Laparoscopic versus open appendectomy for the treatment of complicated appendicitis.

AIM: Laparoscopic Appendectomy (LA) is widely performed for the treatment of acute appendicitis. However the use of laparoscopic approach for complicated appendicitis is controversial, in particular because it has been reported an increased risk of postoperative IntraAbdominal Abscess (IAA). The aim of this study was to compare the outcomes of LA versus Open Appendectomy (OA) in the treatment of complicated appendicitis, especially with regard to the incidence of postoperative IAA. PATIENTS AND METHODS: A retrospective study of all patients treated at our institution for complicated appendicitis, from May 2004 to June 2009, was performed. Data collection included demographic characteristics, postoperative complications, conversion rate, and length of hospital stay. RESULTS: Thirty-eight patients with complicated appendicitis were analysed. Among these, 18 (47,3%) had LA and 20 (52,7%) had OA. There were no statistical differences in characteristics between the two groups. The incidence of postoperative IAA was higher (16,6%), although not statistically significant, in the LA compared with OA group (5%). On the other hand the rate of wound infection was lower (5%) in the LA versus OA (20%). CONCLUSION: Our study indicated that LA should be utilised with caution in case of perforated appendicitis, because it is associated with an increased risk of postoperative IAA compared with OA.

[Treatment of mild malnutrition and reduction of morbidity in major abdominal surgery: randomized trial on 153 patients]. / Trattamento della malnutrizione lieve e riduzione delle compli- canze in chirurgia addominale maggiore: studio randomizzato su 153 pazienti.

OBJECTIVES: Severe malnutrition (defined as weight loss more than 10% in a period of six months) is considered an important risk factor in major abdominal surgery, because of a higher post-operative mortality and morbidity. The aim of our study is to assess the role of mild malnutrition (weight loss low than 10% in a period of six months) as a risk factor in major abdominal surgery and to evaluate the efficacy of therapy in order to improve outcomes in terms of in-hospital mortality, length of hospital stay and post-operative complications. Moreover, we evaluated serum albuminemia and lymphocyte count, important nutritional index, as predictive risk factors. MATERIALS AND METHODS: We performed a randomized prospective trial, and admitted in our institution 153 adult patients, 43 with mild malnutrition and 110 without. The malnourished patients were randomized in two groups: the first one received oral immunonutrition (Impact Oral) for 7-10 days before surgery (22 pz), the second one received no nutritional support. RESULTS: We observed a higher number of complications in the non-treated malnourished patients (57%) versus both the treated malnourished patients (13.6%) and the normal group (19%) (p<0.001). Increased morbidity was observed in patients with serum albuminemia <2.8 gr/dl (69.2%) and with lymphocyte count <1.500 mm3 (57%). CONCLUSIONS: Nutritional enriched support demonstrated his efficacy in reducing morbidity, and length of hospital stay. Pre-operative oral immunonutrition might be suggested and established in all the patients with mild malnutrition that will be operated on major abdominal surgery.

Abdominal tuberculosis with pancreatic involvement: a case report.

A case of abdominal tuberculosis with pancreatic involvement is described. A 27-year-old Italian male, with no known cause of immunodeficiency and with no evidence of pulmonary tuberculosis, was admitted to our division because of acute pancreatitis. Abdominal imaging revealed a large 'tumour-like' mass in the pancreas head compressing the distal choledochous, and multiple adenopathy. Histological examination of multiple specimens removed during explorative laparotomy revealed granulomas with giant cells, caseous necrosis, and positive Ziehl-Neelsen staining. Tissue culture was positive for Mycobacterium tuberculosis. Once specific medical treatment was started, the pancreatic damage completely resolved.

[Results of the local excision of rectal cancer after high-dose radiotherapy associated or not to chemotherapy]. / Risultati dell'escissione locale del cancro del retto dopo radioterapia ad alte dosi associata o meno a chemioterapia.

Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.

[Histopathologic changes of cancer of the rectum after neoadjuvant radio-chemotherapy. Anatomo-radiologic correlation and prognostic implications]. / Modificazioni istologiche del cancro del retto dopo radio-chemioterapia neo-adiuvante. Correlazioni anatomo-radiologiche ed implicazioni prognostiche.

The histopathologic study of 24 specimens of radiated rectal cancers suggested new histologic criteria to define tumor regression after neo-adjuvant therapy. Better than traditional UICC staging system (pTNM), such criteria have identified those patients at higher risk of failure. Moreover, the study has confirmed the known difficulties of imaging studies in assuring an accurate staging of radiated rectal cancer before surgery.