Primary abdominal wall closure after intestinal and multivisceral transplantation may not be possible because of loss of abdominal domain and/or graft size/abdominal cavity mismatch. Traditional closure techniques for the open abdomen may not be valid in these circumstances because of severe scarring of the abdominal wall from multiple previous surgeries in this particular group of patients. We present our initial experience with the use of non‐vascularized abdominal rectus muscle fascia in two patients who underwent deceased donation and living‐related combined liver and small bowel transplantation, respectively, and who could not be closed primarily. The donor fascia was attached to the recipient fascia in both patients. In either case, there was not enough skin cover for closure, the wound was left open, and a negative pressure dressing was applied. In both cases, over a period of 6 months after placement of the non‐vascularized abdominal rectus muscle fascia, the wound contracted, granulation tissue gradually covered the wound, and healing occurred, giving an intact abdominal wall. The abdominal rectus muscle fascia from a deceased donor can be used in a definite procedure for closure of the abdominal wall either at the time of transplant or later when a suitable rectus muscle fascia graft becomes available.

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Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.

Our case is unusual and ongoing follow up is required. However, current disease-free status at conventional and functional imaging is encouraging. A multidisciplinary and indeed multicentre approach may be needed, and oligometastatic disease, even to a bone, may be amenable to curative surgical intervention in highly selected cases.

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preoperative chemotherapy(P=.011), and no postoperative chemotherapy(P=0.31) independently predicted worse OS. Conclusion: Liver resection for PLM is feasible and safe and may be recommended within the framework of an individualized cancer therapy. Multimodal treatment including hepatectomy and systemic therapy may provide prolonged survival in selected patients with metastatic pancreatic cancer.

information on the intraoperative drain placement, drain amylase level on postoperative day one (POD1), postoperative day of last drain removal and patients with POD1 amylase level > 5000 U/L were also excluded. Patients with early drain removal (3 days) were compared to those with late drain removal (4 days). Multi-variable regression models were used to evaluate the possible benefit of early drain removal after adjustment for multiple confounding factors. Results: 1066 patient were eligible for analysis. Patients with early drain removal had significantly lower mean rates of serious postoperative complications (p< 0.001), overall morbidity (p< 0.001), pancreatic fistula (p< 0.001), organ space infection (p=0.007), delayed gastric emptying (DGE) (p=0.026) and shorter mean in-hospital stay (p< 0.001). After adjustment for many confounding factors with multivariable regression models, the early group continued to have a significantly lower risk of all noted complications, except postoperative DGE. Conclusion: Early removal (3 days)of the drain after Whipple procedures is associated with lower rates of postoperative adverse outcomes when POD 1 drain amylase levels are < 5000 U/L.