Total mesorectal excision laparoscopic versus transanal approach for rectal cancer: A systematic review and meta-analysis.

INTRODUCTION: Total mesorectal excision (TME) performed for the first time by Held through an open approach, it has become the standard technique for the surgical treatment of rectal cancer. The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME. MATERIAL AND METHODS: In this meta-analysis, we included all comparative studies, prospective and retrospective, which addressed in low and middle rectal cancer, a comparison between TaTME and LaTME. A search was performed through MEDLINE and Cochrane Database. 846 records were identified. RESULTS: Eight relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt. The eight studies including 471 patients with middle or low rectal cancer. CONCLUSION: The meta-analysis confirmed safety of TaTME for low and middle rectal cancer. TaTME can lead to a high quality of rectal cancer resection specimen.

Short-term outcomes after laparoscopic right hemicolectomy for colon cancer: intracorporeal versus extracorporeal anastomosis.

BACKGROUND: The aim of this study was to compare the short-term outcomes of laparoscopic right hemicolectomy between intracorporeal (IA) and extracorporeal (EA) anastomosis techniques. METHODS: A retrospective chart review of 77 consecutive patients who underwent laparoscopic right hemicolectomy from January 2016 to June 2018 was performed. The intracorporeal group included 36 patients and the extracorporeal group 41 patients. RESULTS: Patient demographics and disease-related characteristics were similar. Mean operative time was 152±38.3 minutes in IA vs. 148±34.8 minutes in EA (P=0.664). IA was not associated with less overall postoperative complications and decreased rate of surgical site infections. There was no statistically significant difference in the incidence of postoperative leak, length of stay, mortality in both groups. There was no perioperative difference in median number of lymph node harvested. There was statistically significant difference in the length of larger incision (50 [50-70] mm in IA vs. 80 [70-100] mm in EA; P<0.001), length of the specimen (323±52.7 mm in IA vs. 295±64.7 mm in EA; P<0.05), free tumor margin (113.6±47.4 in IA vs. 75.6±37.4 mm in EA; P<0.001). There was a statistically significant difference in IA in the less postoperative use of analgesics (P<0.032) and return of bowel function (P<0.021). CONCLUSIONS: IA seems feasible and safe; it does not significantly affect the length of surgery, and it guarantees maintenance of radical oncological standards. Furthermore, IA significantly improves cosmesis and patient comfort postoperatively, reducing the rates of emesis, which leads to higher rates of early regular diet tolerance. Therefore, laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short-term outcomes.

Assessment of surgeon communication skills from the patient perspective: A national evaluation using the Communication Assessment Tool.

OBJECTIVE: The Communication Assessment Tool (CAT) has previously been translated and adapted to the Italian context. This national study aimed to validate the CAT and evaluate communication skills of practicing surgeons from the patient perspective. METHODS: CAT consists of 14 items associated with a 5-point scale (5 = excellent); results are reported as the percent of ''excellent'' scores. It was administered to 920 consenting outpatients aged 18-84 in 26 Italian surgical departments. RESULTS: The largest age group was 45-64 (43.8%); 52.2% of the sample was male. Scores ranged from 44.6% to 66.6% excellent. The highest-scoring items were "Treated me with respect" (66.6%), "Gave me as much information as I wanted" (66.3%) and "Talked in terms I could understand" (66.0%); the lowest was "Encouraged me to ask questions" (44.6%). Significant differences were associated with age (18-24 year old patients exhibited the lowest scores) and geographical location (Northern Italy had the highest scores). CONCLUSION: CAT is a valid tool for measuring communication in surgical settings. PRACTICE IMPLICATIONS: Results suggest that expectations of young people for communication in surgical settings are not being met. While there is room to improve communication skills of surgeons across Italy, patients highlighted the greatest need in the Central and Southern regions.

ZnO Polymeric Composite Films for n-Decane Removal from Air Streams in a Continuous Flow NETmix Photoreactor under UVA Light.

Polymeric composite films have been explored for many photocatalytic applications, from water treatment to self-cleaning devices. Their properties, namely, thickness and porosity, are controlled mainly by the preparation conditions. However, little has been discussed on the effect of thickness and porosity of polymeric composite films for photocatalytic processes, especially in gas phase. In the present study, different preparation treatments of ZnO-based polymeric composite films and their effects on its performance and stability were investigated. The polymeric composites were prepared by solution mixing followed by non-solvent induced phase separation (NIPS), using poly(vinylidene fluoride) (PVDF) as the matrix and ZnO-based photocatalysts. Different wet thickness, photocatalyst mass, and treatments (e.g., using or not pore-forming agent and compatibilizer) were assessed. A low ZnO/PVDF ratio and higher wet thickness, together with the use of pore-forming agent and compatibilizer, proved to be a good strategy for increasing photocatalytic efficiency given the low agglomerate formation and high polymer transmittance. Nonetheless, the composites exhibited deactivation after several minutes of exposure. Characterization by XRD, FTIR-ATR, and SEM were carried out to further investigate the polymeric film treatments and stability. ZnO film was most likely deactivated due to zinc carbonate formation intensified by the polymer presence.

Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery.

INTRODUCTION: The incidence of anastomotic leak (AL) has not decreased over the past decades and some important grey areas remain in its definition, prevention, and management. The aim of this study was to reach a national consensus on the definition of AL and to identify key points to be applied in clinical practice. METHODS: A 3-step modified Delphi method was used to establish consensus. Ten representative members of the major Italian surgical scientific societies with proven colorectal expertise were selected after a call to action. After a comprehensive literature search, each expert drew a list of evidence-based statements which were voted in round one by the scientific board. Panel members were asked to mark "totally disagree", "partially agree" or "totally agree" for each statement and provide comments. The same voting method was used for round 2. Round 3 consisted of a final face-to-face meeting. RESULTS: Thirty-three statements (clustered into 14 topics) were included in round 1. Following the third voting round, a final list of 16 items was formulated, which encompass the following 9 topics: AL definition, patient- and operative-related risk factors, prevention measures, bowel preparation, surgical technique, intraoperative assessment, early diagnosis, radiological diagnosis and management of specific patterns of AL. The overall response rate was 100% for all items in all the three rounds. CONCLUSIONS: This Delphi survey identified items that expert colorectal surgeons agreed were important to be applied in the prevention, diagnosis, and management of AL. This represents the first consensus involving all relevant national scientific societies, defining important and shared concepts in the diagnosis and management of AL.

A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2.

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.

Seudoartrosis atrófica: Efecto de la aplicación de ondas de choque extracorpóreas en un modelo experimental en tibia de conejos / Atrophic pseudoartrosis. Effect of extracorporeal shock waves application in an experimental model in tibia of rabbits

Introducción: Los efectos de las ondas de choque extracorpóreas se han investigado en osteoblastos humanos, focos fracturarios, seudoartrosis y células periósticas. Los mejores resultados del tratamiento de la seudoartrosis con ondas de choque extracorpóreas se han documentado para seudoartrosis hipertróficas. El objetivo de este estudio fue investigar el efecto de la terapia con ondas de choque extracorpóreas sobre un foco de seudoartrosis "atrófica" generado en tibia de conejo. Métodos: Se establecieron tres grupos: A, fracturados sometidos a ondas de choque extracorpóreas; B ("control"), fracturados no sometidos a ondas de choque y C, no fracturados (pierna derecha). Se trataron 37 conejos (cuniculus NV) blancos y esqueléticamente maduros de Nueva Zelanda. Se practicó la cauterización del periostio con electrobisturí bipolar en una extensión de 20 mm, en ambos muñones óseos (proximal y distal). Luego se aplicaron ondas de choque extracorpóreas en una sola sesión. Se realizaron tinciones con hematoxilina-eosina. Se efectuó el análisis biomecánico con un método de carga a "3 puntos". Se estudiaron la carga máxima aplicada y el módulo de elasticidad para cada grupo. Resultados: El estudio histológico permitió registrar signos de consolidación -callo fracturario perióstico y endostal- considerablemente mayores en las tibias de los animales del grupo A (tratado con ondas de choque extracorpóreas) que en las del grupo B "control". Conclusión: En un modelo experimental original de seudoartrosis atrófica generada por electrocauterización en tibia de conejos, se registraron cambios significativos radiográficos e histológicos luego de la intervención del foco mediante ondas de choque extracorpóreas. Nivel de Evidencia: II

Introduction: The effects of extracorporeal shock wave therapy (ESWT) have been investigated in human osteoblasts, fracture foci, nonunion and periosteum cells. The best results of nonunion treatment with ESWT have been documented for hypertrophic type. The objective of this study was to investigate the effects of ESWT in an atrophic nonunion focus generated in a rabbit tibia model. Methods: Three groups were included: A, fractures receiving ESWT; B ("control"), fractures not receiving ESWT, and C, no fractures (right leg). A total of 37 New Zealand white and skeletally mature rabbits (cuniculus NV) were treated. Periosteum was cauterized using bipolar electrocautery at 20 mm in both bone stumps (proximal and distal). Then ESWT was applied in one session. Staining with hematoxylin-eosin was used. A biomechanical analysis with a 3-point loading system was performed. Maximum load and elastic modulus were evaluated in each group. Results: Histological study evidenced signs of union (periosteal and endosteal fracture callus) which were considerably larger in tibias of Group A (treated with ESWT) as compared to the control group (Group B). Conclusion: In an experimental model of atrophic pseudarthrosis caused by electrocautery in tibias of rabbits, significant radiographic and histological changes were observed after focus intervention with the application of ESWT. Level of Evidence: II

IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments.

BACKGROUND: In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. METHODS: IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. RESULTS: Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. CONCLUSIONS: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.

Non-irradiated frozen structural allograft in reconstructive surgeries of the hindfoot and midfoot.

BACKGROUND: A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. METHODS: We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications. RESULTS: We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen. CONCLUSION: This treatment is a good option to treat severe defects or fill sequelae deformities.

The SIC-GIRCG 2013 Consensus Conference on Gastric Cancer.

The topic chosen by the Board of the Italian Society of Surgery for the 2013 annual Consensus Conference was gastric cancer. With this purpose, under the direction of 2 chairmen, 36 experts nominated by the Regional Societies of Surgery and by the Italian Research Group for Gastric Cancer (GIRCG) participated in an experts consensus exercise, preceded by a questionnaire and mainly held by telematic vote, in accordance with the rules of the Delphi method. The results of this Consensus Conference, presented to the 115th National Congress of the Italian Society of Surgery, and approved in plenary session, are reported in the present paper.

Estudio comparativo de la fijación percutánea dorsal de las fracturas de escafoides con y sin asistencia artroscópica, y su infuencia en el pronóstico / Comparative study in percutaneous fixation of scaphoid fractures with and without arthroscopic assistance, and its infuence on prognosis

Introducción: la fractura de escafoides es la más frecuente entre las fracturas del carpo. Su tratamiento puede ser conservador o quirúrgico. Este último ofrece una gama de opciones: la reducción abierta y la fijación interna, la osteosíntesis percutánea y la osteosíntesis percutánea bajo asistencia artroscópica. La asociación de lesiones ligamentarias intracarpianas detectadas en la artroscopía es frecuente. El objetivo del presente trabajo consiste en analizar una serie de casos, procurando determinar si dichas lesiones diagnosticadas mediante asistencia artroscópica son responsables de una evolución subóptima cuando no son tratadas. Materiales y Métodos: se evaluaron 71 pacientes con fracturas de escafoides tratados mediante osteosíntesis percutánea. Cuarenta y cuatro cumplieron con los criterios de inclusión. Se compararon de forma retrospectiva 2 grupos tratados mediante osteosíntesis percutánea con asistencia artroscópica y sin ella. Resultados: los pacientes tratados mediante asistencia artroscópica tuvieron un mayor porcentaje de resultados funcionales más satisfactorios que los tratados sin asistencia artroscópica, expresado por un resultado estadísticamente significativo (p < 0,05). Discusión: hay muchos casos de fracturas de escafoides tratados adecuadamente mediante osteosíntesis que determinan una “muñeca dolorosa con radiografía normal”. No se ha determinado hasta el momento si las lesiones ligamentarias asociadas a estas fracturas determinen una evolución menos favorable cuando no son tratadas precozmente. A pesar del número poblacional reducido del grupo control, se identificó que la mejor evolución en el grupo tratado mediante asistencia artroscópica representa una diferencia estadísticamente significativa. Conclusión: el diagnóstico oportuno y el tratamiento temprano de...

Background: scaphoid fracture is the most common among carpal fractures. Treatment may be conservative or surgical, that offers a range of options: open reduction and internal fixation, percutaneous osteosynthesis and percutaneous fixation under arthroscopic assistance. The association of intracarpal ligament injuries detected by arthroscopy is common. The aim of this study is to analyze a series of cases to determine whether these lesions diagnosed by arthroscopic assistance are responsible for a suboptimal evolution when untreated. Materials and Methods: we evaluated 71 patients with scaphoid fractures treated by percutaneous osteosynthesis. Forty four met the inclusion criteria. We compared retrospectively two groups treated by percutaneous osteosynthesis with and without arthroscopic assistance. Results: patients treated with arthroscopic assistance had a greater percentage of satisfactory functional outcomes than those treated without arthroscopic assistance, expressed by a statistically significant result ( p < 0,05 ). Discussion: there are many cases of scaphoid fractures treated properly by osteosynthesis than determine a “painful wrist with normal radiograph”. It has not been determined so far if ligament injuries associated with these fractures determine a less favorable prognosis if not treated early. Despite the small population size of the control group, it was found that the improved performance in the group treated with arthroscopic assistance represents a statistically significant difference. Conclusion: early diagnosis and early treatment of intracarpal ligament injuries associated with scaphoid fractures using arthroscopic assistance establish a more favorable clinical outcome in the medium term. Study Design: Comparative Retrospective. Level of evidence: III.

End-stage achalasia in a patient with neurofibromatosis treated with laparoscopic Heller myotomy.

Achalasia is an esophageal motility disorder for which the pathophysiology is only partially known for the idiopathic subtype. Many factors are known to be involved with the development of secondary achalasia. Neurofibromatosis is one of the most common autosomal dominant conditions affecting the nervous system, and 25% of those with the disease have been reported to have involvement of the gastrointestinal tract. Three cases of association between neurofibromatosis and achalasia have been reported in the literature so far. Laparoscopic Heller myotomy is the gold standard surgical treatment for patients with achalasia, whereas esophagectomy is reserved for the more advanced stages of disease. There have been reports of successful long-term results in patients with stage IV achalasia treated with Heller myotomy. We report the fourth case in the literature of association between achalasia and neurofibromatosis; it is the first time that such an association is successfully treated with laparoscopic Heller myotomy.

Asociación entre los defectos del cementado femoral y los valores de la presión arterial media / Association between femoral cementation defects and mean arterial pressure values

Introduccion: Se ha demostrado que la disminución dela presión arterial media (PAM) produce un efectohemostático en el conducto endomedular. En relación con la calidad del cementado en las artroplastias, no se han hallado publicaciones que correlacionen in vivo los valores de PAM y los defectos de cementación. Se diseñó un estudio de corte transversal de correlación con el objetivo de investigar la posible asociación entreestos dos factores. Materiales y métodos: Se seleccionaron 56 pacientes sometidos a artroplastias primarias de cadera, de acuerdo con un muestreo por conveniencia. Los valores de presión arterial media durante el cementado se obtuvieron mediante la revisión de los monitoreos anestésicos intraoperatorios. Se consideraron defectos de cementado las burbujas y radiolucencias presentes en la interfaz hueso-cemento. Se efectuaron cálculos de regresión con el método de Spearman entre ambas variables. Resultados: La cantidad de burbujas encontradas por región femoral no se correlacionó con la PAM, R2 = 0,02 (p > 0,05). Se observó una asociación estadísticamente significativa entre la mayor cantidad de radiolucencias en el manto de cemento y los mayores valores de PAM, R2 = 0,7 (p < 0,05). Conclusiones: Se ha logrado establecer una correlación lineal entre la aparición de defectos del cementado en forma de radiolucencias y los valores de la PAM. En cuanto a los defectos denominados burbujas, no seobservó tal correlación.(AU)

Asociación entre los defectos del cementado femoral y los valores de la presión arterial media / Association between femoral cementation defects and mean arterial pressure values

Introduccion: Se ha demostrado que la disminución dela presión arterial media (PAM) produce un efectohemostático en el conducto endomedular. En relación con la calidad del cementado en las artroplastias, no se han hallado publicaciones que correlacionen in vivo los valores de PAM y los defectos de cementación. Se diseñó un estudio de corte transversal de correlación con el objetivo de investigar la posible asociación entreestos dos factores. Materiales y métodos: Se seleccionaron 56 pacientes sometidos a artroplastias primarias de cadera, de acuerdo con un muestreo por conveniencia. Los valores de presión arterial media durante el cementado se obtuvieron mediante la revisión de los monitoreos anestésicos intraoperatorios. Se consideraron defectos de cementado las burbujas y radiolucencias presentes en la interfaz hueso-cemento. Se efectuaron cálculos de regresión con el método de Spearman entre ambas variables. Resultados: La cantidad de burbujas encontradas por región femoral no se correlacionó con la PAM, R2 = 0,02 (p > 0,05). Se observó una asociación estadísticamente significativa entre la mayor cantidad de radiolucencias en el manto de cemento y los mayores valores de PAM, R2 = 0,7 (p < 0,05). Conclusiones: Se ha logrado establecer una correlación lineal entre la aparición de defectos del cementado en forma de radiolucencias y los valores de la PAM. En cuanto a los defectos denominados burbujas, no seobservó tal correlación.

Ruptura del tendon rotuliano en deportistas: tratamiento con anclajes oseos / Patellar tendon ruptures in sports: treatment with suture anchors as a fixation method

Introducción: Las rupturas del tendón patelar son lesiones que afectan principalmente a pacientes jóvenes y deportistas menores de 40 años. El objetivo del presente trabajo es describir la técnica y analizar los resultados funcionales del tratamiento de las lesiones del tendón rotuliano en deportistas utilizando anclajes óseos como método de fijación. Materiales y métodos: Se evaluó una serie de 10 pacientes con ruptura del tendón patelar tratados entre junio de 2004 y junio de 2007. En todos los casos se usaron anclajes óseos. La edad media de los pacientes fue de 31,8 años al momento de la cirugía. Todas las lesiones fueron traumáticas. El seguimiento promedio fue de 24 meses (18-48). El protocolo de diagnóstico por imágenes comprendió radiografias y RNM. Se documentaron las lesiones asociadas y la evaluación funcional fue mediante la escala de Lysholm y el formulario IKDC. Resultados: Se hallaron lesiones asociadas en 7 de 10 casos. El valor promedio posoperatorio en la escala de Lysholm fue de 92 puntos (84-100) Y en cuanto al IKDC, el 100% de las rodillas fueron consideradas normales o casi normales. Un paciente necesitó de limpieza quirúrgica por hematoma postoperatorio. Conclusiones: La técnica descripta ha resultado técnicamente sencilla habiéndose obtenido resultados clínicos excelentes. En opinión de los autores se justifica considerarla opción válida en el tratamiento de las lesiones traumáticas del ligamento patelar.

Ruptura del tendon rotuliano en deportistas: tratamiento con anclajes oseos / Patellar tendon ruptures in sports: treatment with suture anchors as a fixation method

Introducción: Las rupturas del tendón patelar son lesiones que afectan principalmente a pacientes jóvenes y deportistas menores de 40 años. El objetivo del presente trabajo es describir la técnica y analizar los resultados funcionales del tratamiento de las lesiones del tendón rotuliano en deportistas utilizando anclajes óseos como método de fijación. Materiales y métodos: Se evaluó una serie de 10 pacientes con ruptura del tendón patelar tratados entre junio de 2004 y junio de 2007. En todos los casos se usaron anclajes óseos. La edad media de los pacientes fue de 31,8 años al momento de la cirugía. Todas las lesiones fueron traumáticas. El seguimiento promedio fue de 24 meses (18-48). El protocolo de diagnóstico por imágenes comprendió radiografias y RNM. Se documentaron las lesiones asociadas y la evaluación funcional fue mediante la escala de Lysholm y el formulario IKDC. Resultados: Se hallaron lesiones asociadas en 7 de 10 casos. El valor promedio posoperatorio en la escala de Lysholm fue de 92 puntos (84-100) Y en cuanto al IKDC, el 100% de las rodillas fueron consideradas normales o casi normales. Un paciente necesitó de limpieza quirúrgica por hematoma postoperatorio. Conclusiones: La técnica descripta ha resultado técnicamente sencilla habiéndose obtenido resultados clínicos excelentes. En opinión de los autores se justifica considerarla opción válida en el tratamiento de las lesiones traumáticas del ligamento patelar.(AU)

Hepatic artery pseudoaneurysm treated using stent-graft implantation and retrograde gastroduodenal artery coil embolization.

Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed.