Side-to-Side Anastomosis In Left Hemicolectomy, Why and When: A Single-Center Experience.

BACKGROUND: Laparoscopic colectomy represents a safe, effective and well-established procedure for both benign and malignant colic disease. Transanal anastomosis (TA) with a circular stapler is the most commonly performed anastomotic technique in laparoscopic left hemicolectomy (LLH). We report our experience with side-to-side anastomosis (STSA) and side-to-end anastomosis (STEA) in selected patients with both emergency and elective LLH. METHODS: A systematic review of the PubMed database was performed on recent studies that compared different anastomotic techniques after LLH. We collected internal data from June 2014 to July 2018 and compared our experience with the literature. The primary outcome was the anastomotic complication rate. RESULTS: During the observation period, 158 patients underwent left hemicolectomy (LH). One-hundred-nineteen patients had malignant disease; 36 underwent surgery for complicated diverticular disease, one had a large strangulated incisional hernia, one had a sigmoid volvulus, and one had a sigmoid localization of endometriosis. Thirty open left hemicolectomies were performed. In 128 cases, a minimally invasive approach was used. Since conversion to open was necessary in 10 of these cases, 118 were totally LLH. STSA was performed in 64 cases; seven in an emergency setting and 57 in elective procedures. The overall anastomotic leak rate was 3.1% (2/64) and no anastomotic leak was reported in the emergency group (0/7). TA was performed in 15 cases, 93% in an elective setting (14/15), and the anastomotic leak rate was 13.3% (2/15). In 20 cases, we performed elective STEA and no anastomotic leak was recorded. In 19 cases, it was impossible to perform anastomosis and we decided to create a definitive colostomy. CONCLUSION: Consistent with the literature data, our experience shows that, in selected cases, STSA and STEA are both safe and effective, with a lower anastomotic complication rate than TA.

Intracorporeal Anastomosis in Both Elective and Emergency Right Hemicolectomy: Our Experience.

PURPOSE: The aim of this study was to examine whether intracorporeal anastomosis (IA) after laparoscopic right hemicolectomy (LRH) is a safe procedure in both emergency and elective settings. METHODS: A retrospective review of all consecutive adult patients (age > 17 years) who underwent LRH from November 2014 to May 2018 at S. Andrea Hospital, La Spezia, was performed. The primary and secondary outcomes were the anastomotic leak rate and the operative time, respectively. Both IA and extracorporeal anastomosis (EA) were performed according to standardized techniques by the same team of experienced surgeons. Our findings were compared to literature data on recent studies comparing IA and EA during LRH. RESULTS: During the observation period, 167 patients underwent RH at our institution: IA was performed in 115. The mean age was 73.5 y. Thirty-three RH were performed in an emergency setting: 15 laparotomic procedures, 3 conversions from laparoscopic to open, 6 laparoscopic-assisted with EA, and 9 complete IA. The remaining 134 patients underwent elective RH: IA was performed in 106. The overall anastomotic leak rate in LHR IA was 2.6% (3/115), and no anastomotic leak was reported in the emergency group (0/9). The mean operative time was 180 min. In our experience, the operative time is related to the surgeon's experience and confidence with the technique, and not to the anastomosis technique per se. CONCLUSION: Consistent with the literature data, IA in LRH was associated with better outcomes than EA in both elective and emergency settings.

Single-stage laparoscopic adrenalectomy for pheochromocytoma and enucleation of a pancreatic neuroendocrine tumor in Von Hippel-Lindau disease: A case report.

Von Hippel-Lindau (VHL) disease is an inherited syndrome with autosomal-dominant transmission, characterized by central nervous system and retinal hemangioblastomas, visceral cysts and tumors. Optimal surgical treatment, including its timing, remains a controversial topic. The present study reports the case of a 67-year-old female patient with adrenal and pancreatic manifestations of VHL. A laparoscopic cortex-sparing left adrenalectomy for a 4-cm pheochromocytoma and pancreatic enucleation for pancreatic polypeptidoma of the pancreas tail were performed during the same operative procedure. The total operative time was 240 min. There were no operative complications, and the surgery was completed laparoscopically with minimal blood loss. A prolonged hospital stay was necessary to treat a grade C postoperative pancreatic fistula. The histopathological result was an adrenal pheochromocytoma and a well-differentiated neuroendocrine tumor, secreting pancreatic polypeptides. In conclusion, organ-sparing laparoscopic surgery is an important option for treating simultaneous lesions in several abdominal solid viscera, such as VHL disease, and the present case study represents, to the best of the authors' knowledge, the first report of single-stage laparoscopic adrenalectomy and pancreatic tumor enucleation.

Congenital internal hernia through defect in the falciform ligament in adult: A case report and review of the literature.

INTRODUCTION: The incidence of occlusion syndrome caused by internal hernia is very rare, in particular when the defect is congenital discovered in adults with no previous abdominal surgery. PRESENTATION OF CASE: We present a case of a 31 year-old female patient who presented with acute abdominal pain and mechanical obstruction. The patient had never undergone abdominal surgery. DISCUSSION: On diagnostic laparoscopy, it was found a herniation of a loop of small bowel through a hole in the falciform ligament. The obstruction was solved by the division of part of falciform ligament without intestinal resection. CONCLUSION: Internal hernia is a very uncommon pathology, most often discovered in pediatric age because of congenital abnormalities, it must be included in the differential diagnosis in adults. Preoperative diagnosis is difficult. The diagnostic laparoscopic approach has shown to be the best.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy. CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli. CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

Stapled Mesh Reinforcement Technique (SMART) to Prevent Parastomal Hernias: Our Initial Experience and Review of the Literature.

Parastomal hernia is one of the most common stoma related complication, with the correlated risk of incarceration, obstruction, and strangulation. The incidence is high (30-50%) and depends on the length of follow up. Different surgical options for repairing are defective with a 25-70% failure and recurrence rate. Prevention of parastomal hernia with mesh reinforcement seems to be effective. Three available trials are recruiting patients: Prism (with matrix porcine prothesis), Prevent (with preperitoneal polypropylene mesh), and the stapled polypropylene mesh stoma reinforcement technique (SMART). We performed the SMART procedure in six patients undergoing definitive colostomy. Our cases show that the procedure is rapid (duration range 15-20 minutes), cost effective (500 euro), and safe (in our experience, there are no post-surgical complications that are procedure-related). A long term follow-up and a higher number of patients will give us confirmation of the initial hopeful results.

Gastrointestinal bleeding as presentation of small bowel metastases of malignant melanoma: Is surgery a good choice?

INTRODUCTION: Melanoma shows a particular predilection in involving small intestine both in a single site and in multiple localization and acute or chronic gastrointestinal bleedings are often the first sign of tumour. PRESENTATION OF CASE: We report two cases of GI metastases of malignant melanoma, one presented with only a big mass that cause intestinal obstruction and the other with a tumour spread throughout the small intestine that produce enterorrhagia. DISCUSSION: Diagnosis and follow-up are very difficult: CT scan, PET-CT scan and capsule endoscopy should be complementary for the assessment of patients with GI symptoms and melanoma history. CONCLUSION: What is the role of surgery? Several studies suggest metastasectomy to achieve both R0 results and palliative resolutions of acute symptoms, such as obstruction, pain, and bleeding.