TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique-cumulative experience in a single centre.

From January 2011 to December 2015, 70 consecutive patients underwent either laparoscopic surgery (LS) or robotic surgery (RS) total mesorectal excision (TME) for malignancy. Data were prospectically recorded in a dedicated local database including ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results. We enrolled 70 consecutive patients, 35 treated with LS (18 M, 17 F), 35 treated with RS (23 M, 12 F). Median total operative time was 225 min in LS group (IQR 194-255) and 252.5 min for RS group (IQR 214-300). Median first flatus time was 2 days for LS group (IQR 1-3) and 1 day for RS group (IQR 1-2). Stool discharge time (median) was 4 days for LS group (IQR 2-5) and 2 days for RS group (IQR 1-3). Length of stay (median) was 8 days in LS group (IQR 7-10) and 7 days in RS group (IQR 5-8). It was not found any statistically significant difference between the two groups when we analyzed the number nodes harvested the postoperative complications. The 30 day mortality was 0% in both two groups. The conversion rate for LS group was 23% (8/35 pts) and that for RS group was 0% (0/35). The RS may overcome technical limitations of LS. In our experience, it is a feasible and safe technique, it achieves better clinical outcomes due to the lower conversion rate compared to LS, although with higher costs.

Right colectomy: consecutive 100 patients treated with laparoscopic and robotic technique for malignancy. Cumulative experience in a single centre.

Robotic-assisted resections prove beneficial in overcoming potential limitation of laparoscopy, but clear evidences on patient's benefits are still lacking. We report our experience on 100 consecutive patients who underwent right colectomy with either robotic or laparoscopic approaches. Data were prospectively collected on a dedicated database (ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results). Median total operative time was 160 min in LS group (IQR = 140-180) and 204 min for RS group (IQR = 180-230). Median time to first flatus was 2.5 days for LS group (IQR = 2 - 3) and 2 days for RS group (IQR = 1-2). Length of stay (median) was 8 days in LS group (IQR = 6-10) and 5 days in RS group (IQR = 5-7). No statistically significant difference was found between the 2 groups when the number of harvested nodes, the anastomotic leakage and the postoperative bleeding were analyzed. The 30-day mortality was 0% in LS and RS groups. Conversion rate for LS group was 14% (7/50 pts) and for RS group was 0% (0/50). Minimally invasive surgery is a feasible and safe technique. The RS may overcome some technical limitations of laparoscopic surgery and it achieves the same oncological results compared to LS but with higher costs. The lower conversion rate allows to expect better clinical outcomes and lower complication rate.

The long-term efficacy of the intrahepatic portosystemic shunt (TIPS) for the treatment of bleeding anorectal varices in cirrhosis. A case report and review of the literature.

BACKGROUND: In patients with portal hypertension and variceal hemorrhage, the transjugular intrahepatic portosystemic shunt (TIPS) is indicated when drug therapy or endoscopic treatment fails to control bleeding. Ruptured esophageal or gastric varices are the most frequent causes of portal hypertension-related hemorrhage, but anorectal varices may also bleed. Although several case reports have proposed TIPS in this situation, the long-term results of this procedure have not been described. METHODS: We report here the case of a 68-year-old patient with decompensated cirrhosis who presented with recurrent hematochezia due to anorectal varices. RESULTS: A successful control of bleeding could be obtained after placement of TIPS. After 3 years of follow-up, rectal bleeding did not recur, the shunt remained primarily patent, and the patient did not present overt hepatic encephalopathy. CONCLUSION: TIPS procedure should be considered as an effective treatment of recurrent bleeding from anorectal varices in patients with decompensated cirrhosis.

[Left colectomy with immediate anastomosis in emergency surgery]. / La colectomie gauche avec anastomose immédiate dans la chirurgie d'urgence.

PURPOSE OF THE STUDY: A retrospective study of our experience with one-stage left colectomy for acute diverticulitis and obstruction with a review of the literature to more clearly define the indications of this procedure. PATIENTS AND METHODS: 30 patients were operated for acute diverticulitis (group 1) and 47 for obstruction (group 2). Only 7 patients (23%) of group 1 had an intraoperative colonic lavage while this was performed for all the patients of group 2. RESULTS: The postoperative morbidity and mortality for the patients of group 1 and 2 were 37 and 28%, and 7 and 11% respectively. None of the patients of group 1 had clinical anastomotic leak, while this occurred in 2 patients (4%) of group 2. The mean hospital stay was 26 days for patients of group 1 and 17 days for patients of group 2. CONCLUSIONS: Bowel obstruction should be treated by one-stage left colectomy and intraoperative colonic lavage for patients with low anaesthetic risks (ASA 1 and 2). Immediate anastomosis protected by colostomy or ileostomy could be proposed for patients with an intermediate risk (ASA 3). Patients with acute diverticulitis and a localized abscess or peritonitis should be treated with one-stage colectomy; an immediate protected anastomosis could be performed in patients with generalized purulent peritonitis while a Hartmann's type colectomy should be the reasonable option for fecal generalized peritonitis. Intraoperative colonic lavage does not seem mandatory.

[Topical beclomethasone dipropionate (BDP) in intestinal inflammatory diseases: the results of a multicentre trial]. / Beclometasone dipropionato topico nelle malattie infiammatorie intestinali: risultati di un'indagine multicentrica.

The authors assessed the efficacy and tolerability of BDP in an open protocol using rectal enemas and suppositories and in a double-blind protocol vs mesalazine using rectal enemas. A total of 47 patients suffering from ulcerous rectocolitis were enrolled in the study and treated for 42 days while undergoing endoscopic, histologic and clinical controls. In conclusion, the authors affirm that BDP may represent a useful new therapeutic instrument in the treatment of slight to moderately severe forms of inflammatory intestinal disease.

[Differed autologous blood transfusion and its effects during pulmonary lobectomy]. / L'autotransfusion différée et ses effets lors de la lobectomie pulmonaire.

The aim of our study was to determine the value of preoperative autologous blood donation and its importance with regard to pulmonary lobectomies. Over the course of three years and a total number of 220 operations, autologous blood was preoperatively deposited in 74 cases. 21 patients did not meet the criteria for autologous blood donation and were excluded from the study. It was found that only 6.8% of the patients who had donated autologous blood required a homologous blood transfusion versus 27.2% in the non-donor group. This would imply, that the necessity for homologous blood transfusion is reduced by approximately 75% in patients depositing autologous blood prior to surgery. While we observed similar haemoglobin levels in both groups at admission, it was found that autologous blood donors went into surgery with an Hb 1.5 g% lower than non donors; the levels however adjusted themselves immediately postoperatively. No increased complication rate was found as a result of preoperative autologous blood donation. The data indicate that only 30% of patients undergoing pulmonary lobectomy require homologous blood transfusions. 80% of these patients could benefit from preoperative autologous blood donation. For 70% of all patients the procedure would be of no benefit. Bearing in mind the immunosuppressive effect of homologous blood transfusions, which may result in a higher rate of tumor recurrence, we find preoperative autologous blood donation a justifiable procedure even under these circumstances. It would however be beneficial if studies were conducted to investigate to what extent similar results could be achieved by preoperative acute isovolemic hemodilution.

[Acute cholecystitis associated with calculosis of the biliary tract in a high-risk patient. Combined emergency surgical and peroperative endoscopic treatment]. / Colecistite acuta associata a calcolosi della via biliare nel paziente ad alto rischio. Trattamento combinato chirurgico ed endoscopico peroperatorio in urgenza.

Patient age (over 65), and lithiasis of the common bile duct are two factors which increase the morbidity and mortality rate in emergency surgery for biliary lithiasis. Normally, calculi in the CBD can be cleared by means of supraduodenal or transduodenal access. In both cases, however, complications are frequent in high risk patients. Treatment of gallstones can be modified to achieve a reduction in the morbidity and mortality rate. This study presents an initial survey of 4 elderly patients, presenting with acute gallbladder disease and CBD stones, treated with surgical cholecystectomy and contemporary perioperative endoscopic papillotomy and CBD clearance. The underlying rationale and the good initial results support this combined surgical and endoscopic approach.

[Multinodular pulmonary type AL amyloidosis. Report of a case and review of the literature]. / Amyloïdose pulmonaire multinodulaire de type AL. Observation d'un cas et revue de la littérature.

A multinodular lung lesion was discovered in a healthy 56 year-old man on routine chest X-rays. Histology revealed multinodular amyloidosis which histochemically was found to correspond to the AL type. This type of amyloidosis raises the differential diagnosis ith a lung neoplasm. In our case, no cell dyscrasia was observed. The patient was treated by surgery as recommended in the literature.

Haemorheological effects of fructose-1,6-diphosphate in patients with lower extremity ischaemia.

A prospective, single-blind study was carried out in 30 patients with obstructive peripheral artery disease to investigate the haemorheological properties of fructose-1,6-diphosphate (FDP). Patients were allocated at random to receive 7 to 10-days' treatment with either 10 g or 10% FDP twice daily or saline. Measurements were made on entry and at the end of treatment of whole blood and plasma viscosity, erythrocyte deformability and aggregation, and lower limb blood flow was evaluated by Doppler technique. FDP treatment was associated with a reduction in whole blood viscosity (24%) and red blood cell aggregation index (27%), and an improvement in red blood cell deformability (42%) (p less than 0.01). No significant changes were observed in the control group. Plasma viscosity did not change in either treatment group. Limb blood flow increased (p less than 0.05) only in patients treated with FDP; the improvement was more pronounced in the most severely affected side (30%). No untoward events were observed or reported in any of the patients studied.

The use of antisera ('Serocytol') in the management of gastritis: a double-blind clinical assessment versus placebo.

A double-blind, placebo-controlled study was carried out in 40 out-patients with endoscopically confirmed hypertrophic or erosive gastritis, without ulcer, to assess the effectiveness and tolerance of treatment with equine antisera (antidiencephalon and anti-stomach tissue). Patients were assigned at random to receive a single dose in suppository form on 2 days a week for 6 weeks of both antisera (anti-diencephalon on Days 1 and 4, anti-stomach tissue on Days 2 and 5) or placebo (saline solution). No other anti-ulcer treatment was allowed except standard antacid tablets, the consumption of which was recorded and used as an evaluation parameter. Endoscopy, haematology and haematochemistry were performed before and after treatment; symptoms (daytime and night-time pain, heartburn and dyspepsia) and possible adverse reactions were scored 0 to 4 in order of increasing severity before treatment and after 1, 2, 4 and 6 weeks. Five patients in the placebo group had to be withdrawn from the trial at the second week because of therapeutic failure. This proportion was significantly in favour of the antisera group, as was the proportion of patients endoscopically healed and the extent and rate of symptomatic improvement. Concomitant antacid consumption rapidly and significantly decreased in the antisera but not in the placebo group. Signs of intolerance were not observed with either treatment, nor were there any significant alterations in haematology or haematochemistry. In particular, the immune titre of patients did not increase after treatment, thus indicating that the administered heterologous proteins did not elicit an immunization of the patients against horse protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidrine in the management of gastritis and duodenitis. A double-blind placebo controlled clinical trial.

Thirty-nine adult out-patients with dyspepsia and endoscopically proven gastritis and/or duodenitis without ulcer, completed a double-blind, placebo controlled, 8-week clinical trial of either Acidrine (twenty-one patients) or placebo (eighteen patients), at a daily dosage of 2 tablets t.i.d. Treatment with Acidrine resulted in a significant improvement in symptoms and in the endoscopic appearance of the gastritis and duodenitis when compared with placebo.