Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery:An algorithmic approach

AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography. RESULTS:Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulaethat are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

Subcutaneous extension of a large diaphragmatic hydatid cyst

A 53-year-old male patient with a large hydatid cyst of the left hemidiaphragm and smaller secondary cysts located in the left thoracic cavity and upper left abdominal quadrant presented with two progressively enlarging lipoma-like masses in the left hypochondrium and under the left scapulae respectively. Total excision of all the cysts was performed through a bilateral subcostal incision, with the left hemidiaphragm near totally excised and replaced by a synthetic bilayer mesh.

The Religious Tourism as a Competitive Advantage of the Prefecture of Pieria,Greece

The scope of the present paper is the research of whether the prefecture of Pieria comprises an attractive destination for religious tourism and pilgrimage.For this reason,the use of questionnaires takes place which aims to realizing if and to what extend this form of tourism comprises a comparative and competitive advantage for the prefecture of Pieria.The research method of this paper is the qualitative research and more specifically the use of questionnaires with 13 questions in total.The scope was to research whether the prefecture of Pieria is a religious-pilgrimage destination.The sample is comprised of 102 participants,being Greek residents originating from other Greek counties,the European Union,and Third World Countries.The requirement was for the participant to have visited the prefecture of Pieria.The independency test(x2)was used for checking the interconnections between the different factors,while at the same time an allocation of frequencies was conducted based on the study and presentation of frequency as much as relevant frequency.Due to the fact that,no other similar former researches have been conducted regarding religious tourism in Pieria,this research will be able to give some useful conclusions.These conclusions will lead us to more specialized knowledge on the tourism of the under study prefecture.