Background: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre. Materials and Methods: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups. Results: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were 4.9 � 3.2 months and 8.3 � 2.0 months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria. Conclusions: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

A diagnosis of cystic lesion of epigastrium is challenging without strong evidence from history and physical examination. A 33-year-old lady has an epigastric mass without hepato-pancreaticobiliary symptoms, was unable to be diagnosed through radiological assessment and biochemical markers. She was diagnosed with hepatobiliary cystadenoma through intraoperative assessment. We present a case of biliary cystadenoma with diagnostic challenge. � Copyright 2018 by Gazi University Medical Faculty.

Background: We implemented the Enhanced Recovery After Surgery (ERAS) for our post pancreaticoduodenectomy patients in our institution since 2013. This study aim to to determine the differences between the previous postoperative care and ERAS. Material and Method: We included all patients who underwent pancreaticoduodenectomy UKM Medical Centre (UKMMC) from Jan 2011 to April 2015. Subjects are divided into control group comprise pre-ERAS patient and study group comprise post ERAS implementation. Recorded data include demographics, patients� characteristic, surgery data, complication, outcomes and length of stay. Results: Total subjects were 81 patients. There were no significant differences in the demographics and patients� characteristic between both groups. Post-operative morbidity, re-laparotomy and readmission rate was equivalent. Mortality rate were more in pre-ERAS group but not significant. The length of stay was lower in the post ERAS group (11.7 days versus 15.4 days; p=0.002). Non-PD related complication is high within the pre-ERAS group (27.7% versus 5.9%; p=0,019). Conclusions: ERAS protocol have a lower complication rate and reduce hospital stay. It should be the standard management in post-operative pancreaticoduodenectomy care.

Background: A liver-related injury such as bile leak and biloma formation is common in high-grade liver injury (grade III-VI). The presentation is usually non-specific requiring a high index of suspicion in its diagnosis. Although this condition is considered benign, the implication of an untreated biloma is severe. Case presentation: We presented a case of a 25-year-old man who is involved in a road traffic accident and sustained multiple liver lacerations. Liver packing was done with no immediate complication. However, he developed an infected biloma during recovery. Magnetic resonance cholangiopancreatography confirmed a transected right hepatic duct. Biliary duct stenting and percutaneous was done successfully. Conclusion: Biloma is common in high-grade liver injury. Early diagnosis is needed to ensure treatment success. � 2017 Surgical Society of Northern Greece. All rights reserved.

The incidence of pancreatic ascites is unusual. It is uncommon sequelae of chronic pancreatitis. Smith first discovered it in 1953 in the literature. The etiology includes chronic pancreatitis, pancreatic pseudocyst, pancreatic trauma and idiopathic in origin. Despite a rise in the incidence, it is scarcely reported. This is a case of a 20-year-old man presented with repeated acute pancreatitis episode complicated with gross ascites. Pancreatic duct stones were identified intra-operatively. Frey’s surgery was the procedure of choice. We discuss the presentation, choice of treatment and outcome.

Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium. Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients' demographic data were also observed. Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142) Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant.

Radiofrequency ablation (RFA) has evolved to become the treatment of choice for non-resectable recurrent colorectal liver metastasis. It is however, not without complications. Portal vein thrombosis following RFA is rare but can be fatal to the outcome of the patient. Here, we present a case of a 66-year-old man who developed portal vein thrombosis following RFA. CT scan revealed a left portal vein thrombosis. This case report highlights the challenges and multimodal treatment of portal vein thrombosis following Radiofrequency ablation (RFA) in a cirrhotic patient. � Societ� Editrice Universo (SEU).

A 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preceding 3 weeks. Clinically, she was jaundiced with upper quadrant abdominal tenderness. Initial blood tests and imaging scans suggested cholangiocarcinoma. Intraoperatively, no malignancy was observed. A frozen section biopsy suggested tuberculosis (TB). However, subsequent serological examination showed that the patient was nonreactive for human immunodeficiency virus, hepatitis B, hepatitis C, and acid-fast bacilli. A chest radiograph also showed no evidence of pulmonary TB. The patient was then placed on antitubercular therapy and her condition improved. Primary hepatic TB was not initially considered during diagnosis because of its low prevalence, but this led to performing an unnecessary surgery on this patient. We review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with primary hepatic TB. � 2015.

Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for liver resection was initiated. Objective: The aim of this study was to achieve discharge by postoperative day 3 for minor resection and day 5 for major resection. Design and Setting: This is a prospective study conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015. Material and Methods: All patients undergoing open liver resection were included in the study. They were then managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient's demographics data, intra operative parameters, postoperative complications and adherence to postoperative recovery protocol were recorded. Results: Seventeen patients (7 major and 10 minor resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%) in the major group were discharged on time. 9 patients had postoperative complications with no mortality recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in 15 patients (88.3%), nasogastric tube removal (13 patients -76.5%), urinary cathether removal (6 patients - 35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14 patients). Conclusion: From these overall achievement, most of our targets have been met and this shows that our ERAS protocol is safe to be applied to patient undergoing hepatectomy. Limitations: Some patients had achieved their target but not discharged for unknown reason.

Preduodenal portal vein commonly present in neonate and delayed presentation in adulthood is rarely reported. We presented a case of preduodenal portal vein in a man who presented with features of ascending cholangitis. Physical examination was unremark-able. An ultrasound of the biliary system demonstrated gallbladder stone with dilated left intrahepatic ducts. The right hepatic duct and common bile duct were spared. ERCP revealed a small common bile duct and intrahepatic duct with distortion of the ampulla. CT abdomen shows malrotation of the gut with preduodenal portal vein and abnormality of the intrahepatic inferior vena cava. MRCP showed a normal caliber of biliary tree except for a small abrupt tapering at the common channel. Otherwise the anatomical location of pancreatic duct is normal. We are reporting our unique case and the radiographic images are discussed. The literature of PDPV with other visceral organs anomalies are reviewed.

Leiomyosarcoma of the Inferior Vena Cava (IVC) is a rare soft tissue tumour which accounts for only 0.5% of all soft tissue sarcomas. The patients usually presented with non specific clinical signs and often diagnosed at advanced stage. We reported a case of a 58-year-old lady who presented with right sided abdominal pain for 6 months. CT scan showed large Level 2 IVC tumour which encased the right renal vein and had no clear plane of demarcation with the caudate lobe of the liver. She underwent radical resection of the IVC tumour with the right kidney removed en bloc. Vascular reconstruction was not performed as established collateral veins present. She was nursed in Intensive Care Unit for 2 days and discharged well at day 5 post operatively. Histopathological examination results revealed leiomyosarcoma of IVC. � 2018 Faculty of Medicine and Health Sciences. All rights reserved. Keywords: Inferior vena cava leiomyosarcoma, Radical resection, IVC tumour

Background: Single Incision Laparoscopic Cholecystectomy (SILC) was first introduced about 2 decades ago, as an evolution of the gold standard 3-4 ports laparoscopic cholecystectomy. Objectives: The objective of the study was to assess the safety and feasibility of SILC using a novel Glove Port Technique. Methodology: This is an retrospective cohort study of SILC using a novel glove port technique, carried out at our centre from 1st September 2014 to 31st December 2016. Data on patients' demographic data, operative time, postoperative pain, length of stay, postoperative intervention were retrieved from patients' medical records and overall satisfaction were recorded at followup. Results: A total of 50 patients, mean age of 58.2 � 16.5 years, underwent SILC at our centre during the study period and were included in the study. The mean operating time was 83.6 + 39 minutes. Thirty-five patients (70%) underwent SILC without additional ports or conversion. All patients who underwent SILC had minimal blood loss of less than 50mls (only 2 patients who were converted to open cholecystectomy had blood loss of 200mls and 250mls). The mean score for postoperative pain were 3.4 � 1.8. The length of stay was 2.8 � 3.0 days. Only 6 cases developed postoperative complications, which resolved with treatment within 30 days. There was no mortality recorded. The mean satisfaction score at 1 month was 8.9. Conclusion: Although technically more challenging, SILC is a safe and feasible procedure, with good and satisfactory postoperative outcomes. However these satisfactory out-comes are only achieved currently by surgeons who are trained in advanced laparoscopic surgery.

A 20-year-old man presented with peritonitis requiring emergency laparotomy. He was found to have a huge liver abscess on the right lobe. Open drainage was performed but the abscess was persistently unresolved upon follow up. Computed tomography (CT) revealed a solid liver lesion with raised Ca 19-9. Right hepatectomy was subjected and histology was consistent with a rare and aggressive case of embryonal sarcoma of the liver. Despite oncologic resection, he developed local recurrence and succumbed to death in 6 month postoperatively. We describe a unique aetiology of liver abscess with literature reviews of undifferentiated embryonal sarcoma of the liver. �Copyright 2018 by Gazi University Medical Faculty.