Robotic antrum-pyloric resection with intracorporeal anastomosis in a young woman with ectopic pancreas pyloric stenosis.

INTRODUCTION: Ectopic pancreas is pancreatic tissue sited outside its normal location and lacking anatomic or vascular connection with eutopic pancreatic tissue. We present herein a successful robotic antrum-pyloric resection with intracorporeal Roux-en-Y reconstruction in a 24-year-old woman. PATIENT AND METHODS: The patient was admitted for recent worsening vomiting, intermittent epigastric pain, and hyporexia that arose some years previous. Endoscopic ultrasonography (EUS) findings suggested the presence of ectopic pancreas but did not exclude the possibility of gastrointestinal stromal tumor (GIST) or other pathogenesis. Totally robotic (three-arm da Vinci(®)) antrum-pyloric resection was decided. RESULTS: Final pathologic analysis revealed that the lesion comprised exocrine pancreas located in the submucosal layer. Patient was discharged on the 10th postoperative day. DISCUSSION: Robotic antrum-pyloric resection was decided considering its advantages over laparoscopy including stereoscopic vision, loss of tremor, and robotic arm endowrist. These instrumental benefits facilitate procedures such as knot-tying, suturing, organ manipulation, and tissue dissection. CONCLUSIONS: We show that subtotal gastrectomy for ectopic pancreas can be performed robotically and is a feasible and safe procedure.

[Multimodal treatment of liver metastases: our experience]. / Trattamento multimodale delle metastasi epatiche: nostra esperienza.

Our recent experience in multimodal treatment of liver metastases. Surgical treatment of liver metastases is increasing in these years regarding more and more patients, as well as more and more surgeons. In the same time the introduction of therapies allows today the integration of surgical treatment and also satisfactory palliation. Authors report their experience in these last 4 years and suggest interdisciplinary approach to get good results even in non dedicated centres.

[Surgical treatment of gastrointestinal stromal tumors: personal cases]. / Trattamento chirurgico dei tumori stromali gastrointestinali: casistica personale.

Surgical management of gastrointestinal stromal tumors: our experience. Gastrointestinal stromal tumors (GIST) are rare neoplasm even if they are the most common mesenchimal malignancies of the gastrointestinal tract. GIST have long been a source of confusion and controversy, in particular to define their pathological classification, preoperative diagnosis, management strategies, and prognosis. A radical resection of the tumor is often possible and always recommended. Recent studies have identified its principal pathogenic defect. An effective adjuvant therapy treatment (STI571) have been found for advanced and metastatic GIST.

[Distal gastrectomy with Y gastroenteroanastomosis not associated with vagotomy in elective surgical treatment of gastroduodenal ulcer. Clinical and functional long-term results]. / La gastrectomia distale con gastroenteroanastomosi a Y non associata a vagotomia nel trattamento chirurgico di elezione dell'ulcera gastroduodenale. Risultati clinici e funzionali a lungo termine.

During the period 1977-1984, 53 patients with peptic ulcer resistant to H2-blockers (29 gastric and 24 duodenal ulcers) were submitted to distal gastrectomy with Roux-en-Y gastroenteroanastomosis not associated with vagotomy. The indication was used as an alternative to proximal vagotomy in cases with delayed gastric emptying, high acid output, perforation or bleeding. The study plan consisted of serial clinical and instrumental controls including determination of basal (BAO) or maximal (MAO) acid output. Operative mortality was nil. At various times after the operation, 4 patients died for unrelated reasons and 3 were lost to follow-up. Median follow-up was 84 months with an interval of from 4 to 137 months. Fifty-one patients were followed up for at least one year and 49 for at least two. Five patients (2 gastric and 3 duodenal ulcers) developed peptic recurrences (Visick IV, 9.8%) by the end of the first postoperative year and, in all cases but one, healed stably by the second year after medical (3 cases) or surgical (1 case) therapy. In the remaining patients, Visick was grade III in 6 cases (4 gastric and 2 duodenal ulcers), grade II in 6 and grade I in 34. Before operation, mean values (+/- SD) of BAO and MAO were respectively 5.84 +/- 5.03 and 29.6 +/- 18.6 mEq/h. In the immediate postoperative period there was a considerable reduction in BAO (p less than 0.02) and MAO (p less than 0.03) which continued up to the third postoperative year with a tendency to further progressive reduction in MAO. In spite of a considerable individual variability in dimensions and temporal evolution, the phenomenon occurred qualitatively in all cases. No significant difference was observed in the behaviour of BAO and MAO in gastric ulcers by comparison with duodenal ulcers and in cases with recurrence and Visick III compared to those with a favourable clinical result.