When during surgery for gallstone disease a cholecystoenteric fistula is encountered, the possibility of an associated Mirizzi syndrome must be considered. The findings of this study confirm the association of Mirizzi syndrome with cholecystoenteric fistula.

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OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.

Jejunoileal tumors present frequently in patients younger than 49 years of age. Ileal tumors are more likely to develop intestinal obstruction than jejunal tumors. Emergency surgery for these patients precludes a complete and negative margin resection and constitutes a risk factor for residual disease and short-term survival.

Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.

Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

The incidence of incidental pathology found during laparoscopic bariatric surgery has been estimated to be around 2%, and gastric gastrointestinal stromal tumors (GISTs) have been found in 0.8% of patients, constituting a rather uncommon finding. Safe laparoscopic resection of gastric GISTs is an established procedure and has been described associated to gastric Roux-en-Y bypass for morbid obesity. We discuss one case of a gastric GIST incidentally discovered during laparoscopic sleeve gastrectomy for morbid obesity. The procedure was performed via laparoscopy, and the patient recovered without any complication. Currently, the patient has lost weight according to what was expected, is asymptomatic, and free of disease.

Real outcomes for the inguinal tension-free Lichtenstein hernioplasty are not reflected by the usual parameters by which they are measured and habitually reported. It is possible to measure these outcomes from the point of view of the surgeon, as well as from the patient's, using an instrument specifically designed for that purpose. The aim of this study was to analyze the outcomes of the tension-free hernioplasty in 236 patients. Based upon the concept of quality-of-life, we designed a structured questionnaire in the form of a qualitative-and-quantitative measurement instrument. The study had two phases. First, we analyzed retrospectively the clinical records. Second, we interviewed the patients applying the instrument. The score demonstrated that 83% of the patients feel that the outcomes of their surgery are excellent, 9.7% feel that they are very good, and 3.8% feel that they are bad or very bad. Outcomes of the Lichtenstein hernioplasty should not only reflect the technological progress of hernia surgery but also the more intimate aspects of the patient's experience. It is possible to measure the outcomes of this common surgical procedure in a more complete way using a simple measurement instrument.