[Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial]. / Emorroidectomia secondo Longo vs Milligan-Morgan: risultati a breve e lungo termine di uno studio prospettico, randomizzato, controllato. Analisi costo-beneficio.

The aim of this study was to assess the short- and long-term results of treatment for haemorrhoids by prospectively comparing two techniques, namely, stapled rectal prolapse mucosectomy according to Longo and open hemorrhoidectomy. One hundred consecutive patients were randomised to stapled (50 patients) or manual hemorrhoidectomy (50 patients). We analysed postoperative pain, preoperative and postoperative anorectal function, intraoperative and postoperative complications, time needed to return to work and to normal social activities, and costs. Long-term follow data were obtained by means of an outpatient visit. The operative time of the stapled technique was less than that of open haemorrhoidectomy (22 vs 35 minutes). Two cases of early postoperative bleeding occurred after the stapled technique. The mean pain score on a visual scale was significantly less in patients undergoing the stapled technique. In addition, the time needed to return to work and to normal social activities was significantly less after the stapled technique, which, however, proved to be a more expensive procedure. Stapled mucosectomy of the prolapsed rectal mucosa is a safe, rapid, and relatively painless technique, which has a low incidence of complications. It can be performed in a day surgery unit. Patient satisfaction, early return to normal activities and good long-term results counterbalance the high cost of the procedure.

Characterization of carrot root oil arising from supercritical fluid carbon dioxide extraction.

Carrot root oil (SCO), obtained by supercritical fluid carbon dioxide (SC-CO2) extraction, was characterized and compared to a commercial carrot oil (MCO) and a virgin olive oil (VOO) (cv. Coratina). SCO showed much higher contents of carotenes, phenolics, waxes, phytosterols, and sesquiterpene and monoterpene volatiles. In SCO, the most prominent components present in the fully investigated analytical fractions (fatty acids, triglycerides, waxes, phytosterols, long-chain aliphatic alcohols, superior triterpene alcohols, and volatiles) were, respectively, linolenic acid, trilinolein, waxes C38, beta-sitosterol, campesterol and stigmasterol, 1-hexacosanol, 24-methylencycloartanol and cycloartenol, beta-caryophyllene, alpha-humulene, alpha-pinene, and sabinene. In VOO, the major constituents of the above analytical classes were, respectively, oleic acid, trilinolein, waxes C36, unsaturated volatile C6 aldehydes (trans-2-hexenal most markedly), and the same prominent sterols and superior alcohols found in SCO. In MCO, which also contained a proportion of unknown plant oil, several components showed magnitudes that were lower compared to SCO but higher with respect to VOO. The last had the aliphatic and triterpene alcohol concentration higher compared to that of both SCO and MCO. Several chemometric methods, applied to different analytical data sets, proved to be effective in grouping the three oil kinds.

A totally mini-invasive approach for colorectal laparoscopic surgery.

AIM: To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome. METHODS: We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department. Our evaluation criteria were: diagnosis of colorectal carcinoma at presurgical biopsy, elective surgery, and the same surgeon. We excluded: emergency surgery, conversions from laparotomic colectomy, and other surgeons. The endpoints we examined were: surgical time, number of lymph nodes removed, length of stay (removal of nasogastric tube, bowel movements, gas evacuation, solid and liquid feeding, hospitalization), and major complications. Seventy-two patients were divided into two groups: intracorporeal anastomosis (39 patients) and extracorporeal anastomosis (33 patients). RESULTS: Significant differences were observed between intracorporeal vs extracorporeal anastomosis, respectively, for surgical times (186.8 min vs 184.1 min, P < 0.001), time to resumption of gas evacuation (3 d vs 3.5 d, P < 0.001), days until resumption of bowel movements (3.8 d vs 4.9 d, P < 0.001), days until resumption of liquid diet (3.5 d vs 4.5 d, P < 0.001), days until resuming a solid diet (4.6 d vs 5.7 d, P < 0.001), and total hospitalization duration (7.4 d vs 8.5 d, P < 0.001). In the intracorporeal group, on average, 19 positive lymph nodes were removed; in the extracorporeal group, on average, 14 were removed P < 0.001). Thus, intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition, faster recovery of intestinal function, and shorter hospitalization than extracorporeal anastomosis. CONCLUSION: Short-term outcomes favor intracorporeal anastomosis, confirming that a less traumatic surgical approach improves patient outcome.