Laparoscopic colon and rectal resections with intracorporeal anastomosis and trans-vaginal specimen extraction for colorectal cancer. A case series and systematic literature review.

PURPOSE: Intracorporeal anastomosis associated to trans-vaginal specimen extraction decreases the extent of colon mobilisation and the number and size of abdominal incisions, improving the benefits of minimally invasive surgery in female patients. The aim of this study was to evaluate the safety and effectiveness of this procedure for colorectal cancer. METHODS: Between 2009 and 2013, 13 female patients underwent laparoscopic colon and rectal resection for colorectal cancer with intracorporeal anastomosis and trans-vaginal specimen extraction: 2 right colectomies, 1 transverse colon resection, 4 left colectomies and 6 anterior resections were performed. A MEDLINE search of publications on the presented procedure for colon neoplasms was carried out. RESULTS: There were no intraoperative complications and no conversions. Postoperative visual analogue scale (VAS) score in the pelvis, abdomen and shoulder was moderate. In the postoperative period, we observed two colorectal anastomotic strictures, successfully treated with pneumatic endoscopic dilation. Median length of the specimen was 18.5 cm, with a median tumour size of 5.5 cm in diameter. Median number of retrieved lymph nodes was 12. All circumferential resection margins were negative. During a mean follow-up of 31 months (range, 6-62), there was neither evidence of recurrent disease nor disorders related to the genitourinary system. The aesthetic outcome was considered satisfactory in all patients. Nine studies were identified in the systematic review. CONCLUSIONS: Our case series, according to the results of the literature, showed that intracorporeal anastomosis associated to trans-vaginal specimen extraction is feasible and safe in selected female patients.

Incisional hernia: laparoscopic or open repair?

PURPOSE: To compare laparoscopic and open repair of incisional hernia in terms of complications and failure rates. METHODS: Between June 2005 and April 2012, 252 patients underwent incisional hernia repair. Of these, 126 underwent laparoscopic and 126 open repair. The median follow-up was 38.7 months. RESULTS: Baseline characteristics [age, body mass index, American Society of Anesthesiologists (ASA) score, comorbidities, hernia size, and follow-up] did not differ significantly. Mean operative time was similar (72 vs. 83 min). Laparoscopic repair was associated with less postoperative pain, less postoperative complications (3.9% vs. 13.4%, P=0.012), and shorter hospital stay (3.5 vs. 4.3, P=0.002). Recurrence occurred in 6 patients of group 1 and in 7 patients of group 2 (4.7% vs. 5.5%, P=not significant). CONCLUSIONS: In this study, the trend in favor of laparoscopic treatment for incisional hernias is remarkable. Fewer postoperative complications and shorter hospital stay with similar operative time may balance the higher costs associated with the technique.

[Cavernous haemangioma of the lung: a case report and review of the literature]. / Emangioma cavernoso del polmone: caso clinico e revisione della letteratura.

Cavernous haemangioma is a rare benign vascular tumour rarely seen in the lung. A 73-year-old male complaining of haemoptysis and dyspnoea, with a solitary nodule of the left lower pulmonary lobe, underwent left lower wedge resection. Pathology showed a 3 cm cavernous haemangioma. One year later symptoms recurred and CT showed a second nodule in the left upper lobe. Upper left lobectomy was performed, confirming the diagnosis of cavernous haemangioma. There are less than 25 case reports of this type of tumour in the literature. Radiological findings usually show a single pulmonary nodule. The preoperative diagnosis is quite difficult because pulmonary biopsy is often non-diagnostic. Standard treatment is complete surgical resection. For asymptomatic patients a brief period of observation is suggested.