Hyperthermic Intraperitoneal Chemotherapy with Mitomycin C versus Oxaliplatin after Cytoreductive Surgery for the Treatment of Peritoneal Metastases of Colorectal Cancer Origin.

Background: Mitomycin C and oxaliplatin are considered the main chemotherapeutic agents used in the context of hyperthermic intraperitoneal chemotherapy (HIPEC) after the performance of cytoreductive surgery for peritoneal metastases of colorectal cancer origin. However, there is lack of a generally accepted consensus regarding the optimal choice between them as upfront chemo-therapetic agent. Our paper aims to summarize in a comprehensive manner the available evidence, while individualised schemes with targeted therapies are under development. Methods: We conducted a comprehensive, narrative review of the literature including all previous studies until 03/2022, which reported perioperative and/ or oncological outcomes after the use of mitomycin C and/ or oxaliplatin as main hyperthermic chemotherapy agents after cytoreductive surgery for colorectal peritoneal metastatic disease. Results: Data from a total of 23 single-agent and 13 comparative studies were included in our review. Despite the demonstrated safety profile of both chemotherapeutics, the heterogeneity of the included studies, their retrospective nature and the absence of relevant randomized trials prohibits the drawing of safe conclusions regarding the superiority of one of the two agents. However, it seems that perioperative morbidity is less with oxaliplatin-based HIPEC, while mitomycin C appears as a more cost-effective option. Conclusions: Selection of the optimal intraperitoneal chemotherapy agent for peritoneal metastases of colorectal cancer origin after the completion of cytoreductive surgery is still a matter of debate, with significant institutional variation. Further randomized clinical trials between the two commonest HIPEC agents are required, assessing the differences in perioperative outcomes, oncological outcomes, healthcare-associated costs and patientsâ?? quality of life.

The Aftermath of Bariatric Surgery: Can the Average Emergency Surgeon Deal with Its Complications? Comment on Zawadzka et al. Current Knowledge and Perceptions of Bariatric Surgery among Diabetologists and Internists in Poland. J. Clin. Med. 2022, 11, 2028.

We read with great interest the article by Zawadzka et al. [...].

Patient Transfer with Kocher Forceps on the Axillary Artery: A Rare Case of Ongoing Iatrogenic Vascular Injury.

Iatrogenic trauma of the axillary artery by non-vascular surgeons can occur during various general surgical procedures such as resection of soft tissue tumors or axillary lymph node clearance. Prompt recognition, appropriate initial management, and rapid transfer to a tertiary vascular surgery service, if needed, are key steps to ensuring patient safety. Here we present a case of iatrogenic axillary artery injury during the resection of a recurrent soft tissue tumor in a local hospital. The desperate application of a Kocher clamp on the bleeding axillary artery by the operating general surgeons controlled the bleeding but led to further arterial damage. The patient was transferred to our tertiary hospital, where the arterial injury was repaired using a vein interposition graft. Apart from the encountered intraoperative technical challenges, this case highlights the need for broader training of nonvascular specialist surgeons on the core principles of basic vascular surgical techniques and oncovascular surgery.

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept.

Introduction: Post-cholecystectomy choledocholithiasis can occur from retained stones at the cystic duct stump remnant; however, most surgeons would not proceed with extensive dissection of the cystic duct during routine cholecystectomy, mainly in fear of inadvertent bile duct injuries, given the frequent anatomical variations of the extrahepatic biliary tree. Aim: To determine the need and feasibility of extensive dissection of the cystic duct during laparoscopic cholecystectomy, to reduce the risk of post-cholecystectomy choledocholithiasis. Material and methods: We performed a retrospective review of our institutional database of all patients who had magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy over a 3-year period (03/2016-04/2019), assessing the anatomical variations of the cystic duct and the incidence of cystic duct stones. Results: During the study period, from a total of 763 patients who underwent cholecystectomy for symptomatic gallstones, 284 had undergone pre-operative MRCP and were all included in the final analysis. The typical right lateral insertion of the cystic duct in the midpoint between the confluence of the main hepatic ducts and the ampulla of Vater was identified in less than 50% of the patients. In our series, cystic duct stones were present only in 1.8% of our patients. Conclusions: The presence of significant anatomical variations and the low likelihood of incidental cystic duct stones render prophylactic extensive dissection of the cystic duct during standard laparoscopic cholecystectomy a rather unnecessary and probably hazardous step.

Adjunct internal iliac artery procedures in the context of endovascular abdominal aortic aneurysm repair: anything to stress on the consent form?

Adjunct internal iliac artery (IIA) procedures, such as preoperative embolisation or coverage with iliac branch extensions, are not infrequent in the context of endovascular repair of abdominal aortic aneurysms. Moreover, on many occasions, these procedures are performed in a multi-stage approach by interventional radiologists prior to the main operation. Bearing in mind the potential complications of IIA occlusion when revascularization is not initially deemed necessary, various issues arise spanning from appropriate patient counselling to medicolegal consequences. Herein, we aim to provide a roadmap regarding appropriate patient consenting, highlighting the need for multidisciplinary approach of these patients.

Surgical and pharmaceutical treatment of superficial vein thrombosis of the lower limbs: what has changed over the last 5 years?

INTRODUCTION: Superficial vein thrombosis of the lower limbs is a common condition encountered by a wide spectrum of clinical specialties. In contrast to deep vein thrombosis of the lower limbs though, there is significant variability in terms of its treatment with respect to the type and duration of pharmacotherapy, as well as regarding the potential role of operative management. METHODS: Systematic review of the literature in a best evidence topic manner, including only prospective and randomized controlled studies on the treatment of lower limb SVT, focusing on the emerged data over the last 5 years. RESULTS: A total of 17 prospective observational and randomized clinical studies met our set criteria. Despite the major differences in study designs, outcomes and intervention types, upfront pharmaceutical treatment with fondaparinux or intermediate dose of low molecular weight heparins, combined with regular clinical and radiological follow-up, seem to be effective and safe as first-line approaches. Upfront surgical treatment of lower limb SVT can also be safely performed in selected cases in the presence of clinical expertise. CONCLUSIONS: Our review revealed the presence of considerable variability in the therapeutic options of the lower limb superficial venous thrombosis, highlighting the need for further randomized controlled trials in the field in order to establish and standardize its optimal treatment.

Complete agenesis of the infra-renal aorta.

Complete agenesis of the infra-renal aorta is an extremely rare anatomical variant, and its presence can complicate the accurate interpretation of the aortic sonographic assessment.

Iatrogenic tibial arteriovenous fistula after Fogarty balloon catheter graft thrombectomy.

A 75-year-old male presented with an immediately threatened grade IIb acute ischemia of the left leg due to thrombosis of a femoro-infrapopliteal prosthetic bypass graft. After an urgent Computed Tomography Angiography, an urgent graft thrombectomy was performed using a 5 Fr Fogarty catheter, which had a troublesome distal passage, causing a tibial A-V fistula.

Intestinal stenosis of Garré following emergency ventral hernia repair.

Intestinal stenosis of Garré can occur as a result of prolonged ischemia after all types of hernia surgery.

Single-centre experience of emergency hernia surgery during COVID-19 pandemic: a comparative study of the operative activity and outcomes before and after the outbreak.

Aim The outbreak of COVID-19 pandemic in January 2020 affected largely the elective operating for non-urgent surgical pathologies, such as hernias, due to periodical cancellations of the operating lists on a worldwide scale. To the best of our knowledge, the long-term impact of the COVID-19 pandemic in relation to the emergency hernia surgery operative workload and postoperative outcomes remains largely unknown. Methods Retrospective research of admission, operation and inpatient records of all patients who underwent emergency surgery over a 2-year period (2019-2020) was done. Results An 18% increase in terms of emergency hernia surgery operating volume, with a 23% increase of visceral resections due to unsalvageable herniated content strangulation was found. Overall morbidity did not increase during the pandemic period and there was no postoperative mortality or occurrence of COVID-19 related complications. Conclusion Emergency operative management of acutely symptomatic hernias can be safely performed even during the COVID-19 infection peak waves; hernia taxis should be reserved only for patients unfit or unwilling to undergo upfront surgery.

Pericecal fossa strangulated internal hernia.

Pericecal fossa internal hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required to diagnose them.

Small bowel obstruction secondary to primary enterolith: A rare and delayed complication of radiation enteritis.

Primary enteroliths as a result of pelvic radiotherapy are a rare cause of intestinal obstruction.

Colonic obstruction secondary to incarcerated transiliac bone hernia.

Transiliac bone hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required for their diagnosis.

Use of percutaneous cholecystostomy for complicated acute lithiasic cholecystitis: solving or deferring the problem?

<b>Introduction:</b> Percutaneous cholecystostomies are not infrequently used as an adjunct in the treatment of severe lithiasic cholecystitis, particularly in unstable and comorbid patients. However, their out of proportion liberal use tends to substitute the performance of emergency cholecystectomy, which the definitive treatment. </br></br> <b>Aim:</b> Our aim was to assess the short and long-term outcomes of patients who had percutaneous cholecystostomy insertion due to severe lithiasic cholecystitis, aiming to define areas for improvement of our institutional practice. </br></br> <b>Materials and Methods:</b> Retrospective review of our institutional practice including all patients who had a percutaneous cholecystostomy for complex lithiasic cholecystitis, over a 5-year period, allowing for an additional 1-year follow up. </br></br> <b>Results:</b> A total of 34 patients were included in our final analysis. Percutaneous cholecystostomy insertion enabled quick and efficient control of the source of biliary sepsis without major procedural complications in all cases. In 14 (41.2%) patients, cholecystostomy alone served as definitive treatment, while in 20 (58.9%) cases it was used as bridging strategy for delayed elective cholecystectomy. In the delayed cholecystectomy group of patients, we noted a high conversion rate from laparoscopic to open surgery rate of 70%, with an overall subtotal cholecystectomy rate of 60%. </br></br> <b>Conclusion:</b> Percutaneous cholecystostomies should be reserved only for complex lithiasic cholecystitis patients who are unwilling and/or unfit for surgery. We advocate the performance of upfront emergency cholecystectomy in any other case with liberal use of operative bail-out strategies, as a delayed elective operation is anyway likely to be converted to open and/or subtotal cholecystectomy.

Percutaneous Retroperitoneoscopic Drainage of Complex Extraperitoneal Abscesses Using Flexible Endoscopy: Description of Technique and Perioperative Care.

The treatment of primary psoas abscesses usually is performed by a combination of prolongued antiobiotic therapy and drainage with interventional radiology techniques. However, although this combination is usually adequate for the treatment of solitary extraperitoneal collections, the presence of multi-loculated complex abscesses requires usually multiple procedures and feruently mandates open surgery. Herein, we describe an alternative tehnique of percutaneous retroperitoneoscopic drainage of multiple extensive primary psoas abscesses using flexible endoscopy, which can enable treatment these cases as one-stop proedure in a minimally invasive manner.