Roux-en-Y reconstruction at greater curvature in biliopancreatic diversion: effects on early postoperative functional recovery.

Delayed gastric emptying after distal gastrectomy and reconstruction of alimentary tract with a gastroenteric anastomosis can significantly influence early and late postoperative course and the length of hospital stay. The purpose of this study was to compare the effect on postoperative functional recovery of two different Roux-en-Y reconstructions: at the gastric greater curvature and at the transected gastric staple line in the Scopinaro's biliopancreatic diversion. We conducted comparative study; 80 patients were enrolled and divided in two groups: group A (RY-GC) and group B (RY-SL) with 40 patients in each group. We compared the early postoperative functional recovery for both groups measuring four parameters: gastric stasis indicated with the volume of the gastric fluid collected per 24 h, day of removal of the nasogastric tube, day of starting the oral intake, and day of hospital discharge. There was statistically significant (p < 0.001) reduction in gastric fluid volume in favor of the RY-GC group starting from the first postoperative day resulting in earlier removal of nasogastric tube with earlier starting of oral feeding than RY-SL group, with no symptoms of stasis required nutrition suspension; while three patients in RY-SL group experienced persistence of nausea and vomiting and needed nutrition suspension for several days. There was statistically significant (p < 0.001) reduction in the hospital stay for RY-GC group. Roux-en-Y reconstruction at the greater curvature ensures a rapid functional recovery with early hospital discharge. The use of stapler devices made this method easier and safer and no complications have arisen with mechanical anastomoses.

[Self-expanding oesophageal stents: comparison of Ultraflex and Choostent]. / Endoprotesi esofagee autoespansibili: studio di confronto tra Ultraflex e Choostent.

Two types of covered self-expanding metal stents were compared in a consecutive series of 57 patients. Stent placement was successful in all patients. No procedure-related deaths were observed. The overall hospital morbidity was 7%. No significant differences in the efficacy of palliation of dysphagia, rate of complications, and survival rates were seen using the two types of stent. An endoscopic reintervention was required in 14% of the patients. Both stents proved to be safely removable in the short term follow-up, and the benefit of temporary insertion was documented in patients with primary oesophageal neoplasms prior to chemotherapy or chemoradiation therapy and in those with anastomotic strictures/leaks. A multidisciplinary strategy, guided by the concept that a stent should not represent the only, definitive treatment modality, may improve the quality of life of patients with advanced oesophageal carcinoma.

[Laparoscopy in patients with colonic diverticulitis. Results of a prospectic data base]. / Resezioni coliche laparoscopiche per malattia diverticolare. Risultati da un database prospettico.

AIM OF STUDY: To evaluate the outcome of laparoscopic surgery in patients affected by colonic diverticulitis. MATERIALS AND METHODS: A prospective database was established in 1998 at our department to evaluate the results of laparoscopic treatment for diverticular disease. Contraindications to laparoscopic approach were: intestinal obstruction, faecal peritonitis, previuos major abdominal operations, presence of abdominal mass. Parameters evaluated were: indications to operation, age, sex, weight, type of operation, associated operations, operation time, conversion rate, mortality, post-operative complications, postoperative hospital stay, return to normal bowel function, time of removing nasogastric tube and time of restarting oral feeding. RESULTS: From 1998 to 2005, 109 patients operated for diverticular disease were registered. The operation was performed in 17 cases (15.5%) with open technique, in 20 cases (18.5%) throught video-assisted approach with extracorporeal anastomosis and in 72 cases (66%) with laparoscopic approach making intracorporeal anastomosis. The conversion rate was 10.8%. Mortality was 0%. In videolaparoscopic group mean operating time was 177 minutes, major complications were 4 (6.3%), minor complications were 6 (9.5%) and mean hospital stay was 7.8 days. In videoassisted group minor operation time was 158 minutes, complications were 9 (47.3%) and mean hospital stay was 10.1 days. CONCLUSIONS: Laparoscopic approach to diverticular disease of the colon is, in selected cases, a safe, feasible and effective procedure.