Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis - How I Do It?

Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is nowadays the gold standard in patients with ulcerative colitis requiring surgery. It is a complex procedure, being associated with a significant rate of morbidity and mortality. In order to obtain better results, the timing of surgery is essential. In the last decades, with the expansion of the minimally invasive techniques, the procedure can be performed feasible and safe by laparoscopy, bringing all the short term advantages associated with this approach. Due to the long term advantages regarding improved female fecundity function and fewer adhesions the laparoscopic approach is now recommended by the European Crohn's and Colitis Organization in centers with appropriate expertise.

Minimally Invasive Colorectal Surgery - Present and Future Trends.

In the last decades, surgical techniques have evolved, introducing better, more sophisticated devices, aimed at providing the least traumatizing surgical operations, with improved perioperative and longtime results. Based on the results of randomized control trials, current guidelines recommend laparoscopic approach for the treatment of colonic cancer where there is appropriate expertise. Compared with colonic resection, laparoscopic rectal resections are technically challenging procedures associated with a low adoption rate, high conversion rate, debatable functional and oncological results. These drawbacks created the need for a better tool. Robotic surgery emerged to overcome the limits of laparoscopy in terms of visibility and instrument maneuverability. Laparoscopic approach is best suited for colon and superior rectal cancers, while robotic approach is best indicated in medium and inferior rectal cancers(especially in men with a narrow pelvis and in patients with high BMI). In these cases the robotic approach greatly facilitate the minimally invasive approach and, most of the time, allow preservation of the pelvic autonomic nerves leading to a better quality of life. Due to increased costs and relative unavailability of this method, it is difficult to anticipate if the adoption rate of minimally invasive surgery in colorectal cancer will increase significantly.

Surgical Treatment of Splenic Artery Pseudoaneurysm with Digestive Tract Communication - Presentation of Two Cases.

Splenopancreatectomy performed for pancreatic pseudo-cyst with splenic artery pseudo-aneurysm and communication with the digestive tract (stomach or colon) is a very rare indication and a small number of these procedures are described in literature. Managing peri-pancreatic pseudo-aneurysm is complex and can be challenging. Surgical treatment is of curative intent and can involve multiple visceral resections. Surgery can be performed in an emergency setting, if the patient presents cataclysmic bleeding, or in a planned manner if the pseudo-aneurysm is discovered incidentally or if the patient manages to overcome the initial bleeding. In this paper we present two cases of pancreatic pseudo-cysts with splenic artery pseudo-aneurysms and communication with the digestive tract (one with pseudo-cystic-colonic communication and the other one with gastric communication). Both patients were males, suffered from chronic pancreatitis and were known to have pancreatic pseudo-cysts. For the treatment of the first patient, surgery was performed in an elective setting, after intensive investigations. The other patient presented with cataclysmic bleeding and emergency surgery was performed in order to control the bleeding. We conclude that surgery remains the main option of treatment for these patients. It can be used as a first line of treatment or secondary to endovascular procedures.