Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical substances and surgical procedures. In this retrospective study, we aimed to evaluate the safe and adequate option of lateral internal sphincterotomy (LIS) in chronic anal fissure treatment. This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included. Of 417 patients included in the study, 228 (54.7%) were female and the mean ± SD age was 36.1 ± 8.96 years (ranging from 17 to 73 years). Major complaints of patients; pain, bleeding, constipation, pruritus, perianal discharge. Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence (four with gas, four with soiling and seven females, one male). The complaints of all patients with gas incontinence and a patient with fluid incontinence regressed, whereas three patients had permanent fluid incontinence. LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.

Gallstone ileus (GI) is a rare entity which is seen in 0.5% of patients with cholelithiasis. In this study, we aimed to share our clinical approach to GI, to present our long-term results and to dr...

Cite this article as: Güngör F, Sür Y, Gür EÖ, Dilek ON. A rare anatomical variation of the bile ducts: Cystic duct draining to the right hepatic duct. Turk J Gastroenterol 2019; 30(4): 375-6.

Hepaticojejunostomy is a challenging and complex procedure to be done with confidence in conditions that contain a large number of segmental bile ducts. Portoenterostomy can be defined as the joining of multiple bile ducts into a single cavity using segmenter bile duct ends, stents, and surrounding connective tissues. During surgery, in cases with advanced stage biliary tract tumors that cannot be performed hepatectomy, after aggressive dissections to provide a negative surgical margin, a large number of segmental bile ducts can be revealed and needs to ensure the continuity of bile flow. Here, our clinical series of portoenterostomy (PE) in which we applied in patients who had aggressive hilar dissection and resection for hilar cholangiocarcinomas and biliary tract tumors were discussed. The study included 15 patients who underwent PE for biliary tract tumors and hilar cholangiocarcinomas between 2015 and 2019. Six of the patients had a tumor-negative surgical margin, with a mean follow-up of 14.4 months (range 2 to 28 months). Nine of the patients had a tumor-positive surgical margin, with a mean follow-up of 7.7 months (range 2 to 17 months). Portoenterostomy instead of hepaticojejunostomy in small and multiple biliary radicles and bile duct cancers has been successfully performed in 15 patients of bile duct cancer and Klatskin tumor. In the presence of active inflammation, fibrosis, major bile duct trauma, and thin bile duct radicles, this method, which is described in detail, provides an excellent salvage surgical procedure with less morbidity.

Purpose Despite medical progress and laparoscopic cholecystectomy being standard for Grade II-III acute calculous cholecystitis in ASA II patients, optimal management, especially the timing of cholecystectomy (early vs. delayed) considering morbidity, risk-benefit, and cost, is still debated. While percutaneous cholecystostomy is definitive for ASA III/IV patients, its role as a bridge to cholecystectomy and the ideal interval in ASA II medically refractory cases remain unclear. Methods This retrospective study assessed the impact of initial percutaneous cholecystostomy on the timing, duration, and type of subsequent elective cholecystectomy in ASA Class II patients with Tokyo Grade II–III acute calculous cholecystitis. Percutaneous cholecystostomy was performed in patients with moderate cholecystitis unresponsive to conservative management and in those with severe cholecystitis presenting with negative predictive factors indicating a high risk of conservative treatment failure and perioperative complications. In both groups, the procedure served as a bridging intervention to stabilize patients before definitive surgery. The primary aim was to evaluate the effects of this strategy on surgical timing, complexity, and overall treatment outcomes. Results Of the 176 patients initially admitted with acute cholecystitis, 97 met the inclusion criteria, comprising those with Tokyo Grade II–III disease and classified as ASA II. Among patients who underwent laparoscopic cholecystectomy more than eight weeks after percutaneous cholecystostomy, 77% experienced prolonged operative durations, defined as procedures exceeding 60 min. Delayed surgical intervention in this specific cohort was consistently associated with a marked increase in both intraoperative complexity and technical difficulty during the laparoscopic cholecystectomy. Conclusions The liberal use of percutaneous cholecystostomy in patients with Tokyo Grade II–III acute calculous cholecystitis is not recommended. When percutaneous cholecystostomy is necessary as a bridging intervention prior to definitive surgical management, early laparoscopic cholecystectomy should remain the preferred approach in the majority of ASA II cases. Percutaneous cholecystostomy should be reserved for patients who are unresponsive to conservative treatment or present with contraindications to immediate surgery.