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Acute pancreatitis and leakage of pancreaticojejunal anastomosis are the most important causes of operative morbidity and mortality after pancreatoduodenectomy. We have introduced a modified technique for reconstruction that provides a functional exclusion of the pancreatic-jejunostomy in respect of the transit of gastric and biliary secretions. The immediate advantages of this technique are the reduction in the risk of leakage and the possibility of undertaking conservative treatment, in the case that leakage occurs. The preservation of the antral-pyloric unit, according to Traverso and Longmire,1 increases the functional features of the procedure, by reducing entero-gastric refluxes, and assuring a regulated gastric emptying. We herein present our series of 11 pancreatoduodenectomies (PD) for periampullary neoplasms and chronic pancreatitis. Throughout our series we experienced no cases of operative mortality. However, there was one specific instance of morbidity, consisting of one case of external biliary fistula by micro-dehiscence of the hepaticjejunostomy and which was later resolved by conservative treatment. Our most recent results have produced almost normal findings in terms of gastric secretion, gastric emptying and an absence of dumping syndrome, ulcers and refluxes.

The Authors present a case of extrarenal angiomyolipoma. The tumor arose from the pericolonic fat of the sigmoid colon and, increasing in size, caused intestinal obstruction by extrinsic lesion. Extrarenal angiomyolipoma is extremely rare and to our knowledge this is the first reported case arising from the colonic wall.

Aneurysms of the pancreaticoduodenal artery are rare. Nonoperative management of an iatrogenic superior pancreaticoduodenal artery aneurysm which ruptured into the duodenal stump of a Billroth II partial gastrectomy, is described here. Based on a literature review, both aetiology and site of rupture of this observation are very uncommon. Super-selective angiography was used for diagnosis and embolisation for definitive treatment.

The postoperative course of 172 patients with early gastric cancer operated between 1974 and 1987 was reviewed with a median follow-up of 7 years. The survival probability at the end of 1989 was 0.916 (excluding operative mortality and other causes of death) or 0.876 when the operative mortality was included. Univariate analysis showed a significant survival difference according to the presence or absence of submucosal invasion (p = 0.02, Log-Rank test) and lymph node invasion (p = 0.04, age greater than or less than 50 years (p = 0.03) and according to the type of resection performed (total gastrectomy with gastric and perigastric lymph node dissection or subtotal gastrectomy with incomplete lymph node dissection (p = 0.05). Eleven patients died from cancer recurrence, one is still alive with a recurrence of the gastric stump. The other deaths were due to cancers of other organs (6), cardiovascular disease (2), pneumonia (3), septicaemia (1) and a car accident. Although the prognosis of early gastric cancer is relatively favourable in European countries, patients must be carefully followed for a long period because of recurrences and the high incidence of cancers in other organs.

The purpose of this study is to report our single institution transplant surgery referral center's experience with 139 consecutive biliary tract reconstructions performed in a mixed cohort of liver transplant recipients and patients with biliary tract malignancies, iatrogenic injuries, or other benign biliary pathology.Between July 1999 and February 2003, 139 biliary tract reconstructions were performed in 119 patients, using five various types of biliary reconstructions. The records and operative notes of all patients were reviewed with particular attention to surgical technique, operative mortality, post-operative complications and post-operative liver function tests with respect to biliary function.The mean duration of follow-up was 19.4 months (range 1.0 - 44.7 months). We were pleased to find excellent results from bilio-enteric reconstruction as no patient in our series developed cholangitis, jaundice or liver failure.Our goal is to inform the hepatobiliary and general surgeons of the principles of restoring biliary drainage that have arisen from our experience in a variety of reconstruction.

A case of juvenile polyposis is reported and 271 cases are collected from the literature. The risk for neoplasia is analyzed and the endoscopic or surgical therapy is discussed. The authors conclude that juvenile polyposis should be considered as a challenge to the surgeon with regard to familial adenomatous syndromes, and strongly recommend a close follow-up of patients with juvenile polyposis.

The aim of this study was to determine the impact of two reperfusion techniques on the peri-operative hemodynamic changes and early post-operative graft function of adult patients undergoing orthotopic liver transplantation. Material and methods: From June 2003 to May 2004, 50 consecutive liver transplants were performed and divided into two groups: group A, 25 patients, portal vein flush with 500 cm3 of Ringer's lactate without vena caval venting. Group B, 25 patients, vena caval venting with no portal vein flush. Donor and recipient characteristics were similar in both groups. Sixty-four different parameters were analyzed, and Pearson's χ2 test and t-test were used for statistical analysis, p0.05. Results: One patient (4%) in group B experienced a post-reperfusion syndrome (PRS). Pearson's χ2 test found a significant relationship between the analyzed parameters and the two different reperfusion techniques for 10 parameters (t-test analysis showed a significant difference between the two groups in favor of group A). Conclusions: In our transplant center, portal vein flush without vena caval venting provided a lower incidence of hemodynamic changes in the peri-operative period after liver transplantation and earlier recovery of the graft function.