Does the nasogastric tube has a role in elective colo-rectal surgery?

INTRODUCTION: Routine use of nasogastric tubes (NGT) after abdominal operations is intended to hasten the return of bowel function, diminish the risk of anastomotic leakage and prevent pulmonary complications. The aim of our study was to prospectively assess the tolerability and the safety of the non use of NGT after elective colorectal open operations. PATIENTS AND METHODS: Between March 2009 and December 2010, 110 consecutive patients underwent colo-rectal elective open surgery for neoplasm without nasogastric decompression. We analyzed the incidence of nausea and vomiting, the pulmonary complications, the return of bowel function the deep wound breakdown (fascial dehiscence) and the anastomotic leakage. RESULTS: Only 15 patients (13,6%) reported nausea without vomiting immediately after surgery and 9 cases of vomiting were observed (8%), requiring the insertion of the NGT (nasogastric tube) in 5 (4,5%). A total of 105 patients (96,3%) were NGT free. No deep wound dehiscence was observed and only one real pneumonia occurred. Anastomotic dehiscence occurred in 4 patients (3,6%) and a second surgical procedure was needed in three cases. The return of bowel function, except in the last four patients, occurred in 3,8 days average (range 2-7 days). CONCLUSION: We confirm the uselessness of the NGT in the framework of fast track program adopted in elective open colo-rectal surgery.

The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit.

BACKGROUND: Since its first description in the early 1990s, minimally invasive Heller myotomy has become the treatment of choice for esophageal achalasia. We report the experience of a single unit with thoracoscopic Heller myotomy (THM) and laparoscopic Heller myotomy (LHM) and we analyze the short- and long-term surgical outcomes in patients treated by each of the two approaches. METHODS: We evaluated retrospectively 33 patients who underwent surgical treatment for achalasia. Sixteen patients underwent THM without an antireflux procedure, and 17 patients underwent LHM and partial anterior fundoplication (n = 10) or closure of the angle of His (n = 7). RESULTS: Mean operative time was significantly shorter for LHM than for THM (150 vs 222 min, respectively) (p = 0.0001). Mean hospital stay was significantly shorter after LHM than after THM (2.0 +/- 1.0 vs 5.1 +/- 2.2 days, respectively) (p = 0.0001). Six of 16 patients (37.5%) in the THM group experienced persistent or recurrent dysphagia compared to one of 17 patients (5.8%) in the LHM group (p = 0.04). Heartburn developed in five patients (31.2%) after THM and in one patient (5.8%) after LHM (p = 0.07). Regurgitation developed in four patients (25%) after THM and in one patient (5.8%) after LHM (p = 0.149). Lower esophageal sphincter (LES) basal pressure decreased significantly from 30.1 +/- 5.07 to 15.3 +/- 2.1 after THM and from 32.1 +/- 5.9 to 10.5 +/- 1.7 after LHM (p = 0.0001). Mean esophageal diameter was significantly reduced after LHM compared to THM (from 54.5 +/- 5.7 mm to 27.1 +/- 3.3 mm vs 50.8 +/- 7.6 mm to 37.2 +/- 6.9 mm, respectively) (p = 0.0001). CONCLUSION: In our experience, LHM is associated with a shorter operative time and a shorter hospital stay, and it is superior to THM in relieving dysphagia. LHM with partial anterior fundoplication should be considered the treatment of choice for achalasia.

[Esophago-jejuno-gastroplasty in the treatment of peptic stenosis of the esophagus]. / L'esofago-digiuno-gastroplastica nel trattamento delle stenosi peptiche dell'esofago.

From 1973 to 1994, 21 patients with esophageal peptic stenosis were submitted to esophago-jejuno-gastroplasty with Merendino's technique. In 14 cases peptic stenosis developed after Heller's myotomy for achalasia, associated in 3 cases with fundoplication. In 3 patients the stenosis was secondary to fundoplication. Other 3 subjects presented a primary stenosis. One patient showed Barrett's esophagus with in situ carcinoma. Endoscopic esophageal dilatation was attempted in every patient with no satisfactory results. One patient died for a postoperative cardiopulmonary failure (4.7%). One patient developed a fistula of the esophago-jejunal anastomosis treated with enteral nutrition successfully (4.7%). In another subject splenectomy was performed following a iatrogenic injury (4.7%). Minor complications developed in 5 patients (23.7%). After one year from operation in 1 patient a severe stricture of esophago-jejunal anastomosis appeared; it was treated with anastomotic resection and reconstruction. After 8 years one patient was submitted to a partial resection of interposed jejunal loop, that was redundant. In 18 patients long term follow-up showed good results in 14 patients (78%), discrete in 2 (11%), unsatisfactory in 2 (11%). Our results show that Merendino's esophago-jejunal gastroplasty allows to achieve good results with acceptable rate of mortality and morbidity.

[Single asymptomatic splenic metastasis of breast carcinoma: report of a clinical case]. / Metastasi splenica unica asintomatica da carcinoma della mammella: descrizione di un caso clinico.

The spleen is rarely involved from metastatic disease. Metastases from breast cancer are extremely rare although described in the Literature. The Authors report a case of a woman who had undergone to radical mastectomy for breast cancer nine years previously and admitted to the hospital because of a single splenic lesion shown by U.S. scan during the follow up.

[Feasibility and reliability of the study of sentinel lymph nodes with immunohistochemical technique in colonic carcinoma]. / Fattibilità e accuratezza dello studio del linfonodo sentinella con tecnica immunoistochimica nel carcinoma del colon.

Sentinel lymph node sampling, in patients with resectable colon cancer, improved identification of lymph node disease and identified patients likely to benefit from adjuvant therapy. This study examined whether sentinel node sampling accurately predicted lymph node status for patients with resectable colon cancer.