Laparostomy with topical negative pressure for treating severe peritonitis. Preliminary experience with 16 cases and review of the literature.

INTRODUCTION: The aim of this study was to assess the authors' initial experience with laparostomy and intraperitoneal topical negative pressure (TNP) in patients with severe peritonitis. The authors also reviewed the recent literature on the effectiveness and safety of abdominal TNP. PATIENTS AND METHODS: Sixteen patients (10 male, 6 female, mean age 55 years), suffering from severe peritonitis, underwent emergency laparotomy and laparostomy with TNP. Abdominal sepsis originated from the small intestine (n = 7), large intestine (n = 6), biliary tract (n = 2), and pancreas (n = 1). In 2 patients abdominal wall mesh infection and soft tissue gangrene were observed. RESULTS: The mortality rate was 31.2%. The main complications probably related to TNP were enteric fistulae (25%), bleeding (25%), abdominal abscesses (12.5%), bowel ischemia (6.2%). Delayed primary closure was performed in 8 patients (57.1%) whereas in 6 cases a parietal graft was necessary, and one patient underwent an autologous skin graft. CONCLUSIONS: Laparostomy with intraperitoneal TNP is a safe and effective method for managing patients with severe peritonitis. Morbidity can be reduced through individualized application of the laparostomy dressing and pressure gradient. The abdominal wall should be managed in such a way as to make possible delayed primary closure.

Acute afferent loop obstruction treated by endoscopic decompression. Case report and review of literature.

Afferent loop syndrome (ALS) is a rare complication of Billroth-II gastrojejunostomy. Most cases of ALS are caused by obstruction from adhesions, kinking at the anastomosis, internal hernia, stomal stenosis, malignancy, or inflammation surrounding the anastomosis. A 61-years old man, who had undergone gastric resection 30 years before, was admitted at emergency room with severe abdominal pain in acute onset, nausea and vomiting. Ultrasonography and multi-detector computed tomography suggested acute ALS, due probably to adhesions or internal hernia. The patient was conducted to digestive endoscopy unit and successfully treated with endoscopic decompression of dilated afferent loop. Open surgery is actually considered the gold-standard in treatment of ALS. However, some surgeons report a few cases treated by laparoscopic surgery, interventional radiology techniques, endoscopic decompression. Authors suggest endoscopic decompression of acute ALS due to adhesions or internal hernia as the first treatment, especially in high-surgical-risk patients.

[Single incision laparoscopic cholecystectomy: preliminary experience]. / Colecistectomia laparoscopica con singola incisione (S.I.L.S.). Esperienza preliminare.

INTRODUCTION: The Authors describe our preliminary experience with the cholecistectomy with the S.I.L.S. (Single Incision Laparoscopic Surgery), with a multilumen trocar and dedicated laparoscopic instruments. MATERIALS AND METHODS: Five operations of laparoscopic cholecistectomy with S.I.L.S. technique (3 men and 2 women), of age between 26 and 52 years are reported. RESULTS: In one case was applied an additional 5 mm trocar in the right ipocondrium; in two cases a transparietal suture to suspend the gallbladder was used. Operative time was 98 minutes for the first operation, and 45-65 minutes for the following. The operators have been some difficulties to moving the instruments because both the operating instruments and laparoscope are introduced through the same incision and on the same axis, the operator and assistant often impede the movements of each other. Any post-operative complications was registered. All the patients was very satisfied with post-operative pain and aesthetic results. CONCLUSIONS: The S.I.L.S. is a new technique already used in general surgery, urology and ginecology with good results; this surgey is probably destinated to improve his tecnique and instruments, but certainly it going to offer a further push of the mini-invasive "philosophy".