Extended resection for xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: Cases and review of diagnostic approach

Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis, which can involve adjacent organs including liver, colon and duodenum mimicking gallbladder cancer. Preoperative and intraoperative differentiation of xanthogranulomatous cholecystitis from gallbladder cancer is often difficult and the final diagnosis is made on histopathology of the resected specimen. We hereby report four cases of xanthogranulomatous chol ec ystitis w hich were misdiagnosed as cases of advanced gallbladder cancer based on presentation and radiological findings and underwent radical resections but the final histopathology was a diagnostic surprise. Xanthogranulomatous cholecystitis is still a diagnostic challenge as no singlemodality has been helpful to diagnose this entity till date. Radical resection seems justified in patients who present with the features mimicking gallbladder cancer

Short-term outcomes after hepatic resection : perspective from a developing country

Abstract Objective: To review the early outcomes of hepatic resection at our hospital. Methods: This study was conducted at the Aga Khan University Hospital, Karachi, from January 2008 to December 2015, and comprised patients who underwent hepatic resection. We analysed the pathology, magnitude of hepatic resection and short-term outcomes in the patients. Mean and standard deviations were used to describe categorical data whereas frequencies and proportions to describe quantitative data. Univariate analysis was done to look at the factors associated with morbidity, mortality and blood loss during surgery. SPSS 19 was used for data analysis. Results: Of the 75 participants, 43(57.3%) were males and 32(42.7%) were females. The overall mean age was 52±14 years. Besides, 37(49.3%) patients underwent hepatic resection for underlying hepatocellular carcinoma, with 30(81%) of them being cirrhotic. Major hepatectomy (\u3e3 segments) was performed in 30(40%) patients. Postoperative complications were observed in 30(40%) patients including postoperative liver failure in 3(4%) patients. The presence of one or more co-morbid conditions had a statistically significant association with postoperative morbidity (p=0.018). Mortality rate at 30days and 90days were 3(4%) and 5(6.7%), respectively. Discussion: Morbidity, mortality and blood loss were comparatively higher in cirrhotic patient

Apprenticeship to simulation - The metamorphosis of surgical training

Surgery is a dynamic specialty and surgical competencies are a combination of both technical and non-technical skills. After the inception of the art of surgery, surgical education and training has undergone incredible evolution. The first model of surgical training was introduced in the 19th century and is known as the \u27apprenticeship model\u27, followed by the famous \u27Halstedian\u27 model. However, a report by the Institute of Medicine challenged the teaching institutions to formulate alternative methods of surgical education to ensure patients\u27 safety and to reduce the fear among patients of them being practised on. Teaching surgical skills outside the operating room to ensure patient safety has laid the foundation of simulation-based training in surgical education. More recently, the focus of surgical training and residency has shifted to competency and outcome-based models. The current review article was planned to describe the evolution and transformation of surgical training over time

Cost effectiveness of glove endobag in laparoscopic cholecystectomy: Review of the available literatur

Laparoscopic cholecystectomy is the most common procedure performed worldwide and remains the gold standard for symptomatic gallstones. The most common complication obser ved during this procedure is gallbladder perforation resulting in spillage of stones and bile into peritoneal cavity. In order to avoid such complications, gallbladder is commonly extracted in an endobag. The current literature review was conducted to assess the efficacy and cost-effectiveness of glove endobags. PubMed and Google Scholar databses were searched to find relevant studies from January 1990 to December 2017. Search terms used were \u27glove endobag\u27 and \u27laparoscopic cholecystectomy\u27. Literature suggests glove endobag is an effective and comparatively inexpensive compared to commercially prepared endobags

Mentorship in surgical training: Where do we stand?

Mentorship in medicine aims at professional and personal development of trainees in the early stages of their careers. It is more popular in surgical subspecialties since transfer of technical skills is an integral part of surgical training, which makes it distinct compared to other specialties. Effective mentoring in surgery plays a crucial role in academic success, professional development, career guidance and personal growth of residents, and provides guidance and support to mentees to excel in their respective fields, and increases the likelihood of success by enhancing motivation with positive impact on burnout among residents. Efforts have been made by accreditation bodies around the world to implement formal mentorship in residency programmes. Unfortunately, there is lack of formal mentorship at the level of postgraduate medical education in Pakistan, and the evidence to identify potential obstacles is scarce from this part of the world

Surgical and oncological outcomes of hepatic resection for hepatocellular carcinoma: Report from a low volume centre in a developing country

Objective: To review the surgical and oncological outcomes of patients who underwent hepatic resection for hepatocellular carcinoma (HCC).Study design: Cohort study.Place and duration of study: Department of Surgery of the Aga Khan University Hospital Karachi, from 2008 to 2019.Methodology: Consecutive patients who underwent hepatic resection for HCC at the Hospital were included. The data were collected and analysed on aspects including demographics, liver function status, tumour characteristics, perioperative management, and surgical and oncological outcomes. Survival analyses were performed using the Kaplan-Meier method, and log-rank test was applied to determine the influence of variables on overall and disease-free survival.ZResults: A total of 59 patients underwent hepatic resection for HCC during the study period including 38(64%) males. The majority of the patients had a single lesion (88%), unilobar disease (95%), underlying cirrhosis (75%) and BCLC stage B (73%). Major hepatic resection was performed in 27(46%) patients. The mean duration of surgery was 288+101 minutes and the mean estimated blood loss was 986+637 mls. Postoperative complications developed in 22(37%) patients including surgical complications in 11(19%), liver decompensation in 4(7%) and systemic complications in 9(15%) patients. The overall 30-day mortality was 7%. With a mean follow-up of 2.8 years, disease recurrence was documented in 25(42%) patients and the median overall survival was 45 months.Conclusion: Hepatic resection for HCC is an effective treatment option in this setup. Despite low volumes, surgical and oncological outcomes of hepatic resection for HCC were comparable to the international standards

Need for a national cancer registry In Pakistan: Challenges and way forward

The incidence of cancer is rising globally at a remarkable rate. According to the global cancer Observatory, the total number of cases in Pakistan were 178,388 in 2020; and these figures were provided by the Punjab Cancer Registry which represents the population of Lahore and some parts of central Punjab. Considering the overall 220 million population, these figures are severe underestimation of the true cancer burden in Pakistan. Unfortunately, several attempts at establishing a national cancer registry in the country have failed in the past. Resource limitations, including funds, manpower and infrastructure, and the lack of interest on the part of the governments are behind the failure of the establishment of a national cancer database. There is a dire need for establishing a national cancer registry to understand the actual burden of disease, and to implement a national action plan for cancer prevention, and management strategies to control the growing epidemi

Pancreatic gastrointestinal stromal tumour with liver metastasis five years after Whipple’s procedure: a rare case with management challenges

Pancreatic gastrointestinal tumour is an unusual primary tumour of the pancreas. A 31-year-old male came to the clinic with jaundice and weight loss. Cross-sectional imaging showed a mass in the pancreatic uncinate process. Image-guided biopsy revealed gastrointestinal stromal tumour, so pancreaticoduodenectomy was performed, followed by adjuvant Imatinib. The patient had oligo-metastasis in the liver five years post-surgery and underwent liver resection. This is an unusual case where a pancreatic GIST presented with metastasis while on adjuvant treatment.  Hepatectomy and multimodal therapy increases the survival if the disease is confined to the liver. Keywords: Pancreas, Gastrointestinal stromal tumour, Whipple’s procedure

Mandatory multidisciplinary management of hepatocellular carcinoma: Need of the hour in a country with high prevalence of hepatitis C virus infection.

Hepatocellular carcinoma (HCC) is the sixth common cancer diagnosed and fourth leading cause of cancer related deaths worldwide. The incidence of HCC is on rise due to increasing prevalence of chronic hepatitis C virus Infection. Pakistan is ranked second in HCV burdened countries in the world. Management of HCC is complex as it develops on the background of liver cirrhosis; the risk of mortality is contributed both by tumor related factors and liver decompensation. A multidisciplinary tumor board (MDT) is an ideal approach to improve the outcomes of HCC since this ensures assimilation of input from a diverse group of care providers including hepatobiliary and transplant surgeons, gastroenterologists, interventional radiologists, oncologists, and palliative care specialists. MDT provides tailored approach to individual cases in a timely fashion to avoid treatment delays and communication gaps to improve the overall outcomes. Keywords: Hepatocellular carcinoma, multidisciplinary approach, MD

Splenic peliosis and rupture − A surgical emergency: Case report and review of the available literature

Peliosis is an extremely rare condition of unknown etiology, and its pathogenesis is characterized by multiple, cyst-like, blood-filled cavities predominantly involving a mononuclear phagocytic system. Isolated splenic peliosis is extremely uncommon, but may present as a potentially life-threatening situation. An awareness of its clinical condition and prompt management may improve the clinical outcomes. The role of prophylactic splenectomy is not clear in this condition