https://www.theskygallerypattaya.com/hjsr A Heighpubs Open Access Journal en-us 01/13/2021 https://www.theskygallerypattaya.com/hjsr/pdf/ascr-aid1056.pdf &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;Introduction: Solitary fibrous tumor is a neoplasm of mesenchymal origin with benign and malignant forms. We aimed to present a case of solitary fibrous tumor which developed in a patient operated for laryngeal cancer and originated from diaphragm in the light of the literature.&lt;/p&gt; &lt;p&gt;Case report: A 61-year-old male patient with tracheostomy with an undiagnosed lesion that appears to be almost 10 cm was referred to our clinic. Since it was a large volume mass, we chose to perform a thoracotomy over thorachoscopic approach.&lt;/p&gt; &lt;p&gt;Discussion: Although solitary fibrous tumors most commonly occur in the pleura but may also originated from diaphragm, and our case is valuable that originates from diaphragmatic since there are less than 5 reported cases in literature for past two decades.&lt;/p&gt; &lt;p&gt;Conclusion: Even in the case of recurrence, the main treatment remains as total surgical excision. Solitary fibrous tumors are usually detected because of compression symptoms. That is the main reason why we chose thoracotomy.&lt;/p&gt; 12/31/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1055.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Laparoscopic approach in emergency theatre is an irreplaceable tool to manage patients with acute surgical pathology. We retrospectively reviewed surgical access records from the Emergency Department for acute right iliac fossa pathology. We considered 51 patients (16 male, 35 female, mean age 23.8 years) access for acute right iliac fossa pathology over the last year. 44 patients underwent laparoscopic approach (86%); 8 patients were treated with an open approach. Outcomes evaluation was based on data comparison from open appendicectomy over 4 year time period.&lt;/p&gt; &lt;p&gt;Variables considered for data analyses were: role of laparoscopic surgery for gangrenous /perforated appendicitis, Conversion rate, Laparoscopy appendicectomy for elderly patients.&lt;/p&gt; &lt;p&gt;Our study demonstrated that a laparoscopic approach at acute right iliac fossa pathology is feasible, safe and can offer a low incidence of infectious complications, less post-operative pain, rapid recovery, and represent a valid diagnostic tool in doubtful cases, at the expense of longer operating time than OA. We suggest that LA should be the initial choice for all patients with acute right iliac fossa pathology.&lt;/p&gt; 12/22/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1054.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;A knee arthroscopy in spinal anaesthesia was performed on a 67 years old male patient. During the procedure the patient was hemodynamically stable, until he suddenly turned pale and started complaining of severe pain in lower abdomen with signs of guarding. The procedure was finished as urgently as possible and after releasing the tourniquet we noticed significant difference in volume of the leg, with redness distal to tourniquet. Urgent lab results were essentially unremarkable and the patient was sent for the urgent radiological diagnostics.&lt;/p&gt; &lt;p&gt;CD of the left leg described fluid in the soft tissues of the thigh, scrotum, and abdomen; and the unenhanced CT of the abdomen showed free fluid along the entire femoral shaft of the left thigh, extending towards pelvis and abdomen to perihepatic and perisplenic space, and retroperitoneum, with gas bubbles tracking along anterior aspect of the left thigh into the left retroperitoneum.&lt;/p&gt; &lt;p&gt;He was admitted to the ICU, and within few hours all symptoms have resolved and his further recovery was without complications.&lt;/p&gt; 10/31/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1053.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Intentional replantation is an alternative for the treatment of advanced periodontal destruction of the anterior teeth. Systemically healthy three female patient was referred to our clinic with functional complaints. Diagnosis were chronic periodontitis and class III mobility was noted at the mandibular incisors with complete periodontal attachment loss. After phase I periodontal treatment periodontally involved teeth were extracted, endodontic treatment accomplished, the teeth were replanted and fixed to its place with fiber reinforced composite splint. At the end of 2 years tooth was in function with alveolar bone gain. Intentional replantation provided long-term maintenance of patient&amp;rsquo;s own teeth.&lt;/p&gt; 10/06/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1052.php &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Segmentectomy may be applied to all segments; superior segmentectomies (lower lobe superior segments for both lungs), lingulectomies (two segments forming lingulas of upper left lobe) and basal segmentectomies (segments other than superior segment for both lungs). In lung segment resections; segmentectomy has an equivalent morbidity, recurrence and survival rate compared to lobectomy, in patients with stage I lung cancer, tumors smaller than 2 cm and within the segmental anatomical limits. Segmentectomy also contributes more to preserving lung function and exercise capacity than lobectomy. In tumor resection; especially in patients with advanced age, insufficient performance or insufficient cardiopulmonary reserve, 2 cm in diameter and acceptable segmental margins may be provided.&lt;/p&gt; &lt;p&gt;Limited long-term results show oncological results of robotic approach similar to open and VATS approaches. Robotic approach facilitates surgery with more intuitive movements, greater flexibility and high definition, three-dimensional vision. However, high cost and lack of touch sense are main disadvantages of robotic surgery. New studies are needed to assess quality of life, morbidity, oncological results and cost effectiveness. However, considering development of technology in our age and fact that many surgical robot brands will be released in the near future, it is predicted that disadvantages of robotic surgery will be minimized in the near future.&lt;/p&gt; &lt;p&gt;This article reviews experience of segmentectomy in non-small cell lung cancer and discusses benefits and limitations of robotic segmentectomy.&lt;/p&gt; 09/11/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1051.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Pyogenic granuloma is a benign localized lesion of the skin and mucosa closely related to trauma, chronic irritation and hormonal changes. The method of treatment is surgical excision. But relapses can occur. For this reason, treatment with alternative methods such as cryotherapy, electrocautery and laser has been investigated in recent years. In this case, the cause of PG was a feeder vessel. The lesion was excised before and recurred within two weeks. An intraosseous feeder vessel was identified by a magnetic resonance imaging. This vessel was exposed and cauterized with electrocautery.&lt;/p&gt; 08/14/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1050.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Non-small cell lung cancer is one of the leading causes of cancer-related mortality worldwide. Despite recent advances in adjuvant treatments, surgical resection is basis of treatment. With the development of minimally invasive surgery in thoracic surgery, surgeons work on minimally invasive surgery for advanced stages of lung cancer, previously considered non-operable at all or previously considered non-operable with minimally invasive surgery approach.&lt;/p&gt; &lt;p&gt;Minimally invasive surgical techniques which are routinely used in the surgical treatment of early-stage lung cancer have started to be treated in more complicated and advanced stages of lung cancer. Bilateral anatomic resections, operations after neoadjuvant chemotherapy, bronchial sleeve lobectomies, double sleeve lobectomies, complementary pneumonectomies, and carinal sleeve resections can be performed by minimally invasive methods. The option of video-assisted surgery should be considered with oncological principles at foreground if patients have acceptable lung and cardiac performance conditions with minimal comorbidities.&lt;/p&gt; &lt;p&gt;This study reviews VATS experience in patients with advanced-stage lung cancer worldwide and discusses potential benefits and limitations of using VATS technology to perform thoracic surgery procedures.&lt;/p&gt; 07/24/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1049.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laparoscopic sleeve gastrectomy (LSG) is becoming more popular in the treatment of obesity. LSG is safe with a low morbidity. The complications rarely result in morbidity and even mortality. Leaks are the major complication associated with LSG with a reported prevalence between 1.9% and 2.4%.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare surgical intervention and endoscopic stenting for treatment of gastric leakage after sleeve gastrectomy.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients and method:&lt;/strong&gt; Our study included 30 patients presented with post sleeve leaks discovered by routine postoperative imaging or during the follow up period. Patients were recruited from October 6th university hospital during the period from August 2017 to August 2019. Patients were divided to the following groups: 1) Endoscopy group: This included 15 patients with post sleeve leakage undergoing endoscopic stent insertion. 2) Surgery group: which included 15 patients with post sleeve leak age undergoing surgical management. This division was random.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our study showed that Endoscopic stenting for management of post sleeve gastrectomy leakage is an effective method with lower morbidity and shorter post-operative hospital stay than surgical management. Some patients may be good candidates for early surgical intervention in type 1 leakage if managed early before dissemination of leakage and before tissues become friable. Complications of stents include stent migration (26%), stent related ulcer (13%) and stricture (13%). while the surgical intervention carries more complications (DVT, chest infection, wound infection and stricture) and longer postoperative hospital stay.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;endoscopic management of post-sleeve gastrectomy leakage with stenting is recommended because it successfully manages the leaks and avoids invasive procedures with less risk, with shorter hospital stay and early return of function.&lt;/p&gt; 07/24/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1048.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laparoscopic cholecystectomy (LC), is one of the most commonly performed surgical procedures worldwide, it is accepted as the gold standard in the treatment of symptomatic gallstones for its minimal invasiveness, less pain and early recovery.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To predict the difficulty of laparoscopic cholecystectomy in patients according to the recently published scoring system and select the difficult cases to be done by a senior surgeon.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;This is a prospective cohort study. This study took place Oct 6th University Hospital and Kasr El Aini Hospital, Cairo university; the study involved 120 patients admitted with calcular cholecystitis, arranged for laparoscopic cholecystectomy.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Laparoscopic cholecystectomy after applying the scoring system.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our study we found that age, sex and ultrasonographic data were significant predictive factors for assessment preoperatively difficult cases that will be operated upon. We found 14 patients above 50 years who scored to be difficult and very difficult were at outcome difficult, only three patients converted to open surgery over fifty.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We can report that obese patient who were over fifty with history of previous upper abdominal surgery and ultrasonographic picture showed thick walled GB and pericholecystic collection had high risk of conversion. At this study scoring system was used for prediction of difficult laparoscopic cholecystectomy sensitivity was 93.75% and specificity was 52.94% of the scoring system at score 5 for prediction of easy or difficult laparoscopic cholecystectomy.&lt;/p&gt; 07/21/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1047.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; The tracheobronchial injuries are usually fatal and some of the lucky people can reach emergency services without dying in the place of trauma. They can cause severe symptoms which can be lifetreathing. This type of injuries must been taken carefully and need to decide fast what treatment you going to give.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case report: &lt;/strong&gt;We present a 53 years old patient who has been stabbed during a fight and got his trachea ruptured. His complaints shortness of breath and neck swelling. He can be treated conservatively with bronchoscopic and clinical evaluation.&lt;br /&gt; Discussion: Tracheobronchial injuries are life-threatening and the airway must be secured first. They can be treated conservatively in some cases. CT can be useful but fiberoptic bronchoscopy is the key in diagnosis.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Although early treatment of tracheal lacerations is urgent surgery, it is reported that these injuries can be treated with conservative methods under appropriate conditions.&lt;/p&gt; 07/15/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1046.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Acute pancreatitis is commonly diagnosed clinically, with its classical presentation of upper abdominal pain, backed by raised serum levels of enzymes amylase and lipase. However, unusual presentation of this common surgical emergency as a psoas abscess is a rare finding which can lead to missed diagnosis with a fatal outcome.&lt;/p&gt; &lt;p&gt;We present here two such cases of acute necrotising pancreatitis masquerading as psoas abscess, with no classical clinical symptoms and only mildly raised levels of serum amylase and lipase. The region of pancreas involved by necrosis influenced the site of presentation of the psoas abscess. In the first case, acute necrotising pancreatitis involving head and neck of pancreas presented as psoas abscess presenting in the right lumbar region, while the left side collection due to pancreatitis involving body and tail of pancreas manifested as an abscess in left flank.&lt;/p&gt; &lt;p&gt;While evaluating the aetiology of a psoas abscess, a differential diagnosis of necrotizing pancreatitis should be kept as a possibility.&lt;/p&gt; 07/06/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1045.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Aim:&lt;/strong&gt; Percutaneous core needle biopsy (CNB) is considered the gold standard technique for initial histological diagnosis of suspicious breast lesions seen on screening mammogram, but it is less reliable for diagnosing atypical ductal hyperplasia (ADH) due to significant rates of diagnosis upstaging to malignant disease after excision biopsy. The purpose of this study was to identify factors that predict diagnosis upstage to carcinoma in patients diagnosed with ADH on core biopsy.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective database search identified 52 consecutive CNB of suspicious breast lesions revealing pure ADH. Inclusion criteria included asymptomatic women presenting for screening mammogram, who subsequently underwent surgical excision. Logistic regression analysis evaluated clinical, radiological, and histological factors.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 52 patients with ADH on CNB were identified who met our criteria. Twenty-six of 52 patients (50%) were upstaged to ductal carcinoma in situ or invasive carcinoma, based on histological interpretation of the surgically excised specimen. Lesion size was showed to be a statistically significant predictor on univariable logistic regression analysis. Multivariate logistic regression analysis revealed Asian ethnicity and lesion size as independent predictors of malignancy (p = 0.050 and 0.011, respectively). Conversely, women of Middle Eastern and European origin and lesions &amp;lt; 15 mm on mammography were negative predictors of malignancy.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Lesion size &amp;ge; 15 mm on mammography and Asian ethnicity are independent risk factors for breast carcinoma in asymptomatic patients diagnosed with ADH on CNB.&lt;/p&gt; 04/20/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1044.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The Meckel&amp;rsquo;s diverticulum (MD) is the most common anomaly of ductus omphaloentericus that surgeon encounters in clinical practice. The accurate incidence is unknown because most patients with the Meckel&amp;rsquo;s diverticulum are asymptomatic. Most studies report an incidence of about 2%. Approximately 4% of patients with the Meckel&amp;rsquo;s diverticulum become symptomatic.&lt;/p&gt; &lt;p&gt;A 10 years old boy, was sent from regional hospital. His symptoms started the day before he was hospitalized and represented as gastrointestinal bleeding, lower abdominal pain and four times vomiting, without fever. Ultrasound and X-ray of the abdomen were normal. Blood findings showed: RBC 3,19, hemoglobin 0,95, hematocrit 0,27. During a physical examination abdomen was palpatory soft, with no presence of the pain. Digital rectal examination showed blood. A scintigraphy pathologic scan showed a focal lesion of the right hemi abdomen consistent with the Meckel&amp;rsquo;s diverticulum.Patient was treated byLaparoscopic-Assisted Transumbilical Extracorporeal Resection of the Meckel&amp;rsquo;s Diverticulum.&lt;/p&gt; 01/28/2020 https://www.theskygallerypattaya.com/hjsr/ascr-aid1043.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral Pancreaticojejunostomy (LPJ) has recognized applications in the management of Chronic Pancreatitis (CP). It is done for patients with severe pain, obstructed and dilated pancreatic duct. Ductal obstruction by stone or stricture causes rise of intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of removal of stones and strictures from the pancreatic duct system and drainage of the main pancreatic duct by lateral pancreatojejunostomy (LPJ) for chronic pancreatitis in a teaching institute.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methodology:&lt;/strong&gt; We studied 32 cases of chronic pancreatitis operated between January 2010 and January 2017 for a period of 7 years. Patients were selected with ultrasonography, CT scan and or Magnetic Resonance Cholangio Pancreatography (MRCP). Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy for patients with obstruction of the pancreatic duct due to intraductal stones or strictures. Additional distal pancreatectomy were done in two cases for stones and/or abscess in the tail area. We did one Frey&amp;rsquo;s operation for stone and fibro-calcification of the head. In all cases ductal drainage was accomplished by LPJ. We studied their post-operative pain control, complications, recurrence and improvement of exocrine and endocrine function of pancreas and mortality during this period. We followed these patients for about 2 years after surgery.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found 27 out of 32 patients got complete remission of the abdominal pain. Their progression of disease also slowed down. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter have decreased. Two had recurrence of stones in the head and in the parenchyma within a year. 2 patients died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other one died of complications of diabetes and malabsorbtion. Pain free survival is about 84% and recurrence is 6%. Mortality during this follow up period is 6%.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; We found that surgery, if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis and prevent further stone formation in majority of patients. Patient&amp;rsquo;s exocrine and endocrine function improves or remain static. Patient with chronic calcific pancreatitis and diabetes are unlikely to have favorable outcome even after decompressive surgery.&lt;/p&gt; 12/27/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1042.php &lt;h2&gt;Overview&lt;/h2&gt; &lt;p&gt;Bariatric Surgery (BS) from the Greek bari = weight and iatrein = cure) treats obesity and began in Spain in 1973. Its greatest development occurs after the founding of SECO (Spanish Society of Obesity Surgery) in 1997. The purpose of this work is to reflect the changes that have occurred in these 22 years.&lt;/p&gt; 11/20/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1041.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.&lt;/p&gt; 11/20/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1040.php &lt;h2&gt;Letter to Editor&lt;/h2&gt; &lt;p&gt;Acute cholecystitis is a common general surgery disease which may require hospital admission. Delayed or early cholecystectomy is the definitive treatment. Availability of theatre slots may postpone cholecystectomy for weeks. I am writing this letter to explain the importance of early cholecystectomy programme and the necessity of support such programme by hospital managers. I will rationalize the concept of such program and its clinical and economic benefits.&lt;/p&gt; 11/06/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1039.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Pyogenic liver abscess (PLA) is a life-threatening infection that may develop as a result of an underlying hepatobiliary disease. A possible complication of PLA is metastatic spread, resulting in distant seeding of infection in other organs, and occasionally in the epidural space. Spinal epidural abscess (SEA) is a rare infection with severe potential complications. We describe a 71-year-old patient who presented with ascending cholangitis that was complicated by micro PLA, with a subsequent &lt;em&gt;Escherichia coli&lt;/em&gt; bacteremia and metastatic SEA. An emergent surgical intervention with laminotomy and drainage of the epidural collection was performed. The patient was treated with a prolonged antibiotic regimen, with uneventful recovery and no neurologic sequelae. To our knowledge, this is the first reported case of a SEA following &lt;em&gt;E. coli&lt;/em&gt; PLA.&lt;/p&gt; 10/18/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1038.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case Report:&lt;/strong&gt; A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.&lt;/p&gt; 09/06/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1037.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Varicocele therapy is a controversial issue. No single approach is adopted as the best therapeutic option. Testes get blood supply from testicular artery, cremasteric artery and artery to the vas deference. So ligation of testicular artery in the abdomen do not cause ischemia to the testis. This was already demonstrated in many studies. Classical Palomo varicocelectomy also consists of open ligation of testicular vessels in the retroperitoneum. En mass ligation of testicular vein and artery is technically easy and fast in laparoscopic varicocelectomy (LV). Chance of missing some veins are also less. Henceforth recurrence is also less. Recurrence and post-operative complications are high when only testicular vein is ligated by laparoscopy in the retroperitoneum. We wanted to see the outcome of laparoscopic varicocelectomy by mass ligation technique.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 56 patients of symptomatic varicoceles were included in the study from the outpatient services. Symptomatic varicoceles of grade 2 to grade 3 were operated from January 2012 till January 2019 over a period of 7(seven) years in Jahurul Islam Medical college Hospital. The patients were selected for dull pain and ugly veins not for infertility. All were operated by laparoscopy with en-mass ligation of testicular vein and artery in the retroperitoneum. They were followed up for a period of six months after surgery. We collected all the data in a retrospective manner.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The average operation time was 27&amp;plusmn;3 minutes. Average post-operative hospital stay was 32&amp;plusmn;7 hours. There were no technical failures requiring conversion to open varicocelectomy. There was no incidence of hydrocele formation nor testicular atrophy. One patient of bilateral varicocele had 50% reduction of his varicocele. We considered this a recurrence. All other patient had complete reduction of varicocele. One patient developed hemo-peritoneum due to dislodgement of hemo-clip, which required laparotomy. He did not require any further surgery for his varicocele.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. Plastic hemo-lock should be used rather than titanium heom-clip for ligation of testicular vessels. There is no incidence of testicular atrophy or any adverse effect on testis.&lt;/p&gt; 09/06/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1036.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Hemangiomas are known as congenital vascular malformations that can affect almost any organ or tissue, with the liver being the most common intra-abdominal organ to be involved. It is well known that hemangiomas are the most common benign tumours of the liver, and develop in about 4-20% of people, mainly young adult females. Recently, due to the dramatic rise in the use of imaging studies for different purposes, a parallel increase in the incidence of these tumours has been noticed. Most liver hemangiomas are small (less than 4cm in diameter), asymptomatic and found incidentally during abdominal operation for other indication or on radiologic studies. Giant liver hemangioma is defined as hemangioma with a diameter of more than 5cm. This unique and uncommon type of haemangioma usually poses therapeutic challenges for the treating physician, especially hepatic surgeons, due to the unclear natural history, and due to the risk of life threatening complications is yet to be established. While it is already proved by several studies that conservative management of giant hepatic hemangioma is safe, it is not known whether observation of the extremely large hepatic hemangioma (tumours larger than 10cm) is safe as well.&lt;/p&gt; &lt;p&gt;The aim of this article is to review the English literature to find out if conservative management of the extremely giant liver hemangioma is safe and can be recommended.&lt;/p&gt; 08/26/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1035.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The objective of this paper is to emphasis the AngioCT features of carotid dissection/mural hematoma. The image show an internal carotid artery with narrowly eccentric lumen surrounded by a crescent-shaped hypodense mural thickening, with a visibly enhancing vessel wall. The carotid hematoma is a hypodense mural thickening that leads to expansion of the arterial wall, compression of the lumen and release of thrombogenic factors by intimal damage. Hematoma between the intima and media causes vessel expansion diameter and a narrow eccentric lumen. Peripheral hyper density is due to the contrast enhancement of the vasa vasorum in the adventitial layer. The physician should be familiar with the imagiologic features of carotid arterial disease, due to the diferent treatment options.&lt;/p&gt; 07/26/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1034.php &lt;h2&gt;Introduction&lt;/h2&gt; &lt;p&gt;Subungual exostosis (SUE) is a benign phalangeal tumor of an osteocartilaginous nature [1]. SUE is most commonly diagnosed in children and young adults; most of these lesions are located in the big toe, although they can occur (albeit infrequently) in other toes. We report five observations of SUE described in young children under 10 years and discuss the particularities of this pathology in the pediatric population.&lt;/p&gt; 07/22/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1033.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The main aim of the study was to compare outcomes based on diabetic control for patients undergoing formation of a new upper limb arteriovenous fistula (AVF). Research design and methods: A prospective cohort study was performed where we obtained baseline HbA1c in 65 patients before undergoing AV fistula formation. Patients were followed up at our clinic 6 weeks after creation to assess fistula maturity.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Multiple logistic regression was used to analyze the association between HbA1c status and maturity of AVF at 6 weeks after controlling for possible confounding factors such as age, sex, presence of hypertension and dyslipidaemia. Those with HbA1c less than 6.5 were 22 times likely to have maturity of AVF at 6 weeks as compared to those with HbA1c 6.5 or more (AOR = 22.65, p &amp;lt; 0.005).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Good diabetes control, reflected by an HbA1c of less than 6.5, is associated with a very high possibility of AVF maturity at 6 weeks post creation.&lt;/p&gt; 07/22/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1032.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;What is called &amp;ldquo;idiopathic biliary duct system dilatation&amp;rdquo; or better to name it &amp;ldquo;un-explained biliary dilatation&amp;rdquo; is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fields; the technical and the clinical ones. This clinical review is trying to fill this gap and introduce a comprehensive discussion of the subject.&amp;nbsp;&amp;nbsp; Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really difficult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to find a correlation rationale. At some point verification of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.&lt;/p&gt; 07/19/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1031.php &lt;h2&gt;Study questions&lt;/h2&gt; &lt;ol&gt; &lt;li&gt;The concept of wounds.&lt;/li&gt; &lt;li&gt;Classification of wounds.&lt;/li&gt; &lt;li&gt;Signs of wounds.&lt;/li&gt; &lt;li&gt;Factors affecting the course of the wound process.&lt;/li&gt; &lt;li&gt;Phases of the wound process.&lt;/li&gt; &lt;li&gt;Types of wound healing.&lt;/li&gt; &lt;li&gt;Features of wounds in children.&lt;/li&gt; &lt;li&gt;First (first emergency) help.&lt;/li&gt; &lt;li&gt;Complications of wounds.&lt;/li&gt; &lt;li&gt;Specific bite wounds. Notion Treatment. Complications.&lt;/li&gt; &lt;li&gt;Snake bites. First aid.&lt;/li&gt; &lt;li&gt;Arthropod bites. First aid.&lt;/li&gt; &lt;/ol&gt; &lt;p&gt;Wounds are called traumatic violation of the integrity of the skin or mucous membranes with possible damage to the deeper tissues.&lt;/p&gt; 06/03/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1030.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Gastrointestinal (GI) bleeding is a very common medical problem encountered in the acute care setting, and is a major cause of admission to hospitals with about 300,000 patients admitted annually. Obscure GI bleeding, defined as persistent or recurrent bleeding following initial negative upper and lower endoscopy, represents approximately 5% of all GI hemorrhages. The small bowel is the most common source for obscure GI bleeding. Variable lesions of the small bowel can cause obscure GI bleeding, with tumors, Crohn&amp;rsquo;s disease and Meckel&amp;rsquo;s diverticulum being more common in young age group. Meckel&amp;rsquo;s diverticulum, the most common GI congenital malformation, is usually asymptomatic and incidentally found. It can present with GI bleeding, seen more in pediatric patients, and rarely in adult patients. Herein, we present a 45 years old female patient, presenting with massive obscure GI bleeding due to Meckel&amp;rsquo;s diveticulum.&lt;/p&gt; 05/07/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1029.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Abdominal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera. In particular, internal hernias (IH) represents about 0.2-0.9% of all cases with para- duodenal hernias while obturator hernias accounting for only 0.07% of all hernias.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reported the case report of 79 year old women who was admitted to Internal Medicine Department of our Hospital for lung failure and after few days transferred to our Surgery Department for abdominal pain.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Obturator hernia is rare type of hernia and it is more frequent in older women with history of multiple pregnancy, chronic cough, and habitual constipation. In our patients, detailed physical examination and MRI preoperative imaging studies, have induce to the successful diagnosis.&lt;/p&gt; 02/19/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1028.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Minigastric bypass is gaining popularity worldwide as an effective bariatric surgery which has fewer complications than RYGB. There is raising concerns about biliary reflux and its effect on gastric mucosa. In this study we tried to find the link between the presence of bile in the stomach and the incidence of gastritis after MGB.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study was conducted in Ain Shams university hospitals from January 2017 to May 2018 including 40 patients. All patients underwent MGB with a 12-month follow-up, UGI endoscopy was performed 9 months after MGB for all patients, where multiple biopsies and gastric aspirate were obtained for bilirubin level.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age at operation was 32 years (18&amp;ndash;60) and preoperative BMI 44.31 kg/m2. The mean operative time was 95 (&amp;plusmn; 18 min), Mean % EWL was 81.2% at 12 months. Complete resolution occurred of hypertension in 8 patients (80%) and of Diabetes type 2 in 11 patients (84.2%). Level of bilirubin in gastric aspirate was elevated in 8 patients (20%) all of them had different levels pouch gastritis confirmed by histopathological examination.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Biliary reflux reached about 20% after MGB, the severity of biliary gastritis is related to the elevation of bilirubin level in the gastric aspirates, this results need to be confirmed by further studies on the MGB.&lt;/p&gt; 02/07/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1027.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Nothing without risk. As cholecystectomy is one of the most common procedures, any minor risk will be a mass volume. This study was to define the magnitude of that risk. In the study were 1486 patients between Feb. 2009 and April. 2018. Open in 292 (19.6%), 1194 (80.4%) laparoscopically, 1086 [91%] completed so and 108 (9%) converted. There were 18 (1.2%) with bile duct injury. 1 (0.3%) in the open group and 17 (1.4%) in the laparoscopic group. 9 diagnosed during surgery, 4 with jaundice, 2 early and 2 late, 5 with leak. Statistically the operative injury is insignificance in the 2 groups (P&amp;lt;0.3). The jaundice was significantly high in the laparoscopic group of patients (P&amp;lt;0.045). Also the bile leak (P&amp;lt;0.028). The same for morbidity (P&amp;lt;0.01. The revers was for mortality (P&amp;lt;0.04).&lt;br /&gt; &lt;strong&gt;Conclusion:&lt;/strong&gt; The incidence of CBD injury in the literature is less than the actual rate. Laparoscopic interventions have a higher rate of injury and the proximal ducts are at higher risk.&lt;/p&gt; 02/04/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1026.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.&lt;/p&gt; 01/24/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1025.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Purpose:&lt;/strong&gt; To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients:&lt;/strong&gt; The study was carried out at the faculty of medicine &amp;ndash; Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.&lt;/p&gt; 01/22/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1024.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Primary closure of the common bile duct following exploration has been safely and effectively performed, as advocated by Halsted, provided no evidence of pancreatitis, cholangitis, or ampullary obstruction exists. This study was to gain back confidence to primary closure in selected cases. This study was conducted at Beniswaif University Hospital. Between July 2008 to May. 2014. Using this precedent, the operative management and post-operative course of 19 patients undergoing common bile duct (CBD) exploration for choledocholithiasis were studied, twelve had primary closure of the common bile duct following choledochotomy and exploration, and seven had T-tube placement.&lt;/p&gt; &lt;p&gt;Patients were selected for T-tube if there were pancreatitis, cholangitis, undue trauma, ampullary obstruction. Two patients in that study had bile leak, one in each group. Intravenous fluids were less in primary suture (P&amp;lt;0.001). The long of stay were significantly less in primary suture (P&amp;lt;0.001). The outcome of this study greatly support the safety of primary common bile duct closure in selected cases.&lt;/p&gt; 01/14/2019 https://www.theskygallerypattaya.com/hjsr/ascr-aid1023.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair.&lt;br /&gt; Background: the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients:&lt;/strong&gt; The study was carried out at the faculty of medicine &amp;ndash; Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.&lt;/p&gt; 11/20/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1022.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Fractures of both the anterior and posterior pelvic ring are common injuries in polytrauma and the elderly that extend beyond those of simple low-impact trauma. While conventional X-rays predominantly show the ventral aspect of the injury, computed tomography often detect additional fractures of the sacrum. A large number of these fractures are B-injuries by AO, mainly compression fractures at an advanced age. In addition, the prevalence of pelvic insufficiency fractures caused by osteoporosis rather than subsequent to an obvious trauma is increasing, with such an injury often associated with pain that impairs mobilization. The standard sacroiliac screw fixation is often characterized by loosening and thus failure of the osteosynthesis especially in osteoporotic bone of elderly patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A new alternative surgical minimal invasive technique, the &amp;ldquo;iliosacral bridging&amp;rdquo;, stabilizes the fractures of the sacrum with an internal fixation from S1 pedicle of the uninjured side to the ilium on the affected side. The combination of this internal fixation with the standard single sacroiliac screw on the injured side allows an immediate full weight bearing and pain free mobilization. We present a case series of 8 patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The clinical and radiological analysis analogous to the pelvic-outcome-score brought forward that 2 patients showed an excellent and 2 patient a good result. The other 4 patients achieved sufficient results.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The &amp;ldquo;iliosacral bridging&amp;rdquo; we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries.&lt;/p&gt; 11/20/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1021.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Patients undergoing laparoscopic surgery had a lower incidence of major complications, such as anastomotic leak, intra-abdominal bleeding, abscess, and evisceration. Controversies about the operative management of left colonic emergencies are decreasing. Nowadays there is worldwide shifting towards primary resection, on table lavage and primary anastomosis. The aim of this study is to record the safety of laparoscopic primary anastomosis in left-sided colonic emergencies.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;The study was carried out at Beni-Suef University Hospital, in the period between January 2016 and July 2017. Twenty-six patients were included in this study, twelve with left colon cancer, twelve with left colonic complicated diverticulitis and two cases with sigmoid volvulus. Patients presented clinically with either obstruction or perforation. All patients were subjected to laparoscopic resection, on table lavage and primary anastomosis.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Decompression was done prior to starting the intervention, followed by resection and on table lavage then colorectal anastomosis using the circular stapler. The study was approved by the ethical committee in the faculty.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean operative time: 185 min (160- 245).&lt;/p&gt; &lt;p&gt;LOS: 12 (10- 18).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Leak: &lt;/strong&gt;one in obstruction group and two in perforation group.&lt;/p&gt; &lt;p&gt;Redo one in perforation group.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Emergency laparoscopic left-sided colonic resection and primary anastomosis can be performed with low morbidity, however with caution if there was free perforation with peritonitis.&lt;/p&gt; 10/17/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1020.php &lt;h2&gt;Case Report&lt;/h2&gt; &lt;p&gt;A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1].&lt;/p&gt; 10/17/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1019.php A 35-year-old man presented with swelling in the lower abdomen for 2 months. He was found to have left undescended testis. An ultrasound scan showed a solid floating pelvic mass. His chest x-ray and tumour markers for testicular cancer were normal. Exploratory laparotomy revealed the left intra-abdominal testicular tumour. Intra-abdominal left orchiectomy was performed. The patient made an uneventful recovery. Histology showed immature seminoma. A mass in the lower abdomen with a cryptorchidic testis strongly points towards the diagnosis of malignancy in abdominal testis. To prevent this complication all undescended testis gets orchiopexy before 2nd year or orchiectomy in post-adolescent life. But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour. 08/23/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1018.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Laparoscopic cholecystectomy is gold standard and most widely performed surgery for gallstone disease all over the world. Surgeons entering into the field of laparoscopic surgery for the first time faces challenges that are different from those with experienced hands. We in this study tried to enumerate the various such challenges and also recommend few steps to counter them.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Aims &amp;amp; Objectives: &lt;/strong&gt;To study the challenges faced by new surgeons in laparoscopic cholecystectomy and recommendations to reduce them.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Material &amp;amp; Methods: &lt;/strong&gt;This study was carried out in a medical college in the department of General and Minimal Access surgery. In this retrospective study, ten general surgeons working as senior residents in in this medical college over a period of 3 years having never performed laparoscopic surgery in past were included.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 50 cases, five operated by each surgeon with minimal assistance by senior surgeon in few cases. Operative time varied from 90 to 120 minutes. The various technical challenges faced by the new surgeon were in the Creation of Pneumoperitoneum, Creation of second port (epigastric port 10mm), Gallbladder Retraction and Dissection at calot&amp;rsquo;s triangle, Dissection at gallbladder bed and Removal of the gallbladder from epigastric port.it has been observed that following various simple steps will abate these technical difficulties for these beginners while doing laparoscopic cholecystectomy.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Laparoscopic cholecystectomy is the most commonly performed minimal access surgical procedure nowadays and almost all the new surgeons enter the world of laparoscopic surgery via this surgery. Knowing and following the above recommendations will help them abate the technical challenges generally faced during the initial phase in the laparoscopic field.&lt;/p&gt; 08/14/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1017.php A gossypiboma is a mass of cotton material from any source, left in a body cavity after a surgical procedure. This enhances the morbidity, cost of treatment and potential mortality to the patient with the addition of medicolegal issues. We report a case of a 32 year old lady who presented with complaints of central abdominal pain and vomiting for 1 month, fever for 20 days and non-passage of flatus and faeces for 5 days. She had undergone a total abdominal hysterectomy 4 months prior. On clinical examination, adhesive small intestinal obstruction was suspected. On CECT evaluation, a gossypiboma was suggested to have possibly migrated into the small bowel. Laparotomy revealed the presence of clumped bowel loops, which on dissection got torn and showed a gauze like material within the bowel lumen. A diagnosis of gossypiboma with intestinal migration of a retained surgical sponge was ascertained. The possibility of a gossypiboma, particularly in previously operated cases, must be kept in mind and measures must be taken to prevent such incidences. 06/20/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1016.php &lt;h2&gt;Dear Editor&lt;/h2&gt; &lt;p&gt;We read with interest the case report entitled &amp;ldquo;Dieulafoy&amp;rsquo;s Lesion related massive Intraoperative Gastrointestinal Bleeding during Single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Repor&amp;#39;t published in Archives of Surgery and Clinical Research b Ashraf Imam et al. [1]. We appreciate the authors for managing such a complicated case and for sharing their experience but, we have some conϐlict about the management, and we wanted to add some comments regarding the importance of EGD before bariatric surgery.&lt;/p&gt; 05/02/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1015.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;After the closure of patent processus vaginalis (PPV) in boys with indirect inguinal hernia (IIH) or hydrocele, large scrotal hydroceles can occur on rare occasions despite the complete occlusion of internal inguinal ring (IIR). We present some cases that may help to explain the cause of this rare occurrence.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Materials: &lt;/strong&gt;During last 14 years, six boys exhibited non-communicating large scrotal hydroceles (2 right, 1 left, 3 bilateral) among 352 children who underwent laparoscopic repair for hydroceles. Ages ranged from 7 months to 15 years with a median of 12 years. Five of them had a history of repair for hydrocele or IIH prior to the definitive surgery and one boy underwent an initial operation.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In all the patients, laparoscopic inspection at the definitive surgery revealed completely closed IIRs. One infant with primary hydroceles was found to have large hydroceles bulging into the peritoneal cavity. All the patients were treated with subtotal removal of the sac without any recurrence. Marked thickness of the sack walls with abundant lymph vessels was characteristic histopathological findings.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The complete occlusion of the PPV does not always prevent the recurrence of hydrocele through alternative pathogenesis. The pathological findings of resected specimens suggested a disturbance in lymph flow in the testicular system. The subtotal removal of the sac is the treatment of choice. Diagnostic laparoscopy prior to a direct cut-down approach to the neck of the seminal cord is advisable to identify non-communicating hydroceles to avoid further impairment of lymph drainage around the IIR.&lt;/p&gt; 01/10/2018 https://www.theskygallerypattaya.com/hjsr/ascr-aid1014.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The refractoriness in treatment of chronic prostatitis (CP) could be due to repeated infection. This reinfection could be caused by Helicobacter Pylori present in human saliva.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The oral cavities seem to be the important reservoirs for the reinfection. The transmission from these reservoirs could be stopped by avoiding contact between male urethera and saliva.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three patients suffering from refractory symptoms of CP were advised to avoid contact between their urethera and saliva and were prescribed antibiotics. All patients had complete response.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The oral cavity serve as reservoir of microorganisms (H.Pylori) which infects patient&amp;rsquo;s urethera repeatedly in patients of CP.&lt;/p&gt; 11/21/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1013.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The band erosion (BE) is defined as the partial or complete movement towards the lumen of the stomach, is also known as migration, gastric incorporation and gastric inclusion. The presentation of this complication involves failure of bariatric procedures being ineffective and consequently requires the removal of the laparoscopic adjustable gastric banding (LAGB), usually through laparoscopic surgery.&lt;/p&gt; &lt;p&gt;The objective of this study is to describe the clinical presentation, diagnostic methods, surgical procedure, postoperative evolution in the integral treatment of BE. Material and Methods: We captured the data of patients with BE since January 2010 to October 2017. Database included the year of patient care, age, and sex, BMI before band placement, percentage of excess weight loss, number of device adjustments, clinical data and surgical procedure performed for resolution.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total 379 LAGB complications were diagnosed in our Institution; 210 patients with BE were diagnosed and treated, the average age was 39 years; range from 19 to 66 years, sex was 178 women and 32 men. The diagnosis was endoscopic in the 210 patients (100%). The surgical procedure to solve the problem was: to remove the LAGB, the fistulous orifice was closed and patch of omentum. The hospital stay was 3-5 days. The motility was zero. Complications were minor in 3% of the 210 patients (fever, atelectasis, wound infection). One patient was re-operated for evolving to residual abscess.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The BE is a serious failure in bariatric surgery. The resolution in this group of patients was to remove the band, direct closure of the fistulous orifice with patch of omentum. The surgical technique that was performed in this complication is safe, effective and easily reproducible.&lt;/p&gt; 11/14/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1012.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Morbidity and mortality of HIV-infected patients have been improved over the last decades with the advent of combined antiretroviral therapy. As a result, other comorbidities such as chronic kidney and chronic liver diseases have emerged in the HIV population. A considerable percentage of end-stage liver disease (ESLD) in HIV population is attributed to hepatitis C co-infection and reactivation, and a growing need for solid organ transplantation has emerged among those patients. On the other hand, several studies on liver transplantations of patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have shown discouraging results both in patient and graft survival rates. As a result, HIV-HCV co-infection has been considered a relative contraindication for liver transplantation. Thankfully, new drugs for HCV treatment have been discovered, acting direct on viral replication of HCV and they have changed the whole clinical course of HCV/HIV co-infected liver transplant recipients. Our case illustrates the long-term efficacy and safety of the new combination of Sofosbuvir/Ledipasvir in HCV/HIV co-infected liver transplant recipients.&lt;/p&gt; 10/24/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1011.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To date, the scientific community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classification of surgical complications. Complications following surgeries were tested using the 95% confidence interval. Statistical analysis was performed with Statistical Analysis System (SAS).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fistula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical significance) and when compared with MGB/OAGB (without a statistical significance). When dividing the complications by the different grades of the Clavien-Dindo classification, the only significant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study supports a safe profile of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB.&lt;/p&gt; 10/20/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1010.php &lt;h2&gt;Comments&lt;/h2&gt; &lt;p&gt;The story of Nuremberg code in human experiments was evolved by a 70-year old historical link, aiming to provide an alert message for scientists in case of nonprovisional disaster caused by immoral human experiment. It played a safeguard role standing on the front line [1].&lt;/p&gt; 10/10/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1009.php <strong>Introduction: </strong>Laparoscopic approach is emerging as a standard of care approach for management of masses amenable to partial nephrectomy. Laparoscopic partial nephrectomy is a challenging surgery and its successful performance depends on various factors. We aim to evaluate the influence of tumor characterestics on the operative performance for laparoscopic partial nephrectomy. <strong>Methods: </strong>Patients undergoing laparoscopic partial nephrectomy in our institution were recruited for this study. The tumor profile was evaluated by a senior radiologist from cross sectional imaging (computed tomography or magnetic resonance imaging). Tumor characerestics was defined by assessing tumor size, tumor location and RENAL score. The operative performance was evaluated in terms of warm ischemia time, blood loss, operation duration and any significant operative complications. Statistical inference was drawn. <strong>Results: </strong>37 patients who underwent laparoscopic partial nephrectomy between January 2010 and June 2012 were included in this study. The mean tumor dimension was 3.81 cms. 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically significant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters. <strong>Conclusion: </strong>The operative performance of laparoscopic partial nephrectomy is significantly influenced by the tumor location and RENAL score. 09/15/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1008.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the first description of this complication, and the difference of such a lesion from the sporadic ones is discussed.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Gastric bypass saurgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy&amp;#39;s cases.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This is the first description of an intraoperative Dieulafoy&amp;#39;s lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.&lt;/p&gt; 08/28/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1007.php &lt;h2&gt;Letter to Editor&lt;/h2&gt; &lt;p&gt;From the First case of primitive cardiac surgery (CS), treatment of stab wound of the heart (Dr. Daniel Hale Williams, 1893), to recent surgical procedures and device implantations for end-stage heart failure (HF), the CS has grown and emerged in the public health more and more [1].&lt;/p&gt; &lt;p&gt;The heart valve disease had interested immediately since the non-cardiopulmonary era because of the multitude of rheumatic patients and congenital valve disease. In the 1952, Hufnagel implanted the first valve in descending aorta and it was the sign of the first step of the CS evolution. New prosthesis and heart valve techniques were tested between 1970 and 2000 with optimal results in patients&amp;rsquo; quality of life and survival, at the same time of CPB evolution.&lt;/p&gt; 08/18/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1006.php &lt;h2&gt;Introduction&lt;/h2&gt; &lt;p&gt;In actual pharmacological therapy we can see that some drugs can be added to other medical instruments to improve their activity: in example we can see medicated stent for some coronary disease, or hormonal medical devices used in pregnancy prevention, but other example are known today. In example Carmustine wafer is delivered by delivery systems in some brain cancer and radioactive seed implants in prostatic cancer. Ocular intra vitreal implants for some macular degenerations (MABS or cortisones) other implants delivery systems drugs, naltrexone implant for opiate dependence. Other strategies imply carrier use to deliver the drugs in the site of action: In example MABS linked to radioactive isotopes in some relapse of severe Hodgkin disease but many other example we can see in therapy used today. So we can think that other chronic conditions can be treated using a combination of drugs with other instrument to improve the clinical outcomes. This to make possible that the ERLICH MUGIC BULLETS can act in the right site reducing the side effect. In example today we can see various medical interventional radiological strategy to treat in coronary and hearth disease with medicate stents positioning or to local use of contrast agents or other valvle surgery procedures with global good clinical results.&lt;/p&gt; 08/04/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1005.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Chronic Hepatic deficiency due to the ingestion of alcohol remains as one of the main causes of morbidity and mortality in our country. From it a variety of complications arise, one of them is the Hepatopulmonary Syndrome, which usually goes unnoticed and undiagnosed; this syndrome is distinguished by the presence of hypoxemia and pulmonary vasodilation. The gold standard to establish a diagnostic is contrast-enhanced Echocardiogram. No pathognomonic sign is known for this syndrome, which leads the present elaboration to evaluate the use of orthodeoxia by pulse oximetry as a screening test in the detection of Hepatopulmonary Syndrome cases.&lt;/p&gt; 06/27/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1004.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Acute pancreatitis forms a major bulk of our inpatient admission due to gall stone disease. Diagnosis of acute pancreatitis remains a challenge even now. Serum amylase remains the most commonly used biochemical marker for its diagnosis but its sensitivity can be reduced by late presentation, hyper-triglyceridemia and chronic alcoholism. We conducted a study to determine the levels of serum and urinary amylase in patients with acute pancreatitis and compared their sensitivity and correlation with CT findings vis-&amp;agrave;-vis the severity of the disease. The study was taken as a post graduate research model in the Post graduate Department of General and Minimal Access Surgery, Govt. Medical College Srinagar, J&amp;amp;K, India 2014-2016 and submitted for the award of masters in General Surgery. A total number of 150 patients were enrolled in the studies which were admitted in our unit as acute pancreatitis. 73 (48.7%) belonged to the age group of 30-44 years, 15(10%) patients aged &amp;gt;60 years with 86 (57.3%) males and 64 (42.7%) females. We had 81 (54%) patients with biliary tract diseases, followed by 21 (14%) patients with worm induced, 20 (13.3%) had hyperlipidaemia and only 4 (2.7%) patients had post ERCP etiology. Tenderness in epigastrium was the presenting sign in 111 (74%), followed by chest signs in 25 (16.7%) patients, diffuse tenderness in 19 (12.7%), icterus in 11 (7.3%), low grade fever in 9 (6%) patients, shock in 5 (3.3%). Diabetes mellitus as a comorbidity was observed in 48 (32%) patients followed by hypothyroidism 37 (24.7%) patients. Hypertension was seen in 31 (20.7%) patients, COPD in 19 (12.7%) patients and obesity in 13 (8.7%) patients. Twenty two (14.7%) needed ICU admission; while as 128 (85.3%) were managed in the general ward. All the enrolled patients in our study were managed conservatively. Out of a total of 150 patients, 148 (98.7%) survived while as only 2 (1.3%) of our patients expired. At the time of admission in the hospital, 120 (80%) patients had serum amylase level of &amp;gt;450 U/L, 19 (12.7%) patients had 150-450 U/L levels while as 11 (7.3%) patients had &amp;lt;150 U/L serum amylase levels. CT has been shown to yield an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic gland necrosis. The correlation of urinary amylase with the CECT Severity Scoring in a patient of acute pancreatitis is still ambiguous.&lt;/p&gt; 03/27/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1003.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Morgagni hernia represents 2-4% of congenital diaphragmatic hernias. Only one-third of them are symptomatic, due to the hernia of abdominal viscera in the thoracic cavity, causing respiratory and digestive problems, some of them serious ones, such as intestinal obstruction. Acute presentation with incarceration of the contents is rare; there are only 7 cases described in the literature.&lt;/p&gt; &lt;p&gt;We are presenting a case of diaphragmatic hernia that began with obstruction of the colon and secondary ischemia, requiring emergency surgery in two phases: first surgery to control the damage, with an open right hemicolectomy, and then later surgery to repair the hernia and perform bowel transit reconstruction, with proper postoperative evolution and no evidence of relapse.&lt;/p&gt; &lt;p&gt;The treatment of Morgagni diaphragmatic hernia is surgical. Also in asymptomatic cases, due to the risk of incarceration, the most appropriate way to enter is abdominally, whether by way of laparotomy or laparoscopy, for the reduction of the contents of the hernia sac, the repair of the defect, as well as the performing of associated techniques on herniated viscera, as occurred in our case.&lt;/p&gt; &lt;p&gt;A complicated congenital hernia is an infrequent pathology, and there is little experience in handling it. Acute presentation requires a combined treatment of the abdominal symptoms and repair of the hernia defect. The carrying over of surgical techniques for damage control into non-traumatic surgery in the face of serious hemodynamic instability is a widespread, accepted practice with the benefits of reducing mortality in critical patients and at times allowing the avoidance of ostomies.&lt;/p&gt; 01/03/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1002.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its&amp;rsquo; management.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patient description: &lt;/strong&gt;A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fistula and a large impacted stone were found. Separation of the fistula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Discussion and Conclusions: &lt;/strong&gt;Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.&lt;/p&gt; 01/02/2017 https://www.theskygallerypattaya.com/hjsr/ascr-aid1001.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.&lt;/p&gt;