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.

[Acute pancreatitis: case reports from 1992-1997. Analysis of the costs of DRG, role of ERCP in the reduction of hospitalization time]. / Pancreatite acuta: revisione casistica 1992-1997. Analisi dei costi in funzione dei DRG, ruolo dell'ERCP nella riduzione della degenza ospedaliera.

In the period 1992-1997, 211 cases of acute pancreatitis were observed: 81 grave cases; 130 slight cases. The ERCP and endoscopic sphincterotomy were performed in 84 cases. From the critical revision 2 groups of patients emerged, homogeneous for etiology and clinical classification, the first submitted to ERCP within 72 hours from the entry in hospital; the other after 72 from the hospitalisation. The "t" Students test for small numbers was significant (p < 001) showing a decrease of hospitalisation in the submitted group to ERCP within 3 days. In 42 cases of acute pancreatitis observed in 1997 a study was made about the hospitalised patients' costs. Two homogeneous groups of acute and slight pancreatitis have been considered. The parameters analysed were about the costs of: a) days hospitalisations; b) pharmaceutical expenses; c) hematological examination; d) surgical operation, laparothomic and laparoscopic surgery; e) instrumental examination. The results of the expense have been compared with the obtained DRG, both for each single case and also for homogeneous group of grave and slight pancreatitis. This comparison showed that the obtained gain through DRG is: a) insufficient to cover the expenses of the grave pancreatitis cases; b) clearly positive in the slight cases. This last result has been very important in the final balance; in fact is only for this positive result that final balance was economically favourable.