TAP Block Prior to Open Ventral Hernia Repair Improves Surgical Outcome.

BACKGROUND: Ventral hernias commonly affect patients after major abdominal surgery. To reduce postoperative pain, the effects of the transversus abdominis plane (TAP) block, epidural analgesia and medication-only protocol have been investigated. The primary outcome was the cumulative dosage of opioids (morphine milligram equivalents MME), of acetaminophen and diclofenac for postoperative pain control on postoperative day (POD) 0, 1, and 2. Secondary outcomes were length of stay (LOS) and the pain scale rating using the numeric rating scale (NRS) on POD 0, 1, and 2. METHODS: The data were retrospectively extracted from the charts of the patients admitted for a surgical operation for OVHR from January 2015 to December 2019. RESULTS: Patients receiving medication-only analgesia had longer LOS (mean 6.1 days; p < 0.00001). Cumulative opioid consumption was significantly lower at 24 and 48 h after surgery in the TAP block group than in the other groups (mean MME 1.9 mg and 0.7 mg, respectively; p < 0.05). The cumulative consumption of diclofenac was significantly lower in the TAP block group than in the others (44.1 mg; p ≤ 0.00001 on POD 1; 4.4 mg; p = 0.03 on POD 2). TAP block is more effective in pain control in POD 0 (mean NRS 5.4; p < 0.00001), POD 1 (mean NRS 6.1; p = 0.006), and POD 2 (mean NRS 4.9; p = 0.001) if it is performed after adopting the retromuscular technique. CONCLUSIONS: The comparison between the medication-only technique, epidural, and TAP block demonstrated the superiority of the last one for the aims considered in this study.

Evidence-Based Strategies to Promote Long-Term Cardiac Implant Site Health: Review of the Literature.

Cardiac implantable electronic devices (CIEDs) are commonly used nowadays. The association between CIED placement and infections is responsible for the high mortality and device explantation rate. Since CIED placement has increased in the past decade, CIED-related complications have risen. In order to reduce the CIED-related complications rate, the prevention of device infection represents the main goal. Over time, many different studies have proven the importance of the measures to prevent CIED-related infections. This review aims to collect the actual recommendations for CIED infection prevention, providing an overview of the main evidence-based strategies.

Closed Incision Negative Pressure Therapy Achieves Better Outcome Than Standard Wound Care: Clinical Outcome and Cost-Effectiveness Analysis in Open Ventral Hernia Repair With Synthetic Mesh Positioning.

Background Surgical site infections (SSIs) and surgical site occurrences (SSOs) are frequent post-operative complications that are dependent on the presence of different risk factors. The use of closed incision negative pressure therapy (ciNPT) is considered a measure by the WHO guidelines for prevention of SSIs. The prevention of SSOs is an extremely important issue in the ventral hernia repair (VHR) surgical field. SSO onset not only affects the patient's quality of life, but can also cause the onset of life-threatening conditions that may require re-hospitalization, re-intervention and often mesh removal. Such outcome can become extremely costly, contributing to increased health care costs for the patient as well as the hospital. This study aims (1) to describe the epidemiological characteristics of SSOs following VHR in our experience; (2) to compare the post-operative outcomes of those who underwent VHR with synthetic mesh when treated with standard wound care (SWC) using gauze dressings vs ciNPT, and finally (3) to perform a spending review of the ciNPT in the hypothesis of its application after VHR with use of synthetic prosthetic material; financial savings including cost-effectiveness were investigated in terms of prevention of wound complications. Materials and methods A retrospective review was performed on patients who underwent open VHR with synthetic mesh positioning by analyzing the hospital medical records between January 2015 and December 2017, with a primary focus on high risk post-operative complications, such as age > 65, pre-existed wound infection, pulmonary diseases, BMI > 25 kg/m2, malnutrition, ascites, hypertension, diabetes, active smoking, previous radiation therapy, steroid use, pharmacological immunosuppression, chronic inflammatory diseases. In the final analysis, the outcomes of 70 patients who received ciNPT and 110 who were managed with using adherent gauze dressings were compared. Results Nine (12.8%) patients in the ciNPT group and 48 (43.6%) in the control group developed a wound complication (p < 0.0001). The relative risk (RR) was 0.29 (0.15 - 0.56), suggesting that infection is less likely to occur in ciNPT-treated incisions, compared with standard wound care. The differences observed between the superficial infection rate and the deep infection rate were significant with p respectively 0.0006 and 0.04. Wound complications were reported in patients after discharge from the hospital. Fever was reported in 28.6% of patients in the ciNPT group vs 54.5% in the control group (p = 0.0006; RR (95% CI) 0.52 (0.35 - 0.79); OR (95% CI) 0.33 (0.18 - 0.63)); leukocytosis affected 21.4% of patients treated with ciNPT vs 45.4% of patients in the control group (p = 0.001; RR (95% CI) 0.47 (0.29 - 0.77); OR 0.33 (0.16 - 0.65)). ciNPT patients had shorter hospitalization stay than control group (3 ± 1.37 vs 6 ± 2.39; p < 0.00001). The cost-effectiveness deterministic analysis estimated that if the ciNPT is routinely adopted, the reduction of total costs would be €166'944.00 for 100 patients. Conclusions This study demonstrates that ciNPT use in high-risk populations following VHR with synthetic mesh positioning is associated with positive clinical and economic outcomes.

Clinical and Functional Outcome After Abdominal Wall Incisional Hernia Repair: Evaluation of Quality-of-Life Improvement and Comparison of Assessment Scales.

BACKGROUND: Hernias severely impact patient quality of life (QoL), and 80% of patients need surgical operation. The primary outcome of the study is to assess improvements in balance, posture and deambulation after abdominal hernia repair. Moreover, the study investigated the improvement in the postoperative QoL. METHODS: Patients operated at the Policlinico "Paolo Giaccone" at Palermo University Hospital between June 2015 and June 2017 were identified in a prospective database. The functional outcome measures and QoL assessment scales used were numeric rating scale for pain, performance-oriented mobility assessment (POMA) scale, Quebec back pain disability scale, center of gravity (barycenter) variation evaluation, Short-Form (36) Health Survey (SF-36 test), sit-up test and Activities Assessment Scale (AAS). The timepoints at which the parameters listed were assessed for the study were 1 week before the surgical operation and 6 months later. RESULTS: The POMA scale showed a significant improvement, with an overall preoperative score of (mean; SD) 18.80 ± 2.17 and a postoperative score of 23.56 ± 2.24 with a p < 0.003. The improvement of the barycenter was significant with p = 0.03 and 0.01 for the right and left inferior limbs, respectively. Finally, common daily activities reported by the SF-36 test and by the AAS were significantly improved with a reported p of ≤0.04 for 5 of eight items and ≤0.002 for all items, respectively. CONCLUSIONS: The improvement in such physical measures proves the importance of abdominal wall restoration to recover functional activity in the muscle-skeletal complex balance, gait and movement performance.

Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review.

BACKGROUND: Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. METHODS: The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were "minimally invasive," "video-assisted," and "thyroidectomy." We enrolled randomized clinical trials, nonrandomized trials, and noncontrolled trials. RESULTS: Thirty-two articles were considered suitable. Complication rate of MIVAT was quite similar to conventional technique: only one randomized trial found a significant difference concerning overall skin complication, and a single trial highlighted hypocalcemia significantly increased in MIVAT, concerning serologic value only. No difference concerning symptomatic nor definitive hypocalcemia was found. CONCLUSIONS: We can confirm that MIVAT is a safe technique. It should be adopted in mean-high-volume surgery centers for thyroidectomy, if a strict compliance with indication was applied.

Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study.

BACKGROUND: Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2-4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. METHODS: Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey's score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient's age, surgical technique and Boey's score were evaluated. RESULTS: The relationship between laparoscopic or open treatment and the Boey's score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients' Boey's score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey's score group and in the 10.7% of the high Boey's score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). CONCLUSIONS: Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey's score. In our series laparoscopy was not used in high risk Boey's score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.

The abdominal wall hernia in cirrhotic patients: a historical challenge.

Background: The incidence rate of abdominal wall hernia is 20-40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. Methods: Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico "Paolo Giaccone" at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence. Results: The univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)). Conclusions: Concerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction.

Correction to: Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study.

In the original article the credit line for the reuse of Fig. 1 from an article published in the open access journal, World Journal of Emergency Surgery is missing.

Pulmonary Laser Metastasectomy by 1318-nm Neodymium-Doped Yttrium-Aluminum Garnet Laser: A Retrospective Study About Laser Metastasectomy of the Lung.

BACKGROUND: The lungs are among the first organ affected by remote metastases from many primary tumors. The surgical resection of isolated pulmonary metastases represents an important and effective element of therapy. This is a retrospective study about our entire experience with pulmonary resection for metastatic cancer using 1318-nm neodymium-doped yttrium-aluminum garnet laser. METHOD: In this single-institution study, we retrospectively analyzed a group of 209 patients previously treated for primary malignant solid tumors. We excluded 103 patients. The number and location of lesions in the lungs was determined using chest computed tomography and positron emission tomography-computed tomography. Disseminated malignancy was excluded. All pulmonary laser resections are performed via an anteroaxillary muscle-sparing thoracotomy. All lesions were routinely removed by laser with a small (5-10 mm) margin of the healthy lung. Patients received systematic lymph node sampling with intraoperative smear cytology of sampled lymph nodes. RESULTS: Mortality at 2 years from the first surgery is around 20% (10% annually). This value increases to 45% in the third year. The estimated median survival for patients who underwent the first surgery is reported to be approximately 42 months. CONCLUSION: Our results show that laser resection of lung metastases can achieve good result, in terms of radical resection and survival, as conventional surgical metastasectomy. The great advantage is the possibility of limiting the damage to the lung. Stapler resection of a high number of metastases would mutilate the lung.

Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study.

BACKGROUND: Open abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur. METHODS: Non-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients' records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta "modified" technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), abdominal compartmental syndrome (ACS), cardiovascular disease (CVD) and surgical technique performed were evaluated in a multivariate analysis for mortality and fascial closure prediction. RESULTS: Ninety-six patients with a median age of 69 (40-78) years were included in the study. Sixty-nine patients (72%) underwent VAWCM. Forty-one patients (68%) achieved primary fascia closure: two patients (5%) were treated with VAWC (37 median days) versus 39 patients (95%) who were treated with VAWCM (10 median days) (p = 0.0003). Forty-eight patients underwent OA treatment due to ACS, and 24 patients (50%) survived compared to 36 patients (75%) from the "other reasons" group (p = 0.01). The ACS group required longer mechanical ventilator support (p = 0.006), length of stay in hospital (p = 0.005) and in ICU (p = 0.04) and had higher SAPS II scores (p = 0.0002). CONCLUSIONS: The survival rate was 62%. ACS (p = 0.01), SAPS II (p = 0.004), sex (p = 0.01), pre-existing CVD (p = 0.0007) and surgical technique (VAWC vs VAWCM) (p = 0.0009) were determined to be predictors of mortality. Primary fascial closure was obtained in 68% of cases. VAWCM was found to grant higher survival and primary fascial closure rate.

Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis.

PURPOSES: Anastomotic leakage is one of the major complications occurring after anterior resection of rectum. A defunctioning stoma is usually created routinely or on surgeons' discretion. The aim of this study was to investigate the usefulness of temporary ileostomy to prevent anastomotic leakage comparing the postoperative course of patients with and without defunctioning loop ileostomy. METHODS: Patients that underwent anterior resection of rectum were recruited. 140 patients were enrolled and divided in two groups: patients without and with defunctioning loop ileostomy. Patients' characteristics and other useful data were recorded. A comparison between the two groups was made. The minimum follow-up was 11 months. RESULTS AND CONCLUSIONS: 18.6% of patients had a symptomatic anastomotic leakage. We observed more anastomotic leakages after medium-low resections of rectum with anastomosis than after resections with high anastomosis (15.7% vs 2.9%; p=0.03). There were no significant differences in overall and related mortality between patients without/with ileostomy. The presence of ileostomy was not protective towards anastomotic leakage either in the medium-low resections or in the high ones but it was towards its consequences such as clinical features. Nevertheless we found a statistically significative difference between recurrence rate of leakage in patients with and without ileostomy (p-Value=0.009). KEY WORDS: Anterior resection of rectum, Ileostomy, Leakage.

A primary subcutaneous hydatid cyst in the thigh A case report.

AIM: Hydatid disease is a parasitic disease considered endemic in many parts of the world such as South America, Middle East, Africa, Australia and the Mediterranean regions. Liver and lung hydatid disease accounts for 90% of all echinococcal cysts. Primary hydatid disease of subcutaneous sites is rare and the subcutaneous localization of a solitary hydatid cyst accounts for 1.6%. Not enough data exist for this localization, and only many heterogeneous data are described in order to define this rare condition. MATERIAL OF STUDY: We present the case of a 68-year-old-woman affected by a mass in upper-medial side of her right thigh with a 12-year-growing history. Anamnestic data were accurately collected. Many different radiological and specific serum tests were performed in order to define the diagnosis. Surgical approach was decided in order to excide the mass, and a 6-months follow-up was performed. CONCLUSIONS: Hydatid disease is common in endemic area but uncommon localizations, as in subcutaneous tissues, are a rare condition. Scientific Community lacks of complete and homogeneous data about the approach to this manifestation of the disease. Would be useful a complete review of the literature in order to plan guide-lines for the treatment of uncommon localization. KEY WORDS: Echinococcosis, Hydatid cyst, Subcutaneous localization.

Solitary metastasis from melanoma causing bowel perforation.

INTRODUCTION: Skin melanoma can metastasize to any organ or tissue. The median survival in patient with intestinal metastases is inferior to 7 months compared to other sites metastasis. A wide intestinal resection including the resection of the mesentery with lymph nodes remains the main treatment due to the low morbidity and mortality rate it is also associated with. CASE REPORT: We took under analysis a recent case of acute abdomen for small bowel perforation from intestinal metastases in a patient with metastatic melanoma who was under treatment with Pemrolizumab. A bowel resection was performed and no other lesions were found in the abdominal examination. However, the chemotherapy was stopped due to the advanced age of the patient, presence of brain metastases that worsening his performance status and the bowel involvement. DISCUSSION: Preoperative diagnoses of metastatic or small intestine melanoma tend to often be difficult to perform. Before considering a possible elective surgery, in case of non-urgent symptoms, it is important to value first intestinal or extraintestinal spread. The previous report of bowel perforation from melanoma metastases showed an intraoperative finding of multiple widespread brown lesions. There are not reports about the possible involvement of Pembrolizumab in bowel perforation, which leads to the conclusion that it was probably the ingrown of the metastasis to cause it. CONCLUSION: The treatment of metastatic melanoma includes chemotherapy, immunotherapy and target-therapy. It will be useful to do a multicenter study on the survival after complete resection to better define the surgical indication for the treatment of the metastatic disease. KEY WORDS: Intestinal perforation, Melanoma, Metastasis.

Deep seroma after incisional hernia repair. Case reports and review of the literature.

AIM: Wound-related complications are common after incisional hernia repair with mesh; seroma formation is the most frequent problem. The formation of a deep seroma has been rarely reported in the literature. MATERIAL OF STUDY: In one year, September 2012-2013, 136 patients underwent surgery for incisional hernia repair, both elective and urgent. RESULTS: The following complications were observed: one dislocation of polypropylene prosthesis, a massive relapsed seroma and two deep seromas described in this article. A 63- years-old female underwent open incisional hernia repair with an intraperitoneal PTFE patch. She developed recurrent seroma under the mesh drained percutaneously, and finally the prosthesis was removed. A 72- years-old male underwent open incisional hernia repair with an intraperitoneal PTFE patch. After several months the patient had seroma infection. The prosthesis was then removed. CONCLUSIONS: Seroma is a wellknown complication of postoperative ventral hernia repair, especially where prosthetic mesh is used. The formation of a deep seroma is rare. Only few works mention this complication in literature. In the development of these chronic seromas a role may be played by a long-term inflammatory reaction, more pronounced with polypropylene and polyester meshes than with ePTFE. A conservative follow up of the seromas is recommended because drainage can introduce infection. In cases where the seroma causes discomfort or is infected then drainage is necessary. From experience at our institution we suggest that patients with the deep subtype of mesh-associated seromas may require closer clinical follow up. When possible, we recommend attempting the drainage of the liquid, eventually followed by microbiological examination.

Post-ERCP pancreatitis. A single center experience and an update on prevention strategies.

OBJECTIVES: Pancreatitis is the most frequent complication of the ERCP; in unselected patients the incidence is 3.5%, reaching 25%, and is mild-moderate in 90%. A stratification of patients into low or high risk is important to provide adequate information to patients and to decide when refer them to tertiary centers; moreover, many prophylactic measures have been proposed over years. Our aim was to select risk factors for PEP and compare them with current literature in order to propose adequate preventive strategies. METHODS: It was analyzed the occurrence of Post-ERCP Pancreatitis in a series of 492 consecutives patients treated with ERCP by two expert interventional endoscopists. The possible risk factors were evidenced by a multivariate analysis, were states our proposals for Post-ERCP Pancreatitis prevention and compared them to the current literature. RESULTS: We observed 14 PEP (2.8%), 6 mild, 4 moderates and 4 severe. The multivariate analysis evidenced as risk factors the high number of attempts of cannulation and the pancreatic injection of contrast medium and found a protective role for pre-cut sphincterotomy. Our mortality rate was 0.4%. CONCLUSIONS: The guide-wire cannulation technique and, in selected cases, the pre-cut permit to minimize the number of cannulation attempts and to increase the success rate of primary cannulation; we promote their use to reduce PEP occurrence.

Histologic considerations about a rare case of recurrent incisional hernia on McBurney incision.

AIM: Incisional hernias are often related to longitudinal or transverse laparotomy with an incidence that rises from to 2 to 23 %. The oblique incision often used to surgically treat acute appendicitis has little probability to develop incisional hernia with an estimated incidence less than 2%. Some series report 0.1 - 0.9% of it. Anatomic, physiologic and histologic factors have been implicated in herniation development, such as intra-abdominal pressure or alteration on tissue components; many different risk factors can be taken into account to justify this rare condition such as female gender, diabetes, peritonitis, abscess or appendiceal phlegmon as the cause of the first operation, wound infection, seroma, use of cutgut to suture aponeurosis, interrupted suture to the aponeurotic layer. MATERIAL OF STUDY: We present the rare case of young man who underwent surgical operation of acute appendicitis. Mc Burney incision was performed. Successively he underwent re-operation for incisional hernia developed upon McBurney incision and then "recurrence" of the same one. DISCUSSION AND CONCLUSION: Histological analysis of scar tissue was done. Alteration on histological pattern protein expression was discovered.

Liver hydatidosis: reasoned indications of surgical treatment. Comparison between conservative and radical techniques Retrospective study.

Liver hydatidosis is a focal benign parasitic disease that still cause high rate of morbidity particularly in the Mediterranean area. A retrospective study comparing conservative and radical techniques in a General and Urgent Surgery operative unit was carried out in order to find signs of its surgical treatment. A total of 50 patients, 24 men and 26 women, who experienced a surgical treatment from 2000 to 2011, participated, and through the Fisher's Exact Test characteristics of the cysts, post-operative complications and relapse were compared. As a result, 29 patients undertook conservative surgery, while 21 radical surgery. There was a relationship between characteristics of the cysts and the technique chosen, (p<0.001). Likewise, whenever the diameter was smaller than 10cm or localized in the left lobe a radical technique was used. Conversely, a conservative technique was used when the diameter was bigger than 10 cm or they were localized in the right lobe or complicated by intra-biliary or intra-peritoneal rupture as well as in contiguity with major vascular and biliary structures. In this regard, while the post-operative morbidity was related to the conservative techniques (p<0.004), the relapses tended to not be related to any techniques in our case (p<0.14). In conclusion, in a non hepato-bilio-pancreatic center a radical surgery including liver resection is suggested for left lobe's cysts, while a conservative technique tends to be more effective for right lobe's cysts mainly if complex. Consequently, patients with complicated presentation could explain why conservative treatment causes higher rate of morbidity.

Colonic stenting in acutely obstructed left-sided colon cancer Clinical evaluation and cost analysis.

AIM: This retrospective study aims to evaluate clinical and cost effectiveness of colonic stenting as a bridge to surgery and as a palliative treatment in acutely obstructed left-sided colon cancer. MATERIAL AND METHODS: Onehundred fortyfour patients were collected between 2006 and 2012, with acute left-sided malignant colonic obstruction with no evidence of peritonitis: 96 patients underwent surgical treatment, 48 underwent decompressive stenting. For the stenting we used self-expandable metallic stent in nitinol. RESULTS: Patients who had successful colonic stenting were 40, 8 underwent elective surgery within 10 days, 32 decompression stenting had only palliative intent. in 8/48 patients subjected to stenting decompression there was a technical failure (16%) and underwent emergency surgery. 40 patients had follow-up. at the time of observation 36 patients had a functioning stent, within 10 days 8 underwent elective definitive colonic resection with primary anastomosis trought videolaparoscopic thecnical, 4 (10%) had major complications and underwent emergency surgery. no patient of 40 in the stenting group required defunctioning stomas compared to 38 of 96 in emergency surgery group. we also compared the cost of decompressive stenting and emergency surgery treatment in acutely obstructed left-sided colon cancer referring to average cost of drg (1 and 2 code t-student test). the comparison of the average costs between decompressive stenting and emergency surgery was performed in the group of patients underwent palliative treatment separately from ones underwent radical treatment. CONCLUSION: Colonic stenting followed by elective surgery may be safer and cost-effective, comparing to emergency surgery for left-sided malignant colonic obstruction. KEY WORDS: Bowel obstruction, Colonic cancer, Colonic stenting.