Solitary liver metastasis of chromophobe renal cell carcinoma 17 years after nephrectomy. A case report and review of the literature.

The prognosis for renal metastatic carcinoma is poor: in fact only a small portion of patients have metastases surgically treatable for their number and sizes with often a multiorgan involvement. We present a case in whit a solitary liver metastasis was incidentaly detected 17 years after nephrectomy for renal clear cell carcinoma. during a staging computed tomography performed for colonic cancer. We discuss the main feature of this rare condition.

[Laparoscopic sleeve gastrectomy: technique and preliminary results]. / Sleeve gastrectomy: tecnica e risultati preliminari.

According to the WHO about 300 million people in the world are affected by obesity with an increasing trend. The aim of the present study was to assess our preliminary results with sleeve gastrectomy. Over the period from June 2006 to March 2008, 25 laparoscopic sleeve gastrectomy were performed at our Department of Surgery for morbid obesity by the same surgeon. The operation consists in resection of approximately three quarters of the stomach with the creation of a long slender gastric tube, dividing the stomach vertically in two parts and removing all the left side with the greater curvature and gastric fundus. The mean age of the patients was 38 +/- 9 years, and the mean BMI 48 +/- 3. The mean operative time was 110 minutes, and the mean hospital stay 6 days. Mean intraoperative bleeding was negligible (20 cc). In our study we observed just one case of gastric leakage from the staple line, treated by surgical drainage and by placement of an endoscopic stent. There were no cases of bleeding of the resection margin and no long-term stenosis; there was no mortality. The mean follow-up was 18 months. BMI showed a mean reduction of about 17 points. During postoperative visits all the patients reported marked reduction of hunger sensation, together with a sense of early satiety. On the basis of these preliminary results we can consider laparoscopic sleeve gastrectomy as a safe, functional and definitive procedure that constitutes a valid alternative in bariatric surgery, though it is as yet not completely standardised and requires a longer follow-up.

Laparoscopic cholecystectomy without intraoperative cholangiography: audit of long-term results.

There is no uniform consensus on the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC). In this paper, we present a 10-year retrospective audit of our cases of LC without IOC, performed by a search of readmission cases through our electronic database. Data regarding all patients subjected to LC at our unit in the period January 1996-December 2006 were obtained through our hospital database system. Subsequently, a query was made to ascertain if there were any readmissions to any of our city hospitals, up to December 2006. A total of 1321 patients underwent LC at our unit in the period January 1, 1996-December 31, 2006. The median operating time for LC without IOC was 58 minutes (range, 15-370). The median hospital stay was 2 days (range, 1-30). Postoperative outcome was uneventful in 1250 patients (94.7%). There was no mortality. Grade I and II complications occurred in the remaining 71 patients. Patients were stratified by risk of common bile duct stones (BDSs) according to clinical, ultrasonographic, and serum chemistry data. Patients with suspected BDS underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and BDS clearance (142 patients). No patient in our series of LC was readmitted to any of the city hospitals for biliary desease up to 10 years after the operation. Our retrospective audit confirms the safety of LC without routine IOC and the rarity of readmissions for retained BDS and supports the policy of selective IOC.

[Dysphagia after laparoscopic Nissen fundoplication]. / La disfagia dopo fundoplicatio laparoscopica secondo Nissen.

The aim of the study was to consider all the factors associated with the development of postoperative dysphagia which, in its transitory form, can be present in as many as 40 to 70% of cases. From 1996 to 2007, 302 Nissen fundoplications were performed at our department of surgery. We divided this series into two groups, the first consisting of 149 cases (from March 1996 to March 2004) where short gastric vessels were not dissected (nl-VGB) and the second of 153 cases (from April 2004 to December 2007) where short gastric vessels were dissected (I-VGB).The incidence of postoperative dysphagia was distinctly lower in I-VGB than in nl-VGB (4.5% vs 19.5%). One month after operation, the incidence of postoperative dysphagia in I-VGB and nl-VGB was 12% and 1,5%, respectively, while 3 months after surgery the percentages were 2% and 0.5%. Exclusion of cases performed during the learning curve period yielded similar results. At postoperative examinations we noticed a substantial reduction in gastro-oesophageal reflux disease symptoms in both groups, with no significant difference between the two. L-VGB patients appeared clearly more satisfied after operation than nl-VGB patients (97% vs 88%), even if the results were similar after 3 months. Our experience confirms the good results obtained with Nissen fundoplication with a distinct, rapid reduction in postoperative dysphagia.

[Radiofrequency Milligan-Morgan haemorrhoidectomy in the outpatient setting]. / Emorroidectomia secondo Milligan-Morgan mediante radiofrequenza in regime ambulatoriale.

The demand for shorter admissions and quicker recoveries prompted us to adopt a new approach, favouring day surgery as the preferred organisational modality. Since 2004, 312 Milligan-Morgan haemorrhoidectomies have been performed at our department of surgery. The operations were performed at our proctological outpatient unit by means of LigasureTM with immediate discharge. In our study we observed postoperative bleeding in 3 cases (0.96%), while 4 patients (1.28%) required an ordinary admission. There were no cases of acute urinary retention in our experience. Operating time is about 12-16 minutes; and recovery time around 60-70 minutes. Over the period 1992-2003, 978 Milligan-Morgan haemorrhoidectomies were performed at our department of surgery using diathermy. Historical comparison of the results of the two groups shows a reduction in complications, operating times and recovery times. On the basis of our experience, radiofrequency ablation causes less postoperative pain and makes for shorter recovery times compared with diathermy, because of its lower tissue damage. The aim of the present study was to verify the safety and effectiveness of day surgery haemorroidectomy in selected cases.

[Laparoscopic surgical treatment of polycystic liver: a case report]. / Trattamento chirurgico laparoscopico della policistosi epatica: un caso clinico.

The preoperative diagnosis of polycystic liver is easily obtainable by ultrasound, while computed tomography is more sensitive for making the differential diagnosis versus other hepatic lesions. This report describes a case of polycystic liver with mass-related symptoms. A laparoscopic fenestration of the larger and superficial cysts was performed. At a three-years follow-up neither postoperative complications nor recurrent episodes were observed. A number of studies have shown that the rates of cyst and symptom recurrence are 9% and 4.5%, respectively, and that the reduction of liver volume is 12.5%. in our opinion the choice of adequate treatment must be based on an accurate evaluation of the patient's clinical aspects and on tthe characteristics of cystic lesions, such as number, size and location. In conclusion, laparoscopic fenestration of liver cysts is a safe, effective procedure for obtaining excellent outcomes in terms of absence of recurrence, as well as being a more sparing approach.

Avoiding complications after laparoscopic esophago-gastric banding: experience with 400 consecutive patients.

BACKGROUND: Among bariatric operations, laparoscopic adjustable gastric banding (LAGB) has been the preferred one in Europe and Australia, and has become recently popular in the USA. Like every surgical procedure, however, it is not devoid of specific complications, like slippage, band erosion, outlet obstruction and port problems. Assuming that the absence of the pouch may avoid postoperative slippage, we introduced the technique of esophago-gastric placement, instead of the original gastric banding technique. A further technical variant, introduced in June 2002, consists of suturing the gastric fundus to the left hemidiaphragm, using two non-resorbable sutures and pledgets. METHODS: Between January 1999 and July 2005, 400 LAGBs have been placed in 90 males and 310 females, with the technical variants above. Mean age was 42 (range 17-69 years), and mean BMI was 44.8 kg/m(2) (range 33-67). RESULTS: Mean hospital stay was 2.5 days (range 1-17). Mortality has been zero. Major complications included: 16 slippages (after a range of 6-45 months), 5 outlet obstructions (immediately after the operation), and one intragastric migration (after 2 years). Minor complications included 18 port problems. Since the introduction of gastric fundus fixation to the diaphragm in 2002, gastric slippage has decreased from 8% to 0.9%. BMI has decreased from 44.8 to 32 kg/m(2) at 60 months. CONCLUSIONS: The technique herein presented is effective and useful to prevent postoperative gastric slippage. It does not induce pseudo-achalasia, if strictly controlled. In fact, it is avoided by the patient due to the immediate appearance of dysphagia, in the case of wrong food ingestion. Long-term clinico-radiological follow-up confirms that the technique is safe and effective in motivated patients with good compliance and willing to undergo periodic studies.