Colorectal anastomotic leakage corrected by transanal laparoscopy.

AIM: Interest in transanal laparoscopy has increased in the last decade. This approach can allow primary procedures such as polypectomy, total mesorectal excision and the treatment of postoperative complications such as bleeding, leakage and fistula formation. METHOD: Two patients treated by transanal repair for leakage of a colorectal anastomosis after laparoscopic anterior resection of the rectum are reported. The first developed leakage immediately during the surgery and in the second leakage presented at 4 weeks. A new transanal platform according to DAPRI (Karl Storz-Endoskope, Tuttlingen, Germany), formed by a reusable port and reusable monocurved instruments was developed to permit manipulation of sutures introduced via the anus in a maximally ergonomic manner. Laparoscopic suturing was performed transanally and a protective ileostomy was added as well. RESULTS: The transanal procedures took 60 and 45 min and the patients were discharged after 5 days and 2 days. At 2 months both defects were found to be healed on contrast radiology and endoscopy; therefore the ileostomy was closed. Anal function was satisfactory with a frequency of two and one times per 24 h with no incontinence or evidence of sepsis. CONCLUSION: Intra-operative or late leakage of colorectal anastomosis can be safely treated by transanal laparoscopy. This new transanal platform offers the surgeon the possibility to work in ergonomic positions, without increasing the cost of the procedure thanks to the reusable nature of the material used.

SINGLE-ACCESS TRANSUMBILICAL LAPAROSCOPIC APPENDECTOMY USING CURVED REUSABLE INSTRUMENTS: AN INITIAL REPORT OF THREE CASES.

INTRODUCTION: The continuous evolution of laparoscopic surgery and the ambition of better cosmetic results raise the need for less invasive procedures. The umbilicus represents a natural scar and constitutes a well-healing site of access to the peritoneal cavity. Single-access Transumbilical Laparoscopy (SATL) is gaining popularity and can be an alternative surgical treatment for acute appendicitis. We report three cases of SATL appendectomy using curved reusable instruments. PATIENTS AND METHODS: Three female patients, wanting minimal scarring (mean age - 30 years) were admitted to our hospital in April 2015 with acute abdominal pain in the right iliac area. A SATL appendectomy was performed using a standard 11-mm reusable trocar for a 10-mm, 30 degrees- angled, rigid scope and curved reusable instruments according to DAPRI (Karl Storz-Endoskope, Tuttlingen, Germany) placed transumbilically. RESULTS: Neither a conversion to open surgery nor an insertion of extraumbilical trocars was necessary. The mean operative time was 101.6 ± 24.66 minutes and the mean blood loss 6.66 ± 11.54 mL. The mean scar length was 16.66 ± 0.57 mm. No intraoperative complications were registered and the use of minimal pain killers allowed the discharge after 2 or maximum 4 days. After three months of follow-up no late complications occurred and the umbilical scar was not visible. CONCLUSION: In young and scarless-demanding females with acute appendicitis SATL appendectomy can be performed safely and offers the possibility of surgical treatment without a visible scar.

EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY.

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

Single-access retroperitoneal adrenalectomy.

AIM: To report the first case in our country of a single access--adrenalectomy with lateral retroperitoneal approach by using SILS port and to evaluate the feasibility and safety of this new technique. MATERIALS AND METHODS: A 50-year-old man presented with 38 mm right adrenal incidentaloma, functionally nonactive and without radiologic characteristics suggestive of a malignant lesion, discovered on abdominal computed tomography for nephrolithiasis. The single access adrenalectomy was attempted with multichannel SILS port (Covidien), inserted through a 3 cm transverse incision at the tip of rib XII on the right side. RESULTS: The single access retroperitoneal adrenalectomy (SARA) was successfully completed without any intraoperative complications. An additional lateral 5-mm port was needed for retraction of the kidney and for tubular drain in the end stage of the surgery. The operating time was 120 minutes with 40 mL of blood loss. Postoperative recovery was uneventful. The patient was discharged from the hospital on the second postoperative day. Pathologic examination confirmed cortical adenoma of the adrenal grand. No morbidity within one month of follow-up, and excellent cosmetic results. CONCLUSION: This is the first case of a single access retroperitoneal adrenalectomy (SARA) by using SILS port was performed in our country. Based on our primary experience, we believe that SARA is a safe and feasible procedure for selected patients with adrenal tumors and when performed by a surgeon experienced in laparoscopic and adrenal surgery. Although initial technical adjustments are inevitable, simplifying the procedure. However, more surgical experience using this technique is required to confirm our initial impressions.

Case of classic Kaposi sarcoma.

A rare case of 66-year-old man with Classic Kaposi sarcoma and a few month histoty of asymptomatic purple lesion located on right foot. A surgical excision was performed. The histological examination was confirmed the diagnosis. Case report and literature review.