PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial.

PURPOSE: This multicenter randomized study was designed to compare the clinical and functional results of stapled transanal rectal resection (STARR) performed with 2 staplers (PPH-01 vs. PPH-03) in the treatment of hemorrhoidal disease associated with a large internal rectal prolapse. METHODS: From a total of 937 patients, referred for hemorrhoidal disease in the 20 centers involved in the study, 425 (45.3%) with prolapsed hemorrhoids associated with a large internal rectal prolapse were randomized to undergo STARR with PPH-01 or PPH-03. Postoperative evaluation was made at 3, 6, and 12 months. RESULTS: The incidence of bleeding at the stapled line was significantly lower in the PPH-03 group than in the PPH-01 group (58/207 [28.0%] vs. 145/201 [72.1%]; P < .0001); the mean number of hemostatic stitches was significantly higher in the PPH-01 than in the PPH-03 group (3.2 ± 0.1 vs. 1.8 ± 0.8; P < .0001). The mean operative time was 25.1 ± 11.5 minutes in the PPH-03 group and 38.1 ± 15.7 minutes in the PPH-01 group (P < .0001). No major complications occurred in either of the groups. At 12-month follow-up, the success rate in the 2 groups was 94.5% in the PPH01 group and 94.2% in the PPH03 group. CONCLUSION: STARR performed for the treatment of hemorrhoidal disease associated with a large rectal prolapse is a safe and effective procedure. The use of the PPH-03 stapler instead of the PPH-01 guarantees a statistically significant reduction of intraoperative bleeding and a significant decrease of the operative time.

Transanal excision of rectal pyogenic granuloma: case report and literature review.

Pyogenic granuloma (PG) is a benign vascular lesion occurring most commonly on the acral skin of children. It is a capillary hemangioma of lobular subtype, often prone to bleeding. Surgical removal of the lesion is indicated to prevent bleeding and avoid diagnostic uncertainty. We describe a successful surgical removal of a rectal PG with transanal endoscopic microsurgery and review the reports of gastrointestinal tract PG in the international literature.

[Laparoscopic total gastrectomy for multifocal gastric GIST: a case report and review of the literature]. / Gastrectomia totale laparoscopica per GIST gastrico multifocale: caso clinico e revisione della letteratura.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the GI tract, deriving from interstitial Cajal cell degeneration. Over 95% of GISTs express CD-117 and CD-34, thus differing from other mesenchymal-derived tumours. The aim of this study was to evaluate our experience with a multifocal GIST, treated by laparoscopic total gastrectomy, and review the literature. A 74-year-old man with a preoperative diagnosis of sub-cardial GIST, obtained by endoscopy, CT scan and endoscopic ultrasound, was submitted to laparoscopic total gastrectomy with an end-to-side oesophago-jejunal anastomosis, using the Or-Vil system. GISTs account for only 1% of all GI tumours, with a variable behaviour, from indolent forms to aggressive tumours with potential for hepatic and peritoneal metastasis. Surgery is the cornerstone of therapy, the aim being to obtain an R0 resection, so as to minimise the risk of recurrence. Laparoscopic total gastrectomy is an excellent solution for their treatment, with possible adjuvant therapy based on imatinib-mesylate, for high-risk GIST.

Laparoscopic incisional hernia repair: our experience with 105 consecutive cases.

Conventional repair of incisional hernia is associated with significant complications and a high recurrence rate (30-50%). The laparoscopic approach offers an effective alternative and reduces the recurrences to less than 5%. The aim of this study was to review our experience with laparoscopic incisional hernia repair. Medical records of all patients who underwent laparoscopic incisional hernia repair from January 2002 to December 2006 were reviewed. Demographic and postoperative data were recorded. The study population consisted of 105 patients, 72 females (68.5%) and 33 males (31.5%); the mean age was 56 years (range: 17-83 years). The mean fascial defect size was 116.9 cm2 and the average mesh size used was 256 cm2. Operative time was 118 min and the average hospital stay was 5 days. An expanded polytetrafluoroethylene (ePTFE) prosthesis was used In all patients. Perioperative complications occurred in 33 patients (31.4%) including seroma, cellulitis at the trocar site and prolonged ileus. During the follow-up there were 3 hernia recurrences (2.8%). Our study shows that laparoscopic incisional hernia repair resulted in a moderate rate of perioperative complications, a short hospital stay and a low recurrence rate. Hence the laparoscopic technique should be considered an effective and safe alternative to conventional incisional hernia repair.