Total pancreatectomy: doing it with a mini-invasive approach.

OBJECTIVE: Pancreatic laparoscopic surgery represents one of the most discussed and demanding fields in surgery. Total pancreatectomy is considered to a viable option for treating both benign and malignant pathologies of the pancreas and, thanks to the introduction of laparoscopic techniques for pancreatic resections into clinical practice, it can be performed nowadays with a less invasive approach. CASE REPORT: We report the case of a combined total pancreatectomy, consisting of a totally laparoscopic body-tail mobilization followed by the opening of a right subcostal mini-laparotomy in order to perform a pancreaticoduodenectomy and a reconstructive phase. DISCUSSION: This technique represents the result of experience acquired in the last decade in the field of advanced laparoscopic pancreatic surgery. It consists of a widely accepted laparoscopic splenopancreatectomy and of a traditional pancreaticoduodenectomy which nowadays is considered safer and less time-consuming than the experimental laparoscopic one.

Neuromuscolar and vascular hamartoma of the duodenum. A clinical case and review of the literature.

BACKGROUND AND AIMS: The NMVH of the intestine is a rare lesion, typical located in the small bowel. After the first 2 cases, reported in 1982, other 12 cases have been described, ten localized in the jejunual or ileal tract, only 1 in the cecum. SUBJECTS AND METHODS: A case of NMVH of the duodenum, simulating a Crohns disease, is described. The lesion extended about 12 cm. and it caused intestinal stenosis. The microscopic analysis on the operative specimen highlighted the presence of a neuronal hyperplasia at mucous membranae and submucosal levels, associated to muscolaris mucosae hypertrophy and disorganisation. Expanded and ectasic veins, proliferation of nervous fibres and ganglion cells in the submucosal were also observed. RESULTS: NMVH is a non-epithelial hamartomatous, submucosally based proliferation of mature submucosal elements capable of causing small bowel obstruction. In the controversy about the nature of the NMVH, we consider it a separate entity, where the final diagnosis depend on the clinicopathologic setting, as well as on the location and number of the lesions. CONCLUSIONS: The Authors analyse the main characteristics of this rare pathology with regard to clinical, diagnostic and therapeutic aspects.

[Mesenteric fibromatosis]. / La fibromatosi mesenterica.

Mesenteric fibromatosis is a rare benign mesenteric tumour, characterised by infiltrative growth and high rates of recurrence. Histological examination is the only diagnostic procedure capable of ruling out a malignant mesenteric neoplasm. It is not always possible to perform a radical removal of the tumour mass because it may have infiltrated important anatomical structures. In the present study the Authors report two cases of mesenteric fibromatosis and analyse the main clinical-diagnostic, therapeutic and prognostic problems posed by these tumours.

Pancreatic metastases: observations of three cases and review of the literature.

BACKGROUND: The aim of the study is to analyze pancreatic metastases and their clinical, radiological, therapeutic and prognostic features. METHODS: Three cases of pancreatic metastases observed and a world literature review of 333 cases were recorded. RESULTS: Pancreatic metastases are due more frequently to renal cell carcinoma; they are usually metachronous and characterized by a long period of time between the resection of the primary tumor and their detection. The differential diagnosis with other pancreatic masses is difficult, but an accurate anamnesis, some peculiar findings of imaging techniques and percutaneous fine needle aspiration could allow preoperative diagnosis. Pancreatic resections are the treatment of choice allowing the better palliation and improving survival. 150/234 pancreatic metastases underwent pancreatic resections (resectability index = 64.1%); 88/132 patients are alive with a mean follow-up of 27.1 months; of the 44 dead patients the mean survival time was 21.3 months. Among pancreatic metastases the primary tumor with better prognosis is renal cell carcinoma. CONCLUSION: Pancreatic metastases are rare; their preoperative diagnosis is difficult but useful and possible. Surgical resection is suggested because the patient still may have a prolonged survival.