclusionOur case demonstrates a rare complication with serious clinical manifestation of the afferent loop syndrome. This advanced form of afferent loop syndrome led to the development of huge enterobiliary reflux, which had a serious clinical manifestation as cholangitis and systemic sepsis, due to bacterial overgrowth, which usually present in the afferent loop. The diagnosis is difficult and the interventional radiology gives all the details to support the therapeutic decision making. A variety of factors can contribute to its development including adhesions, kinking and angulation of the loop, stenosis of gastro-jejunal anastomosis and internal herniation. In order to decompress the afferent loop dilatation due to adhesions, a lateral-lateral jejunal anastomosis was performed between the afferent loop and a small bowel loop.

Objective:The aim of the present study was to evaluate the role of age on different types of liver surgery. Methodology: Between 2002 and 2007, 50 patients underwent a variety of liver surgical procedures due to primary or metastatic tumours. Of these, 24 were 70 years old or older, and 26 patients were younger than 70 years old at the time of the operation. Results: Among the patients included in the study, 22 underwent radiofrequency ablation. Another 11 underwent non-anatomical liver resection. The remaining 17 patients underwent liver resection, with more than three segments resected. The type of procedure, duration of operation, estimated blood loss, and postoperative death and morbidity rates were not significantly different between the two groups. The mean survival of patients that underwent radiofrequency ablation or non-anatomical resection was not significantly different between the two groups. However, in the patients in which liver resection was performed, mean survival was significantly greater in the younger group. Conclusions: These results indicate that hepatic resection is a safe and feasible procedure in elderly patients. The postoperative outcome in this age group is comparable of that of younger patients.