Totally laparoscopic right hemicolectomy with up-down approach. A single institution experience.

AIM: Many laparoscopic techniques have been described for the treatment of right colon cancer. The purpose of this study is to communicate our experience in the totally laparoscopic treatment of right colon cancer and to report our short-term results in order to confirm the feasibility and safeness of this demanding procedure. MATERIAL OF STUDY: From November 2017 to April 2020, we performed 384 surgical operations for colorectal cancers, of these 81 have involved tumors of the right colon in urgent and elective conditions. Right hemicolectomies with a totally laparoscopic approach were performed, by the same surgical team, in 55 patients in elective surgery. RESULTS: During the study period we evaluated intra and postoperative complications in terms of: demographic data and preoperative clinical characteristics, intraoperative and postoperative outcomes (operative time, blood loss, conversion rate, surgical complications, hospitalization, readmission, and mortality), pathological outcomes. DISCUSSION: Our experience confirms that totally laparoscopic approach, with up to down dissection, for the treatment of right colon cancer, performed by expert surgeons is a safe and feasible technique. CONCLUSION: This procedure allows the mesocolon excision with outstanding number of harvested lymph nodes ensuring low complications and better oncological cleaning. KEY WORDS: Central Vascular Ligation, Colorectal Cancer, Fluorescence GLaparoscopy, Right Hemicolectomy, Complete Mesocolic Excision, Surgery.

Laparoscopic appendectomy for the treatment of acute appendicitis: A single center experience.

AIM: The aim of our study is to compare the pre, intra- and post-operative variables of the two surgical techniques, to demonstrate if laparoscopic appendectomy can be considered safer and associated to better outcome. MATERIAL OF STUDY: A retrospective analysis of 175 patients has been carried out. Alvarado score, time of surgery, analgesic therapy and length of hospital stay calculated. Finally, postoperative complications were recorded. RESULTS: From January 2011 - April 2016 175 patients were enrolled: 128pts underwent laparoscopic technique and 47pts open technique. The average value of Alvarado score is lower in LA group than in OA group just as the average time of surgery and the use of post-operative analgesic therapy. DISCUSSION: LA has become the surgical technique mostly performed for the treatment of simple and complicated acute appendicitis. Our study shows that LA pts are younger with a statistically significant difference CONCLUSIONS: Most of the emergency appendectomies were performed via laparoscopic technique, especially in young patients. Laparoscopy is safer and associated to better outcome. KEY WORDS: Alvarado Score, Laparoscopic appendectomy, Open appendectomy.

Surgical approach for ulcerated locally advanced breast cancer. A single Center experience: a retrospective study.

AIM: The aim of our retrospective study is to analyze surgical possibilities for the extended LABC in those cases not suitable for a neoadjuvant chemotherapy step and to consider various reconstruction techniques. MATERIAL OF STUDY: Between 2009 and 2015 we enrolled 11 patients, admitted to the Emergency Department, presenting ulcerated LABC that needed palliative surgical demolitive procedures because of bleeding and anemia and in which was necessary to use natural tissues transposition or synthetic substitutes for the reconstruction of the skin flaps. RESULTS: The mean follow up was 12 months. Mortality rate was 82% (9 patients); in 2 cases there was local relapse after 6 months; 9 months was the longest disease free survival. DISCUSSION: Thanks to multidisciplinary strategies LABC's surgical treatment improved results with a five-year survival rate between 30-40% and better quality of survival. Despite extended demolitive approach, there is still a 50% of death because of metastases. CONCLUSIONS: Our results confirm that musculocutaneous flap, skin anterior thigh grafts, bilayer matrix wound dressing are excellent reconstructive strategies in locally advanced ulcerated breast cancer after aggressive extended surgery even if palliative to improve patients' further survival. Our data also showed that those patients presenting medium level of malignancy as "luminal b" subtype (7 patients) if treated earlier with a radical surgical procedure would have better prognosis. KEY WORDS: Oncoplastic techniques, Ulcerated breast cancer.

Laparoscopic and Open Surgical Treatment in Gastroduodenal Perforations: Our Experience.

INTRODUCTION: Peptic ulcer perforation (PPU) is a common surgical emergency and the mortality rate ranges 10% to 40%, especially in elderly patients. Laparoscopic repair achieved encouraging results. MATERIALS AND METHODS: We enrolled patients performing surgical repair for PPU from January 2007 to December 2015 in our surgical unit. The aim of this retrospective observational study was to compare the results of PPU laparoscopic repair with open technique. The following characteristics of patients were evaluated: age, sex and American Society of Anesthesiologists classification. The site and the diameter of perforation were recorded: gastric, pyloric, duodenal, and the location on the anterior or posterior wall. RESULTS: In total, 59 patients (39 males and 20 females) with a mean age of 58.85 years (±SD) were treated surgically. Laparoscopic repair was accomplished in 21 patients. The mean operative time for laparoscopic repair was 72 minutes (±SD), significantly shorter than open repair time (180 min ±SD). The results demonstrated that laparoscopic repair is associated with a shorter operative time, reduced postoperative pain (4.75 vs. 6.42) and analgesic requirements, a shorter hospital stay (7.5 vs. 13.1), and earlier return to normal daily activities. DISCUSSION: Laparoscopic surgery minimizes postoperative wound pain and encourages early mobilization and return to normal daily activities. The benefit of early discharge and return to work may outweigh the consumable cost incurred in the execution of laparoscopic procedures. CONCLUSIONS: Complications in both procedures are similar but laparoscopic procedure shows economic advantages for reducing postoperative hospital stay, postoperative pain, and for a good integrity of abdominal wall.