Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%) Results Colonic tuberculosis was diagnosed in 50 patients during this 10 year study period. Sixteen had disease confined to the ileocaecal region, 14 had ileocaecal and contiguous involvement of variable lengths of the ascending colon, 13 had segmental colonic tuberculosis with involvement of the ascending colon in five, transverse colon in six, and descending colon in two. Five had ileocaecal and non-confluent involvement of another part of the colon, and in two the entire colon was affected.Abdominal pain occurred in 90%, weight loss in 74%, anorexia in 60% and fever and diarrhoea in 56% of all patients. None had pulmonary symptoms.A firm, usually tender abdominal mass of variable size (58%), and ascites (10%) were the only abnormal physical findings. The erythrocyte sedimentation rate was raised (>30 mm/h) in 38 of the 50 patients.Chest radiographs showed evidence of healed tuberculosis (fibrosis and/or calcification) in nine patients and active pulmonary tuberculosis (presence of acid fast bacilli in the sputum and/or gastric juice) in seven patients with ileocaecal disease and in both patients with pancolitis. COLONOSCOPYUlcerated areas a few millimetres up to 2 cm long, and a nodular friable mucosa were the most common lesions. These were often present in the same patient. The areas of ulceration were superficial and generally had sharply defined but irregular margins. The ulcer base was not friable and was covered with slough which was difficult to wash away. The surrounding mucosa was nodular and hyperaemic and blended imperceptibly with normal mucosa. In two patients numerous pale, polypoidal mucosal lesions of variable size arising from a slightly hyperemic mucosa were seen, and in one patient a solitary linear ulcer in the caecum was present. When the ileocaecal valve was involved it was oedematous and deformed and usually had areas of superficial ulceration. In the two patients with diffuse involvement of the colon, the mucosa from the rectum to the caecum was hyperaemic and friable 347 on 9 May 2018 by guest. Protected by copyright.

Objective: To establish consensus recommendations for the use of fluorescence imaging with indocyanine green (ICG) in hepatobiliary surgery. Background: ICG fluorescence imaging has gained popularity in hepatobiliary surgery in recent years. However, there is varied evidence on the use, dosage, and timing of administration of ICG in clinical practice. To standardize the use of this imaging modality in hepatobiliary surgery, a panel of pioneering experts from the Asia-Pacific region sought to establish a set of consensus recommendations by consolidating the available evidence and clinical experiences. Methods: A total of 13 surgeons experienced in hepatobiliary surgery and/or minimally invasive surgery formed an expert consensus panel in Shanghai, China in October 2018. By the modified Delphi method, they presented the relevant evidence, discussed clinical experiences, and derived consensus statements on the use of ICG in hepatobiliary surgery. Each statement was discussed and modified until a unanimous consensus was achieved. Results: A total of 7 recommendations for the clinical applications of ICG in hepatobiliary surgery were formulated. Conclusions: The Shanghai consensus recommendations offer practical tips and techniques to augment the safety and technical feasibility of ICG fluorescence-guided hepatobiliary surgery, including laparoscopic cholecystectomy, liver segmentectomy, and liver transplantation.

Background: Wide variations exist in the reported morbidity and mortality rates for major pancreatic resections. The Physiological and Operative Scoring System for enUmeration of Morbidity and mortality (POSSUM) was developed for comparative audit in general surgical patients. It has also been found to be reliable for audit in colorectal, thoracic and vascular surgery with minor modifications. Aims: To evaluate POSSUM and its modification for mortality, P-POSSUM, in pancreatic surgery. Methods: Retrospective analysis of 50 patients undergoing partial pancreaticoduodenectomy (PD) (46 tumours, 4 chronic pancreatitis) using the POSSUM and P-POSSUM as predictors of morbidity and mortality. These were then compared with the observed values. Results: The POSSUM-predicted mortality was 26%. The P-POSSUM predicted a mortality risk of 6%. The observed mortality was 4%. Using POSSUM for morbidity, the predicted value was 76%. The observed morbidity was 46%. The risk scores for patients with and without morbidity were similar (66.4 ± 11.0 vs. 68.8 ± 12.9, p = 0.49). Conclusions: While P-POSSUM appeared satisfactory for predicting mortality risk, POSSUM overestimated morbidity and mortality for PD in a specialist centre. Modifications are needed prior to its application for comparative audit in pancreatic surgery.

Outside Japan portosystemic shunts have been favored as the surgical procedure of choice for the management of portal hypertension of noncirrhotic etiology. Devascularization procedures have resulted in high rebleed rates probably owing to a limited extent of devascularization. We performed this study to assess the efficacy of our modification of Sugiura's procedure for long-term control of variceal bleeding in patients with noncirrhotic portal hypertension. Forty-six patients with extrahepatic portal venous obstruction (EHPVO) and 22 with noncirrhotic portal fibrosis (NCPF) were subjected to transabdominal extensive esophagogastric devascularization with esophageal or gastric stapled transection (modified Sugiura's procedure), 38 in an emergency situation and 30 electively. Follow-up endoscopies were performed every 6 months. Operative mortality, morbidity, variceal status, and causes of recurrent bleeding were evaluated. The postoperative mortality was 4%. Early procedure-related complications were seen in 6%, and esophageal strictures formed in 7 of 45 survivors undergoing esophageal transection (15%). Over a mean +/- SD follow-up of 53 +/- 34 months, 95% of patients were free of varices. Seven survivors (11%) had a rebleed, but only 5% were due to varices (two esophageal, one gastric). Six (9%) patients developed gastropathy. The 5-year survival was 88%. The modified Sugiura's procedure is safe and effective for long-term control of variceal bleeding especially in the emergency setting and in patients with anatomy unsuitable for shunt surgery or if surgical expertise for a shunt operation is not available.