Gastroenterology International

 Double pyloric opening (DPO) is a condition in which there are two openings of the stomach in to the duodenum with the normal anatomy in the rest of the stomach. DPO may be considered as a gastroduodenal fistula consisting of a short accessory channel between the distal stomach and the duodenal bulb, such that the gastric antrum and the duodenal bulb are connected by two openings separated by a septum or bridge of tissue1 . This is reported to be a rare anomaly of the stomach which could be congenital or acquired [2-6]. Even though it is considered as a congenital anomaly anatomy textbooks does not state this anomaly in their text under the developmental deformities of the stomach or the duodenum and it is said to be very rare congenital anomaly of which was first reported in 1971 [1]. Mechanism of occurrence of DPO as an acquired condition is said to be secondary to chronic gastric or duodenal ulcers leading to gastro-duodenal fistula [2,4,7]. DPO is most of the time an incidental finding during routine investigation of the upper gastrointestinal tract due to the fact that this is asymptomatic unless present with symptoms related to the concurrent peptic ulcer disease [6,9]. However, some of them have presented with complications such as upper gastro intestinal bleeding and pyloric stenosis. On the other hand inadvertent injury of the abnormal band separating the pyloric cannal is possible during upper gastro intestinal endoscopies. Therefore the knowledge of presence of this anomaly is important for gastrointestinal surgeons and physicians.

Keyword: Double Pylorus; Anomalies in Stomach.

  Laparoscopic sleeve gastrectomy is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. However, utility of drain placement in laparoscopic sleeve gastrectomy remains controversial. We report our experience of unexpected esophageal perforation caused by drainage tube in a 45 yr old female with a BMI of 49 kg/m2 who underwent laparoscopic sleeve gastrectomy at our institute. This unusual complication, in our opinion, has not been reported anywhere in literature. 

Keywords: Gastrectomy; Laparoscopic sleeve gastrectomy; Esophageal Perforation. 

  Introduction: Gastrointestinal stromal tumors (GIST) are specific, C- Kit (CD117) - positive, mesenchymal tumors of the gastrointestinal tract which encompassing a majority of tumors, previously considered gastrointestinal smooth muscle tumors. Diagnosis is based on histological and immunohistochemical examination characterized by c-kit (CD117,CD34) staining. Objective: To present diversity of presentations of this disease and treatment protocols based on 4 variety of presentations in our case studies. Materials and Methods: We present an analysis of clinical presentation and course, surgical management and pathological features of 4 patients with gastrointestinal stromal tumors treated in our institution. Result: Our results confirm that in stromal tumors complete surgical resection remains the mainstay of treatment in localized gastrointestinal stromal tumors. Discussion and conclusion: Complete removal of the tumor is curative in localized tumours with no recurrence in 2 yrs follow up. In large lesions with metastasis c-kit targeted chemotherapy and surgery gives a better disease free stage.

 Keywords: Gastrointestinal Tumours;  Jejunal GIST; Chronic Intussusception; Imatinib; C-Kit; CD-117.  

  Objective: The aim of the study was to compare between anterior to posterior laparoscopic partial fundoplications. Patients and Methods: During a 2-year period, 50 patients with gastroesophageal reflux disease were enrolled in this study, comparing a partial posterior (Toupét, n = 26) fundoplication and an anterior partial wrap (Watson, n = 24). All patients were assessed postoperatively, and the 6-month follow- p. Results: Both patient groups were strictly comparable. All operations were completed laparoscopically, and no serious complications were encountered. Post fundoplication symptoms were recorded with no difference between the groups. Conclusions: When performing a laparoscopic partial fundoplication, the posterior modification (Toupét) offers advantages in terms of better reflux control compared with an anterior type (Watson). 

Keywords: Fundoplication; Posterior modification; Dysphagia; Gastroesophageal junction. 

  Objective: To compare the results and outcomes of the laparoscopic cholecystectomy (LC) with the small incison cholecystectomy (SIC). Place and Duration of Study: Department of Surgery, SIMS from August 2014 to august 2016. Methodology: Patients with symptomatic gallstones that were referred and enrolled in the study for LC or SIC. Operation, anaesthesia, analgesics and postoperative care were standardized. The patients were assessed for operation time, postoperative pain, nausea, vomiting, hospital stay, return to work time and complications in the postoperative period on day 1, 1 week, 1 month and 3 months, postoperatively. Results: Of 145 patients, 82 underwent LC and 63 underwent SIC. Both groups were matched for age, gender, BMI, clinical findings and ASA grading. The mean duration of operation was 68 and 58 minutes in the LC and SIC groups, respectively (p = 0.0059). Duration of hospital stay and return to regular activities were shorter after LC compared to SIC. Pain scores, nausea and vomiting were the same in both groups, although the frequency of intra-operative complications were greater in LC compared to SIC. Conclusion: Outcome and complications of SIC were comparable with those of LC.

 Keywords: allstone;  Laparoscopic Cholecystectomy; Small Incision Cholecystectomy; Complications.   

  Enterocutaneous Fistulas are a common presentation in general surgical wards, and despite advances in the management of these lesions, they are still responsible for a significant mortality rate, ranging from 5- 0%, due to associated sepsis, nutritional abnormalities, and electrolyte imbalance. Enterocutaneous fistulas are more commonly seen in post-operative setting. An enterocutaneous fistula (ECF) is a potentially catastrophic postoperative complication. It seems prudent, then, for every surgeon to have a thorough grasp of optimal treatment strategies for ECF to minimize their patients’ mortality. Ultimately, the algorithm must begin with prevention. Morbidity associated with fistulas is significant; the principle cause of death are sepsis and malnutrition [9]. Special mention is given in this article to complicated fistulas such as those with high output, abdominal sepsis and large abdominal defects. There is stress on diversion of fecal matter through ileostomy at a normal site of intestines at a distance of fistula site and damage/devitalized and inflammed gut (Proximal loop ileostomy) and fistula repair at comparatively early stage to prevent the further complications of sepsis and malnutrition. This plan gives a framework for the difficult task of successfully treating the postoperative ECF with a multidisciplinary approach. 

Keywords: Enterocutaneous Fistula; Nutritional Support; Sepsis; Proximal Loop Ileostomy