Hemorrhoidectomy in day surgery.

UNLABELLED: Day-case hemorrhoidectomy has shown to be safe and acceptable to patients. There are principally two procedures: Milligan-Morgan hemorrhoidectomy (MMH) and Longo stapled hemorrhoidopexy (SH). Furthermore great progress has been done in surgical technologies with the use of the Ligasure and the Doppler-guided hemorrhoidal artery ligation. The aim of this study is to analyze randomized controlled trials using all the major electronic databases (MEDLINE, EMBASE, CENTRAL) about hemorrhoidopexy and conventional excisional surgery, and randomized controlled trials about the Ligasure versus the conventional hemorrhoidectomy, and some reports about the use of a new device (Doppler transducer) in an outpatient setting. RESULTS: We found 17 studies from 2004 up to 2008, 1276 patients, 409 in the stapled group, 389 in the conventional group, 268 in hemorrhoidal artery ligation procedure and 210 in Ligasure hemorrhoidectomy group. This study confirms that SH is associated with less postoperative pain and shorter postoperative symptoms, compared with MMH. SH may be a viable alternative to the conventional surgical therapy for hemorrhoids with some advantages and some disadvantages in postoperative complications and costs. An other suitable alternative to conventional procedures is the use of Ligasure, although long-term evaluation of outcomes and morbidity is still needed. Hemorrhoidal artery ligation procedure is safe and easy to learn and to perform, even with a recurrence rate of 12, but randomized trials are mandatory.

Antibiotic prophylaxis and preoperative colorectal cleansing: are they useful?

The utility of antibiotic prophylaxis for colorectal surgery has been assessed and largely confirmed worldwide. There is homogeneous consensus that the antibiotic chosen for prophylaxis must cover both aerobic and anaerobic bacteria, that the toxicity should be minimal and it should be cost effective. Recent studies have questioned the role of preoperative bowel cleansing, which is considered by many surgeons as a widely established practice prior to elective colorectal procedures. New clinical trials are needed to resolve these key questions such as the efficacy of bowel preparation and how to obtain effective timing of antimicrobial prophylaxis.

Infectious complications in colorectal surgery.

Postoperative infectious complications still represent a relevant problem in colorectal surgery. They always results in suffering for the patients and often prolonged hospitalization. Furthermore, they result in additional expenses to cover the cost of antibiotics, blood derivates, total parenteral nutrition, nursing and additional surgical procedures. Prevention and control of hospital infections start with surveillance, which is an important means to constantly evaluate the local bacterial epidemiology. An infection surveillance program finalized to minimize the incidence of postoperative infections through the respect of available techniques leads to a better quality of work in each surgical unit, to a decrease in postoperative hospital stay and to cost reduction.

The role of EUS and MRI in rectal cancer staging.

Rectal cancer continues to be one of the most common tumors worldwide. Its prognosis mainly depends on early diagnosis and precise stage evaluation in order to choose the most effective treatment. In recent years, new and promising technologies have been proposed and are now available in daily practice. Each rectal cancer patient should be considered individually, choosing the diagnostic pretreatment exams that are appropriate for that single clinical case mainly related to the tumor and the available instruments. Clinicians must be informed about the efficacy of these technologies and be aware of any cause of mistake in tumor staging in order to reduce the risk of both improper use and inaccurate staging.

Colorectal cancer: the role of laparoscopy.

Since the first report in 1991 the laparoscopic resection of colon cancer is progressing slowly and just in the last 2-3 years is becoming more popular. The resistance to its use by some general and colo-rectal surgeons is receding. The explanations are that technology is evolving quickly and there is a worldwide diffusion of more sophisticated surgical instruments. Moreover several randomized trials have been published showing that the outcomes of laparoscopic colon surgery are similar or better than those of conventional surgery and the early reports suggesting the tumour dissemination were not confirmed. The revolution in oncological surgery that we are observing in these last decades with the introduction and diffusion of mini-invasive approach is comparable to that regarding conventional surgery during the period of Halsted. Therefore the principles of surgery accepted during the years must not be forgotten.

Female psychopathologic profile during menopausal transition: a preliminary study.

OBJECTIVES: To evaluate the psychopathological profile and the incidence of major depressive disorders in consecutive women attending a Menopause Clinic. METHODS: Women attending outpatient menopause clinic at Filippo del Ponte Hospital in Varese (Italy), referring to the centre from 1 March to 30 April 2005, were invited to fill up a specific questionnaire while waiting for the visit. The questionnaire included demographics and history (e.g. current or past use of antidepressant drugs); symptoms check list (SCL-90-R); Beck depression inventory (BDI). RESULTS: Sixty-four women were enrolled to the study. On the SCL-90-R, "somatic" symptoms cluster was the most frequent. Patients diagnosed as depressed using the Beck depression inventory (BDI) were 18 (28.1%). Thirteen (70%) of currently depressed women presented a positive history of depressive disorders. The analysis of depressed women according to previous depressive disorders revealed higher scores for women with positive history in both scales. Depressed patients have a significantly lower mean age compared to non-depressed patients (53.3+/-6.2 years versus 57.33+/-4.9 years, p=0.023). CONCLUSIONS: Our preliminary data show a high correlation between a history of depressive disorder and recurrence of depression in the menopausal period. Perimenopause seems to be a higher risk period for the development of a depressive disease compared to menopausal status. The somatization cluster warrants further investigation.