The authors review the treatment and outcome of patients with benign bile duct strictures who underwent biliary enteric repair. The authors conducted a retrospective review of all clinical records of patients referred for treatment of benign bile duct strictures caused by surgery, trauma, or common bile duct lithiasis or choledochal cyst. The authors performed univariate and multivariate analyses of clinical and pathologic factors in relation to patient outcome and survivals. Eighty-four patients with documented benign bile duct strictures underwent hepaticojejunostomy, choledochojejunostomy, and intrahepatic cholangiojejunostomy during a 15-year period (January 1975 to December 1989). Morbidity, mortality, and patient survival rates were measured. Early and late outcomes correlated neither with demographic and clinical features at presentation nor with etiologic or pathologic characteristics of the stricture. Best results correlated with high biliary enteric anastomoses and degree of common bile duct dilatation independently of bile duct stricture location. High biliary enteric anastomosis provides a safe, durable, and highly effective solution to the problem of benign strictures of the bile duct. Transanastomotic tube stenting is unnecessary. Endoscopic and percutaneous transhepatic dilatation seems more appropriate for the treatment of patients in poor condition and those with anastomotic strictures.

Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

STANDARD surgical techniques offer a good chance of cure for the majority of patients affected by extrahepatic benign biliary stricture.^1-11 Nevertheless, operative repair has a long-term recurrence rate of stricture in 10% to 30% of patients. Advances in endoscopic procedures have provided alternative options of relieving biliary obstructions, but prolonged length of treatment and rehospitalization have to be considered if endoscopy is performed.^12-15 The purpose of this study was to compare the effectiveness of endoscopic and surgical treatments of benign stenosis of the bile duct.

Research from JAMA Surgery — The Need for Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy — A Prospective Randomized Study

PELVIC RECURRENCE following curative surgery for rectal cancer is common, ranging between 5% and 45%.^1-4 This considerable variation in different series is probably due to differing quality of surgical treatment.^3,4 It is increasingly believed that many of these local recurrences are due to incomplete excision of metastatic deposits scattered in the supporting structures around the rectum.^1,3,5,6 Most frequently, local cancer spread discontinuous with the primary rectal tumor takes place in the mesorectal lymph nodes (nodal metastases [NM]). However, nonnodal metastases (NNM), which have been described in other organs,⁷ have been found within the mesorectum and outside it along lateral pelvic vessels, autonomic nerves, and the pelvic wall.^1,2,5,7-9 Our aim was to determine the incidence of NM and NNM, their relation to other clinicopathologic characteristics, and their influence on survival and recurrence rate in patients treated with curative low anterior resection (LAR).