Vinay K Kapoor

..We propose some modifications in the existing classification and recommend guidelines for management based on the stage of the disease...

....

..Major complications of pancreaticoduodenectomy include leaks from the pancreaticojejunostomy and an intra-abdominal bleed from the gastroduodenal artery stump. The omentum has been used for the prevention of anastomotic leaks...

..The aetiological role of gallstones in the causation of gallbladder cancer needs to be investigated to decide the place of prophylactic cholecystectomy, if any...

..Both these factors result in prolonged exposure of the gallbladder to stones. Besides gall stone disease, various other factors may also play a role in the causation of gallbladder cancer which is an (north) Indian disease...

..Only a few studies address the financial impact of the management of bile duct injuries (BDI). This study was aimed to assess the cost of BDI sustained during cholecystectomy...

..This study was aimed to find out the factors predicting failure after surgical repair in patients with BBS...

..T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival...

..The management and the outcome of such complicated cysts differ from that of an uncomplicated CDC. This presentation is an analysis of our experience with complicated CDCs...

..Post-cholecystectomy malignant biliary obstruction masquerading as benign biliary stricture (BBS) has not been reported in the literature; it presents a diagnostic and management challenge...

..CONCLUSIONS: In patients with gallbladder cancer, R0 status could be achieved in only 43% of patients undergoing extended resections. R0 status and N0 disease were associated with better longterm survival...

..This study addresses the factors that determine the severity of pathological changes on liver biopsy and the correlation with long-term outcome following repair...

..To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection (AR) and its subsequent management...

....

..A proportion (10%-15%) of patients with variceal bleeding do not respond to medical management and require surgical intervention...

..Surgery is more difficult and blood transfusion requirements are higher in patients with AHC during surgical repair of BBS. Atrophy-hypertrophy complex is a risk factor for recurrent stricture formation after hepaticojejunostomy...

..Invasion of common bile duct (CBD), termed as xanthogranulomatous choledochitis, may mimic malignancy. We describe clinico-pathological features and management of xanthogranulomatous inflammatory biliary strictures...

..Perioperative blood transfusion and vascular invasion were associated with recurrent disease...

..Serum bilirubin levels and PJ leak were significant factors associated with bleeding complications. Septicaemia and acute renal failure were significant factors associated with mortality in the bleeders...

..The present study was aimed at studying the clinical profile, course and outcome of patients with EPF following surgical or percutaneous management of these infective complications...

..CONCLUSIONS: Staging laparoscopy in patients with gallbladder cancer detected liver and peritoneal metastases that were missed on imaging. It reduced the number of unnecessary surgical explorations and improved the resectability rate...

..CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results...

..GBC is an "Indian disease" and Indian surgeons have to be prepared to accept the "challenge" of GBC...

..We evaluated our experience of managing post-ERCP perforations to help define the role of surgery with percutaneous drainage (PCD)...

..CONCLUSION: Endobiliary stent placement results in significant morphological and fibroproliferative inflammatory changes in bile ducts, making dissection difficult...

..Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers...

..Excellent results can be obtained when BDI is managed at a hepatobiliary center...

..Both preoperative FNAC and peroperative FNAC/imprint cytology failed to reveal the associated GBC with XGC in some patients...

..A uniformly accepted classification allows an accurate comparison of results and formulation of a standardized treatment plan. Suggested herein is a subclassification of Bismuth type III post-cholecystectomy benign biliary strictures (BBS)...

..Close long-term follow up of these patients is essential, because they are likely to present with complications related to the residual intrahepatic part of the disease...

..In patients with endoscopic failure, a staged procedure (portosystemic shunt followed by biliary surgery) should be preferred. Strictures alone may resolve after a portosystemic shunt. Endoscopic stenting may be required as an adjunct...

..In the majority, the diagnosis of GBC was made on final histology, after cholecystectomy; hence, this group of patients with GBC are to be treated like any other patients with incidental GBC...

..Splenic involvement of tuberculosis, which is rare, warrants better definition in the current era of resurgence of tuberculosis...

..Splenectomy still has an important role in establishing the pathology in patients presenting with idiopathic splenomegaly...

..The roles of surgery and PCD are complementary...

..Patients with pT1b tumors require extended cholecystectomy. Incidental GBC extending up to the muscularis merits early reoperation for completion of extended cholecystectomy, which offers the only chance of cure...

..Brunner's gland adenoma (Brunneroma) is a rare entity. We report a patient who presented with severe anemia due to bleed from a large Brunneroma arising from the duodenal bulb, and was managed successfully by surgical excision of the tumor...

..This is the first study on lipid profiling of gallbladder tissue by (1) H NMR spectroscopy, and has possible implications for the development of future diagnostic approaches...

..Simpler regimens that preserve an adequate spectrum of coverage, but allow easier administration and have fewer side effects, may be a more desirable option...

..These clues could lead to the identification of patients with GS in vivo who are at high risk of developing GBC, and advocate prophylactic cholecystectomy to prevent GBC...