Low-pressure versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: It has been previously demonstrated that the rise of intra-abdominal pressures and prolonged exposure to such pressures can produce changes in the cardiovascular and pulmonary dynamic which, though potentially well tolerated in the majority of healthy patients with adequate cardiopulmonary reserve, may be less well tolerated when cardiopulmonary reserve is poor. Nevertheless, theoretically lowering intra-abdominal pressure could reduce the impact of pneumoperitoneum on the blood circulation of intra-abdominal organs as well as cardiopulmonary function. However, the evidence remains weak, and as such, the debate remains unresolved. The aim of this systematic review and meta-analysis was to demonstrate the current knowledge around the effect of pneumoperitoneum at different pressures levels during laparoscopic cholecystectomy. MATERIALS AND METHODS: This systematic review and meta-analysis were reported according to the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, and the Cochrane handbook for systematic reviews of interventions. RESULTS: This systematic review and meta-analysis included 44 randomized controlled trials that compared different pressures of pneumoperitoneum in the setting of elective laparoscopic cholecystectomy. Length of hospital, conversion rate, and complications rate were not significantly different, whereas statistically significant differences were observed in post-operative pain and analgesic consumption. According to the GRADE criteria, overall quality of evidence was high for intra-operative bile spillage (critical outcome), overall complications (critical outcome), shoulder pain (critical outcome), and overall post-operative pain (critical outcome). Overall quality of evidence was moderate for conversion to open surgery (critical outcome), post-operative pain at 1 day (critical outcome), post-operative pain at 3 days (important outcome), and bleeding (critical outcome). Overall quality of evidence was low for operative time (important outcome), length of hospital stay (important outcome), post-operative pain at 12 h (critical outcome), and was very low for post-operative pain at 1 h (critical outcome), post-operative pain at 4 h (critical outcome), post-operative pain at 8 h (critical outcome), and post-operative pain at 2 days (critical outcome). CONCLUSIONS: This review allowed us to draw conclusive results from the use of low-pressure pneumoperitoneum with an adequate quality of evidence.

[Neuroendocrine carcinoma of the breast: a rare entity]. / Carcinoma neuroendocrino della mammella: una rara evenienza.

Nowadays neuroendocrine breast cancer is a rare entity, though the presence of neuroendocrine cells is often detected within breast cancers. Most of these tumours are associated with conventional ductal or globular breast cancers. We describe the case of neuroendocrine cancer of the breast and discuss its clinical, radiological and cytological aspects.

Leiomyosarcoma of the inferior vena cava: a case report and review of the literature.

Leiomyosarcoma of the inferior vena cava is a particularly rare tumour, originating from the smooth muscle of the vessel wall. The authors describe the case of a female patient admitted with a picture of anorexia and weight loss, accompanied by epi- and mesogastric pain. Preoperative examinations revealed the presence of a mass of considerable size originating from the inferior vena cava. The patient was submitted to surgery consisting in removal of the mass and of part of the wall of the vena cava. A review of the literature confirms the rarity of this tumour and demonstrates that optimal anatomical knowledge is absolutely indispensable for the management of this pathology.

Repair of primary and incisional hernias using composite mesh fixed with absorbable tackers: preliminary experience of a laparoscopic approach with a newly designed mesh in 29 cases.

Outcome of primary and incisional hernia repair is still affected by clinical complications in terms of recurrences, pain and discomfort. Factors like surgical approach, prosthesis characteristics and method of fixation might influence the outcome. We evaluated in a prospective observational study a cohort population which underwent primary and incisional laparoscopic hernia repair, with the use of a composite mesh in polypropylene fixed with absorbable devices. We focused on assessing the feasibility and safety of these procedures; they were always performed by an experienced laparoscopic surgeon, analyzing data from our patients through the EuraHS registry. Seventy nine procedures of primary and incisional hernia repair were performed from July 2013 to November 2015 at Santa Maria Regina degli Angeli Hospital in Adria (RO). All cases have been registered at the EuraHS registry ( http://www.eurahs.eu ); among them, we analyzed 29 procedures performed using a new composite polypropylene mesh (CMC, Clear Composite Mesh, DIPROMED srl San Mauro Torinese, Turin, Italy), fixed with absorbable tackers (ETHICON, Ethicon LLC Guaynabo, Puerto Rico 00969). We performed 23 incisional hernia repairs, 4 primary hernia repairs (1 umbilical, 2 epigastric and 1 lumbar hernia) and 2 parastomal hernia repairs. The median operation time was 65.1 min for elective and 81.4 min for urgent procedures (three cases). We had two post-operative complications (6.89%), one case of bleeding and another case of prolonged ileus successfully treated with conservative management. We had no recurrences at follow-up. According to QoL, at 12 months patients do not complain about any pain or discomfort for esthetic result. Laparoscopic treatment of primary and incisional hernia with the use of composite mesh in polypropylene fixed with absorbable devices is feasible and safe.

Urinary and sexual disorders after laparoscopic TME for rectal cancer in males.

BACKGROUND: Urinary and sexual dysfunctions are frequent after surgery for rectal cancer. Total mesorectal excision (TME) improves local recurrence and survival rates, and does not hamper recognition and sparing of hypogastric and pelvic splanchnic nerves. It is not known how laparoscopic rectal resection could change functional complication rates. MATERIALS AND METHODS: From a global series of 1,216 laparoscopic interventions for colorectal diseases, 35 cases of males less than 70 years old, undergoing rectal resection and TME for a T1-3M0 medium and low rectal cancer were selected. Urinary and sexual functions after the operations were retrospectively recorded by means of specific tools (International Prostate Symptom Score (IPSS) and IIEF questionnaires, respectively). RESULTS: None of the patients necessitated permanent or intermittent catheterization. More than half the patients had no complaints about urinary functions; about one third had nocturia; 72% of the patients had an IPSS less that 10, and no case of IPSS worse that 31 was recorded. Sexual desire was reduced and spontaneous erectile function was impaired in almost half the cases, while induced erections were possible in about 90% of cases; about 70% of patients still had the possibility of penetration and a normal ejaculation and orgasm after the intervention. DISCUSSION AND CONCLUSIONS: The present series confirms previous data and contribute to the creation of a benchmark specifically related to the laparoscopic approach to which surgeons should face when informing the patients before the operation. While severe urinary dysfunction is rare, sexual impairment remains a serious concern after rectal resection with TME.