The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones. Late sequelae include recurrent bile duct stones and bile duct strictures. With the number of cholecystectomies being performed increasing in the laparoscopic era the number of patients presenting with PCS is also likely to increase. We briefly explore the syndrome and its main aetiological theories.

The role of Intra Operative Cholangiogram during laparoscopic cholecystectomy remains controversial. This review discusses the modalities used in the pre- and peri-operative assessment of Common Bile Duct. It also discusses the advantages and disadvantages of selective and routine IOC. In this review we explore the role of Intra Operative Cholangiogram in current day practice.

The incidence of concomitant abdominal aortic aneurysm and gastrointestinal malignancy is rare. Current treatment strategies in patients with both lesions remain controversial. It is unclear whether to treat the AAA and gastrointestinal malignancy simultaneously or in a staged manner. In patients with concomitant AAA and gastrointestinal malignancy surgical orthodoxy dictates that the most symptomatic lesion or the most life threatening condition should be treated first, however there is a therapeutic dilemma when neither or both of the lesions are symptomatic .In this review we explore (a) Priority of treatment in patients with concomitant abdominal aortic aneurysm and gastrointestinal malignancy (b) The role of EVAR in the management of abdominal aortic aneurysm and concomitant gastrointestinal malignancy.

Background Chronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques. Methods This review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon's perspective are added. The outline includes pathophysiologic aspects, classifications and patientcentred surgical approaches. Results There has not been a standardized treatment for CP so far as clinical and radiological appearance of the disease have a wide range due to great heterogeneity of this complex disease; therefore, level 1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is a feasible option in selected patients to avoid endocrine insufficiency. Conclusion A tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.

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