Objective: Unusual clinical course Background: Crohn disease is a chronic inflammatory bowel disease known for causing fistulous tracts, abscesses, and bowel perforation. Enterohepatic fistulas, a rare but significant complication, are scarcely reported. This article presents the case of a hepatic abscess due to an enterohepatic fistula in a patient with long-term Crohn disease and reviews the existing literature on this phenomenon. Case Report: A 59-year-old female patient with a known history of Crohn disease and previous ileocolic resection due to enteroenteric fistulas presented to our Emergency Department with right-sided abdominal pain persisting for 10 days. Diagnostic investigations, including imaging, revealed an enterohepatic fistula with a 3-4 cm hepatic abscess in segment V of the liver. Initial management involved conservative treatment with radiological drainage and antibiotics, leading to the patient's discharge. An elective laparotomy was scheduled 1 month later. The patient underwent resection of the ileocolic anastomosis with ileotransverse re-anastomosis and catheter removal. Postoperative management included treatment for paralytic ileus. She was discharged in good condition on postoperative day 11. Conclusions: This report highlights the range of complications that can occur in patients with Crohn disease and presents the rare association between Crohn disease and enterohepatic fistula and abscess formation. Only 2 other case reports of enterohepatic fistula due to Crohn disease exist in the literature. Given the scarcity of evidence, no standardized guidelines are available, necessitating an individualized treatment approach. Initial conservative management can be effective; however, close monitoring is crucial to determine the need for subsequent surgical intervention.

Introduction The cyst of the canal of Nuck is a rare cause of inguino-labial swelling in adult women, arising from an obliteration failure of the processus vaginalis during embryological development. Its rarity often leads to misdiagnosis and improper treatment. This article highlights its diagnosis and surgical management. Case presentation A 21-year-old woman presented with a two-month history of symptomatic swelling in the right inguino-labial region, after consulting multiple doctors. Various investigations including abdominal ultrasonography, computed tomography, and Magnetic Resonance Imaging revealed multiloculated cystic lesion with thin walls, without communication to the peritoneal cavity. During surgery, an encysted sack was discovered at the external inguinal ring, with no associated hernia. The cyst was ligated high and excised along with the round ligament. The anatomical defect was repaired without using prosthetic mesh. The patient had an uneventful post-operative recovery at six-months follow-up. Discussion The encysted hydrocele (Type 1) is the most common among the three types of canal of Nuck hydroceles. This rare entity should be considered in the differential diagnosis of groin masses, even in adult women. Ultrasonography is often used initially, while Magnetic Resonance Imaging is reserved for complex cases. Surgical intervention is essential for both diagnosis and treatment, with dissection extending up to the deep inguinal ring to address any associated hernias. The choice between open or laparoscopic procedures depends on the nature of the defect. Conclusion Surgery remains the sole standard therapeutic approach for the management of the cyst of the canal of Nuck.

Colorectal cancer (CRC) affects 4.5% of the general population, with 15% involving the right colon. Surgery, when feasible, varies from conventional right colectomy to Complete Mesocolic Excision (CME). Although better oncological outcomes were reported in the literature after CME, there is an acknowledged higher risk of operative vascular lesions. Various approaches have been proposed to facilitate CME, such as the “open book” model and 3D modelling of the mesenteric vessels, however CME remains technically challenging. Our study aims to analyze whether preoperative CT imaging with vascular mapping (PVM) of the superior mesenteric vessels could offer guidance on the vascular anatomy during CME. This prospective, monocentric study aims to include 30 patients undergoing CME for right CRC. Preoperatively, a biphasic CT scan with 3-D vascular reconstruction of the superior mesenteric vessels is performed. Vascular distances are calculated based on CT, then compared to intraoperative documentation of the mesenteric vessels. Primary outcomes are the surgeons’ evaluation of the benefit of vascular mapping and the statistical correlation of the vascular distances between CT guidance and operative finding. To this day, 22 patients have been included. Surgeons found the preoperative vascular mapping very useful (3.58/5 on a Likert scale). Mean operation time was 263 minutes, with a mean of 36 lymph nodes harvested and no vascular lesions. Postoperative ileus occurred in 27% (6/22), Clavien-Dindo complications III-V in 13,6% (3/22) with one anastomotic leak (4,5%) and one death after discharge at home of unknown cause. Statistical analysis of the vascular distances will be performed upon completion of the study. Our preliminary data suggest that PVM may be a valuable tool for reducing the risks associated with CME and aiding vascular ligation in this complex surgical technique. Further studies are required to asses PVM utility in CME and confirm these outcomes.

PURPOSE:Approximately 7% of patients with rectal cancer experience local recurrence within 5 years of curative surgery. A positive circumferential resection margin (CRM) is among the most significant risk factors. Other reported risk factors include histopathologic type, anastomotic leakage, positive distal margins, and more recently, the anterior localization of the tumor. In this retrospective cohort study, we aimed to assess risk factors for local recurrence in our institution, with a focus on tumor localization as an independent negative predictive factor. PATIENTS AND METHODS:From 2007 to 2018, all patients with stage II or III rectal cancer were included in this study. Patients underwent neoadjuvant chemoradiotherapy followed by surgical resection with total mesorectal excision. The tumor's anterior or posterior localization was assessed by preoperative endosonography or magnetic resonance imaging. Risk factors for local recurrence were assessed using univariate and multivariate regression analyses. RESULTS:A total of 128 patients were included. The 3-year and 5-year local recurrence rates were 4.7% and 7%, respectively. In univariate and multivariate analyses, the histologic type of a poorly differentiated tumor (P=0.001) and a positive CRM (P=0.001) were correlated with local recurrence. Tumor localization (anterior or posterior) was not identified as a statistically significant factor associated with local recurrence. CONCLUSION:Positive CRM and a poorly differentiated tumor histological subtype were found to be independent risk factors for local recurrence. In contrast to previous findings, anterior localization was not identified as an independent risk factor for local recurrence in our patient cohort.

Objectif Environ 7 % des patients atteints d’un cancer du rectum présentent une récidive locale dans les 5ans suivant une chirurgie curative. Une marge de résection circonférentielle (CRM) positive est l’un des facteurs de risque les plus importants. Parmi les autres facteurs de risque signalés figurent le type histopathologique, les fuites anastomotiques, les marges distales positives et, plus récemment, la localisation antérieure de la tumeur. Dans cette étude de cohorte rétrospective, nous avons cherché à évaluer les facteurs de risque de récidive locale dans notre institution, en mettant l’accent sur la localisation de la tumeur en tant que facteur prédictif négatif indépendant. Patients et méthodes De 2007 à 2018, tous les patients atteints de cancer du rectum de stade II ou III ont été inclus dans cette étude. Les patients ont subi une chimioradiothérapie néoadjuvante suivie d’une résection chirurgicale avec excision totale du mésorectum. La localisation antérieure ou postérieure de la tumeur a été évaluée par endosonographie préopératoire ou imagerie à résonance magnétique. Les facteurs de risque de récidive locale ont été évalués à l’aide d’analyses de régression univariées et multivariées. Résultats Un total de 128 patients a été inclus. Les taux de récidive locale sur 3ans et 5ans étaient respectivement de 4,7 % et 7 %. Dans les analyses univariées et multivariées, le type histologique d’une tumeur peu différenciée (p=0,001) et une CRM positive (p=0,001) étaient corrélés avec la récidive locale. La localisation de la tumeur (antérieure ou postérieure) n’a pas été identifiée comme un facteur statistiquement significatif associé à la récidive locale. Conclusion La présence d’une CRM positive et d’un sous-type histologique de tumeur peu différenciée s’est avérée être un facteur de risque indépendant de récidive locale. Contrairement aux résultats précédents, la localisation antérieure n’a pas été identifiée comme un facteur de risque indépendant de récidive locale dans notre cohorte de patients.

Abstract Background Revisional bariatric surgery (RBS) represents up to 15% of all bariatric procedures. The most performed conversion procedures are Roux-en-Y-Gastric Bypass (RYGB) and Vertical Sleeve Gastrectomy (VSG) after adjustable gastric banding (AGB), VSG or vertical banded gastroplasty (VBG). While the overall complication rate is known to be higher compared to primary surgery, the optimal surgical approach, laparoscopic or robotic, remains controversial. Aims We aimed to compare laparoscopic and robotic RBS in terms of peri and post-operative complications, ICU admission, operative time, and the length of hospital stay. Methods We conducted a retrospective multi-center case control study of patients who underwent RBS from 2013 to 2023 in two centers. Cases and controls were matched by the index procedure, - AGB or a stapled procedure and the revisional procedure, - RYGB or VSG. Results 59 revisional procedures were performed (36 and 23 per center). After matching according to index and revisional procedures, 46 patients were included, 23 in the robotic and 23 in the laparoscopic group. There were no statistically significant differences in demographics, BMI, or comorbidities between the groups. The overall peri- and early post-operative complication rate was similar while patients in the laparoscopic group had a higher rate of severe complications and reoperations (13% versus 0%), however, without reaching a statistically significant difference (p = 0,07). The operative time was shorter in the laparoscopic group (161 +/- 55 versus 232 +/- 63 minutes, p < 0,05). Conclusion Our retrospective study showed a tendency towards more severe perioperative complications and reoperations in laparoscopic compared to robotic revisional surgery in patients with similar index and conversion procedures. Patients with complex revisional RYGB could benefit from robotic surgery. As the literature provides contrasting results, further studies should be performed to address this question.

Abstract Background Bariatric surgery procedures as the laparoscopic Roux-en-Y-Gastric Bypass (RYGB) are highly standardized procedures. The difficulty in two-dimensional (2D) laparoscopic surgery is the loss of the depth perception which complicates surgical techniques as suturing and knotting. The development of three-dimensional (3D) laparoscopy has been shown to reduce operative times and surgeons’ performances errors. Aims To compare operative times, post-operative complications and the lengths of hospital stay of patients having undergone laparoscopic RYGB before and after the introduction of the 3D-technology. Methods We conducted a retrospective cohort study including patients having undergone RYGB (without cholecystectomy) at our institution by the same surgical team before and after the introduction of the 3D-laparoscopic technology (Karl Storz, Tuttlingen, Germany). The primary outcome was the operative time, the secondary outcomes the post-operative complications and lengths of hospital stay. Results 100 consecutive patients, operated on 2019-2021 were included; 50 were operated utilizing the 2D- and 50 the 3D laparoscopic technology. There were no statistically significant differences in age, gender, body mass index or comorbidities, however, patients in the 3D-group had significantly more previous interventions. Operative time and hospital length of stay were significantly reduced in the 3D-group (83 (± 20.8) vs. 91 (± 13.5) minutes; p < 0.05 and 2.1 (± 0.4) vs. 2.7 (± 1.1) nights; p < 0.05). There were no statistically significant differences found between groups concerning post-operative complications and re-interventions. Conclusion 3D technology may help reducing the operative time and length of hospital stay in laparoscopic RYGB surgery with similar post-operative complications. We cannot completely exclude reduced operative times by the still growing experience of the surgical team.

BackgroundPredictive weight loss models can help patients meet their expectations after bariatric surgery and assist physicians in responding to deviations from the predicted weight. A model published by Seyssel et al. appears to accurately predict postoperative body mass index.ObjectivesWe aimed to demonstrate this model’s performance in terms of rapid detection of insufficient weight loss (surgical nonresponse).SettingCantonal Hospital, Switzerland.MethodsWe retrospectively analyzed weight and body mass index deviations at 2 years postoperatively, based on values predicted by the model of Seyssel et al. The primary outcome was the timing of detection of surgical nonresponse. The secondary outcome was how patients’ weight loss expectations influenced their real weight loss.ResultsBetween 2016 and 2019, 190 patients underwent Roux-en-Y gastric bypass. Of these patients, 36 were lost to follow-up and 154 were included in this study. At 24 months, 16 patients had surgical nonresponse, defined as a real weight of +1 standard deviation higher than that predicted. Among these patients, 44% had a weight of ≥+1 standard deviation higher than predicted at 3 months, and 63% at 12 months. The positive and negative predictive values at 12 months were 59% and 95%, respectively. Patients with a lower hypothetically wanted weight (38.5%) exhibited greater weight loss (P < .05).ConclusionsThe predictive weight loss model of Seyssel et al. enables rapid detection of surgical nonresponse, allowing physicians to react as early as 3 months postsurgery. Patients’ overestimation of postoperative weight loss was positively correlated with the actual weight loss achieved.

Background Current management of patients with borderline resectable pancreatic adenocarcinoma (BR-PDAC) depends on the degree of involvement of the major arterial and venous structures. The aim of this study was to evaluate 3D segmentation and printing to predict tumor size and vascular involvement of BR-PDAC to improve pre-operative planning of vascular resection and better select patients for neoadjuvant therapy. Methods We retrospectively evaluated 16 patients with BR-PDAC near vascular structures who underwent pancreatoduodenectomy (PD) with or without vascular resection between 2015 and 2021. The pre-operative computed tomography (CT) images were processed by segmentation with 3D reconstruction and printed as 3D models. Two radiologists specialized in pancreatic imaging and two pancreatic surgeons blindly and independently analyzed the pre-operative CT scans and 3D models using a defined checklist. Their evaluations were compared to the pre-operative 2D-CT reports utilized for patient management. A positive delta was defined by the 3D analysis resulting in greater accuracy in predicting vascular involvement as proven intraoperatively or histopathologically. Results Fourteen PD, one total pancreatectomy, and one exploratory laparotomy were performed. Ten patients had a positive delta concerning vascular involvement of the superior mesenteric or portal vein. Tumor extension was also more accurately evaluated by 3D modeling than by 2D-CT (p<0.05). Conclusions Our pilot study demonstrates that 3D segmentation can provide additional information for choosing the best treatment strategy and surgical plain in patients with BR-PDAC. Especially for upcoming mini-invasive techniques like laparoscopic and robotic resections, better pre-operative planning is essential to allow safety and prevent vascular injury.

IntroductionVaccination hesitancy is an important barrier to vaccination among IBD patients. The development of adverse events is the main concern reported. The purpose of this monocentric study was to assess SARS-CoV-2 vaccination safety in IBD patients by evaluating the postvaccination flare risk and incidence of overall adverse events.MethodsSurveys were handed out on three consecutive months to each patient presenting at the Crohn-Colitis Centre, where they documented their vaccination status and any side effects experienced after vaccination.Dates of flares occurring in 2021 were recorded from their electronic medical records. Baseline and IBD characteristics and flare incidence were compared between the vaccinated and unvaccinated patients, and among the vaccinated population before and after their vaccination doses. The characteristics of patients who developed side effects and of those who did not were compared.MethodsSurveys were handed out on three consecutive months to each patient presenting at the Crohn-Colitis Centre, where they documented their vaccination status and any side effects experienced after vaccination.Dates of flares occurring in 2021 were recorded from their electronic medical records. Baseline and IBD characteristics and flare incidence were compared between the vaccinated and unvaccinated patients, and among the vaccinated population before and after their vaccination doses. The characteristics of patients who developed side effects and of those who did not were compared.ResultsWe enrolled 396 IBD patients, of whom 91% were vaccinated. The proportion of patients who experienced flares was statistically not different between the vaccinated and the unvaccinated population (1.8 vs 2.6 flares per 100 person-months (p = 0.28)). Among vaccinated patients, there was no difference across the prevaccination, 1 month post any vaccination, and more than 1 month after any vaccination periods, and between the Spikevax and Cominarty subgroups. Overall, 46% of patients reported vaccination side effects, mostly mild flu-like symptoms.ConclusionSARS-CoV-2 vaccination with mRNA vaccines seems safe, with mostly mild side effects. The IBD flare risk is not increased in the month following any vaccination.

Polyorchidism means the presence of more than two testicles, which is a rare congenital anomaly of the genitourinary tract. Less than 200 cases have been reported in the literature. We report here a case of polyorchidism diagnosed following a testicular torsion. An 11-year-old patient with a history of left retractile testis was admitted to our emergency department with acute left scrotal pain. On clinical examination, the scrotum showed slight redness on the left, significant swelling locally, and pain on palpation. An immediately performed beside-ultrasound showed a uniform left testicle of slightly smaller size than the right one, a decreased testicular vascularisation compared with the contralateral one, the presence of a large reactive hydrocele and a spermatic cord that looked twisted. The patient underwent an emergency operation: scrotal exploration on the left side showed a torsion with two clockwise turns of a still viable testicle showing only slight signs of suffering. The patient underwent left testicular detorsion and bilateral testicular fixation. Examination at 2 weeksʼ follow-up suspected the presence of a supernumerary testicle on the left side. Control ultrasound confirmed the diagnosis of polyorchidism with the presence of two testicles on the left side. Polyorchidism is rare but should be considered when assessing any additional scrotal mass. The recommended imaging is ultrasound or MRI. The management of uncomplicated polyorchidism is most commonly surveillance. In the case of torsion, detorsion and bilateral fixation of all testes should be performed. The recommendation is to preserve the supernumerary testicle if it is viable and without signs of malignancy. In cases of persistent fertility after vasectomy, polyorchidism should be excluded.

Abstract Background In order to avoid abdomino-perineal amputation and permanent colostomy in patients with low rectal cancer sphincter sparing low anterior resection (SSLAR) techniques with/without neoadjuvant radio-chemotherapy are administered. However, a lot of SSLAR-patients have life quality limiting symptoms afterwards, like fecal urgency, incontinence, constipation and sensation of incomplete rectal emptying. Such symptoms are defined as “low anterior resection syndrome” (LARS). LARS quantification can be made by a specific and validated quality of life (QoL) questionnaire (see annex). Aims Assessment of the QoL in patients after SSLAR suffering from LARS before and after specific therapy. Methods This is a monocentric, retrospective cohort study including patients having undergone SSLAR for rectal cancer 2014 - 2021. Initial LARS-scores were obtained by completion of the specific questionnaire. Patients with a minor LARS (scores 21-29) were treated with electrostimulation and bio-feedback physiotherapy. Those with a major LARS (scores >29) were first investigated by anal manometry followed by physiotherapy. After treatment LARS-scores were obtained again. Results Of 136 identified SSLAR-patients, 68 did not fulfill the inclusion criteria’s (see annex). Of the remaining 54 patients, 20.4% had a minor, 37% a major and 42.6% no LARS. Of all LARS-patients, 13 completed pelvic physiotherapy, 4 are still completing and 14 (26%) refused such a treatment. The mean-LARS score was 32.77 and 22.92, before and after treatment, respectively (p=0.004). Risk factor analysis (diabetes, type of anastomosis, neoadjuvant radio-chemotherapy, previous operations, nicotine, alcohol) did not reveal any significant difference between groups. Conclusion More than 50% of patients undergoing SSLAR are suffering from LARS, more than one third from major LARS. QoL is impressively improved by specific physiotherapeutic measures. In order to avoid later treatment hesitancy (26%), we began to initiate early specific physiotherapy as a standard in all SSLAR-patients.

Platelets play a crucial role in tissue regeneration, and their involvement in liver regeneration is well-established. However, the specific contribution of platelet-derived Transforming Growth Factor Beta 1 (TGF beta 1) to liver regeneration remains unexplored. This study investigated the role of platelet-derived TGF beta 1 in initiating liver regeneration following 2/3 liver resection. Using platelet-specific TGF beta 1 knockout (Plt.TGF beta 1 KO) mice and wild-type littermates (Plt.TGF beta 1 WT) as controls, the study assessed circulating levels and hepatic gene expression of TGF beta 1, Platelet Factor 4 (PF4), and Thrombopoietin (TPO) at early time points post-hepatectomy (post-PHx). Hepatocyte proliferation was quantified through Ki67 staining and PCNA expression in total liver lysates at various intervals, and phosphohistone-H3 (PHH3) staining was employed to mark mitotic cells. Circulating levels of hepatic mitogens, Hepatocyte Growth Factor (HGF), and Interleukin-6 (IL6) were also assessed. Results revealed that platelet-TGF beta 1 deficiency significantly reduced total plasma TGF beta 1 levels at 5 h post-PHx in Plt.TGF beta 1 KO mice compared to controls. While circulating PF4 levels, liver platelet recruitment and activation appeared normal at early time points, Plt.TGF beta 1 KO mice showed more stable circulating platelet numbers with higher numbers at 48 h post-PHx. Notably, hepatocyte proliferation was significantly reduced in Plt.TGF beta 1 KO mice. The results show that a lack of TGF beta 1 in platelets leads to an unbalanced expression of IL6 in the liver and to strongly increased HGF levels 48 h after liver resection, and yet liver regeneration remains reduced. The study identifies platelet-TGF beta 1 as a regulator of hepatocyte proliferation and platelet homeostasis in the early stages of liver regeneration. Platelets contain high levels of transforming growth factor-beta 1 (TGF beta 1), a pleiotropic growth factor. Following a 2/3 hepatectomy in Plt.TGF beta 1 WT mice, platelet activation in the liver sinusoids leads to an early increase in plasma TGF beta 1, which is significantly reduced in platelet-TGF beta 1 deficient (Plt.TGF beta 1KO) mice. In these Plt.TGF beta 1KO mice, hepatocyte proliferation is significantly impaired, associated with a marked increase in hepatic IL6 expression and circulating hepatocyte growth factor (HGF) on day 2 of liver regeneration. Furthermore, mice lacking platelet-TGF beta 1 exhibit an earlier rise in circulating thrombopoietin (TPO) and a faster recovery of platelet numbers during liver regeneration. These findings highlight platelet-TGF beta 1 as an early inducer of liver regeneration and a negative regulator of platelet homeostasis following substantial liver mass loss.image

We describe a case of an uncommon early pancreatic cancer presentation in a patient in his 60s who had haemorrhagic shock from extensive haematochezia and required blood transfusions as well as surveillance in an intensive care unit. A splenic artery pseudoaneurysm that had been effectively embolized by angiography was seen to be actively bleeding into the colon lumen on a computerized tomography (CT) scan along with a necrotic mass of the pancreatic tail. A pancreatic mucinous adenocarcinoma was diagnosed by a transgastric biopsy. A pancreatico-colic fistula was discovered by CT scan after a colic contrast enema. A transabdominal drainage of the necrotic collection and targeted antibiotic treatment had been performed with a satisfying patient outcome. In order to assess a potential secondary surgical resection, systemic chemotherapy was planned. In conclusion, haematochezia with hemodynamic instability originated from a splenic artery pseudoaneurysm fistulising into the colon (arterio-colic fistula) and sepsis originating from a tumoral pancreatic abscess fistulising into the colon (tumoral pancreatico-colic fistula).

Background With increasing use and enhanced accuracy of cross-sectional imaging, the diagnosis of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has increased over the last few decades. The extent to which malignant transformation occurs remains unclear, making the management of IPMNs controversial. The aim of this study was to evaluate the progression rate and outcome of follow-up in patients with IPMNs. Methods A database of all patients diagnosed with IPMN at the Cantonal Hospital HFR Fribourg, Switzerland, between January 2006 and December 2019 with a follow-up of at least 6 months was analyzed retrospectively. Descriptive statistics were performed on patient demographics, IPMN characteristics, and follow-up data. Results A total of 56 patients were included in this study. Ten patients underwent primary surgery, 46 were enrolled in a surveillance program.21.7% (n = 5) of patients under surveillance presented with worrisome features of IPMN; progression rates were significantly higher in these patients (p = 0.043). Most progression occurred in the early follow-up period. Five patients underwent surgery due to progression, of which 2 presented high-grade dysplasia and 2 malignancy on postoperative histology. Conclusions The limited predictive value of current guidelines may lead to surgical overtreatment, and the decision to proceed with surgical resection should be made with caution. Further prospective analyses and the development of novel biomarkers are needed to better understand the natural history of IPMN and improve diagnostic precision.

Background: Following the recommendations by a panel of experts gathered by the World Health Organization (WHO) in 2005, an inventory was established to collect practices of human xenotransplantation worldwide (www.humanxenotransplant.org). The website was activated in October 2006, in collaboration with the International Xenotransplantation Association (IXA) and the WHO. A first report on the collected xenotransplantation activities was published in 2010 in the journal Transplantation. We present here the update over the last 12 years. Methods: We collected information from publications in scientific journals, presentations at international congresses, the internet, and declarations of International Xenotransplantation Association members on xenotransplantation procedures in humans performed. Results: A total of 9 new applications of human xenotransplantation were identified, with pig as source animal in all applications. The procedures involved transplantation of islets of Langerhans, skin, cornea, choroid plexus cells, heart, and kidney. The treatments were performed in USA, China, New Zealand, and Argentina. Conclusion: Recently, several clinical applications of organ and cell xenotransplantation were initiated. Compared to the previous reported period (1995-2010, with 29 activities, mostly without governmental regulation), the recent number of clinical activities was reduced, and all were officially approved. This information should be used to inform healthcare officials, staff, and the public with the objective of encouraging good practices based on internationally harmonized guidelines driven by initiatives such as the Changsha Communiqué. References: 1. Sgroi A, Buhler LH, Morel P, Sykes M, Noel L. International human xenotransplantation inventory. Transplantation. Sep 27 2010;90(6):597-603. doi:10.1097/TP.0b013e3181eb2e8c 2. Matsumoto S, Tan P, Baker J, et al. Clinical Porcine Islet Xenotransplantation Under Comprehensive Regulation. Transplantation Proceedings. 2014/07/01/ 2014;46(6):1992-1995. 3. Wynyard S, Nathu D, Garkavenko O, Denner J, Elliott R. Microbiological safety of the first clinical pig islet xenotransplantation trial in New Zealand. Xenotransplantation. 2014;21(4):309-323. 4. Matsumoto S, Abalovich A, Wechsler C, Wynyard S, Elliott RB. Clinical Benefit of Islet Xenotransplantation for the Treatment of Type 1 Diabetes. EBioMedicine. 2016;12:255-262. 5. Morozov VA, Wynyard S, Matsumoto S, Abalovich A, Denner J, Elliott R. No PERV transmission during a clinical trial of pig islet cell transplantation. Virus Research. 2017/01/02/ 2017;227:34-40. 6. Zheng J, Huang X, Zhang Y, et al. Short-term results of acellular porcine corneal stroma keratoplasty for herpes simplex keratitis. Xenotransplantation. Jul 2019;26(4):e12509. doi:10.1111/xen.12509 7. Snow B, Mulroy E, Bok A, et al. A phase IIb, randomised, double-blind, placebo-controlled, dose-ranging investigation of the safety and efficacy of NTCELL((R)) [immunoprotected (alginate-encapsulated) porcine choroid plexus cells for xenotransplantation] in patients with Parkinson’s disease. Parkinsonism Relat Disord. Apr 2019;61:88-93. 8. Cooper DKC, Groth C-G. A Record of International Meetings on Xenotransplantation 1988–2010. Xenotransplantation. 2011;18(4):229-231. 9. Sykes M, Sandrin M, Cozzi E, Rees MA. World Health Organization resolution on xenotransplantation. Xenotransplantation. May 2004;11(3):224-5.

BACKGROUND:Since the introduction of the Critical View of Safety approach in laparoscopic cholecystectomy, exposure of the common bile duct, and common hepatic duct is not recommended, therefore, the length of the cystic duct remnant is no longer controlled. The aim of this case‒control study is to evaluate the relationship between the length of the cystic duct remnant and the risk for bile duct stone recurrence after cholecystectomy. METHODS:All MRIs with dedicated sequences of the biliary tract taken between 2010 and 2020 from patients who underwent prior cholecystectomy were reviewed. The length of the cystic duct remnant was measured and compared between the patients with and without bile duct stones using multivariate logistic regression analysis. RESULTS:A total of 362 patients were included in this study, 23.5% of whom had bile duct stones on MRI. The cystic duct remnant was significantly longer in the patients with stones than in the control group (median 31 mm versus 18 mm, P < 0.001). In the MRIs performed > 2 years after cholecystectomy, the cystic duct remnant was also significantly longer in the patients with bile duct stones (median 32 mm versus 21 mm, P < 0.001). A cystic duct remnant ≥ 15 mm in length increased the odds of stones (OR = 2.3, P = 0.001). Overall, the odds of bile duct stones increased with an increasing cystic duct remnant length (≥ 45 mm, OR = 5.0, P < 0.001). CONCLUSIONS:An excessive cystic duct remnant length increases the odds of recurrent bile duct stones after cholecystectomy.

In patients with atherosclerotic disease in two of the three main vessels in the splanchnic circulation, symptoms of chronic mesenteric ischemia may arise, depending on the disease chronicity and the presence of mesenteric collateral pathways. The most commonly described collateral pathways are between the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA); and between the IMA and the internal iliac artery (IIA). Another collateral network between the deep femoral artery and the IIA can also become important, especially in patients with aorto-iliac occlusion. Here we report a patient with a symptomatic anastomotic aneurysm of the right femoral artery after a previous aorto-bi-femoral bypass. This patient's bowel viability relied on a well-developed collateral network from the ipsilateral deep femoral artery. This unusual anatomy required special surgical considerations and planning, to minimize the risk of perioperative mesenteric ischemia. During open repair, distal femoral debranching with a distal-to-proximal anastomotic sequence allowed minimizing of the ischemic time, and avoidance of potential ischemic complications from the visceral circulation. This case emphasizes the importance and benefit of the deep femoral artery and its collaterals as a reserve network of the splanchnic circulation. Favorable outcomes can be achieved with careful analysis of the preoperative imaging and proper planning, with adaptation of the surgical strategy.