Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

INTRODUCTION: Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. MATERIAL AND METHODS: A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. RESULTS: Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). CONCLUSIONS: DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Role of a Stoma Nurse in the Management of the Specific Stoma-Related Complications.

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life.

The Crucial Role of Nurses in the Comprehensive Management of Postoperative Enteroatmospheric Fistula: A Narrative Review.

Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.

The Impact of Cancer Stem Cells in Colorectal Cancer.

Despite incessant research, colorectal cancer (CRC) is still one of the most common causes of fatality in both men and women worldwide. Over time, advancements in medical treatments have notably enhanced the survival rates of patients with colorectal cancer. Managing metastatic CRC involves a complex tradeoff between the potential benefits and adverse effects of treatment, considering factors like disease progression, treatment toxicity, drug resistance, and the overall impact on the patient's quality of life. An increasing body of evidence highlights the significance of the cancer stem cell (CSC) concept, proposing that CSCs occupy a central role in triggering cancer. CSCs have been a focal point of extensive research in a variety of cancer types, including CRC. Colorectal cancer stem cells (CCSCs) play a crucial role in tumor initiation, metastasis, and therapy resistance, making them potential treatment targets. Various methods exist for isolating CCSCs, and understanding the mechanisms of drug resistance associated with them is crucial. This paper offers an overview of the current body of research pertaining to the comprehension of CSCs in colorectal cancer.

The Role of Ileostomy in the Prevention and Treatment of Anastomotic Leakage after Elective Rectal Cancer Surgery - A Retrospective Analysis of Specific Risk Factors, Outcomes, and Complications.

Background: The objective of this paper is to highlight the role and place of ileostomy from the perspective of the risk of anastomotic leakage (AL). Materials and method: This was a retrospective study of 74 (46.54%) low and ultra-low anterior resections from 159 cases of rectal cancer operated on in a seven-year interval (2015 - 2021). The cases were divided into two groups: Group A with protective ileostomy (47 cases = 63.51%) and Group B without protective ileostomy (27 cases = 35.49%). Results: The type of anastomosis was low colorectal for 15 cases and ileorectal for two cases, both in Group A, with either mechanical or manual sutures. Continuous loop ileostomy was the only fecal diversion procedure used for protection. The ileostomy-specific complications recorded in Group A were peristomal skin lesions (8 cases), early peristomal hernia (2 cases), and severe dehydration with acute renal-insufficency (7 cases). The closure of the ileostomy was performed in 42 cases (89.36%), with the time between the primary operation and the closure being 4.28 months on average, with limits between 12 days and 10 months. AL treatment was conservative in 13 (76.47%) cases and surgical in four cases, with the types of operations performed at reintervention being take-down of the anastomosis + left terminal colostomy + ileostomy closure in three cases (2 in Group A and 1 in Group B) and terminal ileostomy in one case in Group A. Conclusions: To reduce its specific complications, ileostomy should be performed in well-selected patients. Those with risk factors for leakage include males, the elderly, and those having important comorbidities, neoadjuvant chemoradiotherapy, low tumors below 5 cm from the anal verge, or complete circumferential stenosis and peritumoral inflammatory infiltrate.

Management of Anastomotic Leakage after Low Anterior Rectal Resections with Total Mesorectal Excision - A Retrospective Study.

Background: This study sought to investigate the diagnostic procedures, treatment modalities, and consequences of anastomotic leakage (AL) in low anterior resection rectal cancer patients. Methods: A retrospective analysis was conducted on 186 patients consecutively admitted and treated in the 1st Department of Surgery in Craiova, between January 2018 and June 2022, all of whom had undergone surgical interventions for adenocarcinoma of the rectum. Among this cohort, 106 patients who had undergone scheduled low and ultralow anterior rectal resections with total mesorectal excision were selected for further analysis. Twenty-four patients were diagnosed with postoperative AL and underwent diverse management strategies based on the severity of their condition. Results: The study revealed an incidence of 22.6% for postoperative AL, with all of them being classified as grade B and C, according to the 2010 International Study Group of Rectal Cancer Classification, which were associated with significant morbidity and mortality. Notably, patients exhibited various comorbidities, including obesity, arterial hypertension, type 2 diabetes mellitus, and kidney failure. The management approach depended on the severity of the clinical presentation and the availability of treatment options. Early diagnosis and conservative management constituted the initial therapeutic strategy for grade B AL, with surgical reintervention or transanal vacuum therapy being used in grade C AL. Conclusions: The incidence and mortality associated with AF following low anterior resections were notably elevated. Grade B AL were successfully managed through conservative treatment, whereas grade C AL required either surgical reintervention for drainage or diversion procedures, or transanal vacuum therapy.

Ventral Hernia Repair and Diabetes Mellitus - A Prospective, Observational and Comparative Study of Outcomes.

Diabetes mellitus (DM) and obesity are known to influence postoperative outcomes in surgical patients. This study aimed to analyze the divergence in outcomes between patients with and without DM who underwent ventral hernia repair, while also assessing the additional impact of obesity on postoperative complications, hospitalization, and costs. A prospective, non-interventional, observational study was conducted over five years (2018-2022) at the First Surgical Clinic of Craiova Emergency Clinical Hospital. The study included 216 patients, with 42 (19.44%) having DM, half of whom were also obese. There were no significant differences in age between patients with or without DM. However, diabetes and obesity were more prevalent in female patients. The mean duration of hospitalization was 10.7±8.6 days, with no significant differences observed between patients with or without DM or obesity. Statistical analysis revealed that patients with DM had a higher incidence of seroma formation, wound infection, and hematoma formation compared to patients without DM. However, there were no significant differences in mesh infection, hospitalization days, or costs between the two groups. Similarly, no significant differences were found between obese and non-obese patients in terms of complications, hospitalization days, or costs. In conclusion, this study highlights that DM is associated with an increased risk of specific complications in ventral hernia repair, including seroma formation, wound infection, and hematoma formation. However, the impact of obesity on these outcomes appears to be limited. Individualized preoperative optimization and targeted interventions are necessary to mitigate the risk of complications in patients with DM or obesity.

Ventral Hernia Repair and Drainage - A Prospective, Observational, and Comparative Study of Outcomes.

Background: While ventral hernia repair is a frequent surgical intervention, the possibility of complications remains present. The use of drains to mitigate complications is a topic of debate, with conflicting evidence. This study aimed to evaluate the association between drain usage and postoperative complications in ventral hernia repair. Materials and Methods: A single-center prospective study included patients undergoing ventral hernia repair from 2018 to 2022. Patient data and surgical techniques were recorded. Statistical analysis was performed to assess risk factors for drain insertion and complications. Results: Of the 216 patients included, 19.44% had diabetes, and 20% had cancer. Postoperative complications (Clavien Dindo grade IIIB) occurred in 9.3% of cases, resulting in a 3.7% mortality. Decision factors for drain insertion included older age, larger hernia size, bowel resection with anastomosis, emergency setting and the need for adhesiolysis. No differences were found between the two groups regarding seroma and hematoma formation and mesh infection. Patients with drains had a longer hospital stay and higher costs. Conclusion: The decision to use drains in ventral hernia repair was influenced by surgical complexity factors rather than patient characteristics. While drain usage did not correlate with postoperative morbidities, it was associated with longer hospitalization and higher costs. Individualized decision-making is crucial to balance complications and resource utilization in ventral hernia repair.

Schwannoma: A Rare Case of Submucosal Gastric Tumor.

Schwannoma is a tumor that originates from the Schwann cells that surround a neuron's axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they account for only 0.2% of gastric tumors. We present the case of a 56-year-old asymptomatic patient who was diagnosed, following a routine ultrasound examination, with an abdominal tumor. An abdominal MRI confirmed the gastric origin of the tumor. Although a subsequent upper-digestive endoscopic ultrasound was performed, a definitive diagnosis could not be established. Thus, a laparoscopic wedge resection of the stomach was performed. The immunohistochemical examination of the tumor established the diagnosis of benign schwannoma. Despite the availability of advanced endoscopy and imaging techniques, the diagnosis of gastric schwannoma is very rarely preoperative. The immunohistochemical identification of S-100 on the surgical specimen confirmed the diagnosis.

Could there be an interplay between periodontal changes and pancreatic malignancies?

The term "periodontal disease" refers to a group of chronic inflammatory illnesses caused by specific microorganisms from subgingival biofilm, that affect the tooth-supporting tissues. Recent research has also shown that periodontal infection plays a role in aggravating systemic disease states at distal sites, reinforcing the significance of the oral cavity for general health. Additionally, it has been suggested that gastroenterological malignancies may be promoted by hematogenous, enteral or lymphatic translocation of periopathogens. In the past 25 years, the global burden of pancreatic cancer (PC) has more than doubled, making it one of the major causes of cancer-related mortality. Periodontitis has been linked to at least 50% increased risk of PC and it could be considered a risk factor for this malignancy. A recent study performed on 59000 African American women with a follow up of 21 years showed that participants who had poor dental health had higher chances of PC. The findings, according to researchers, might be related to the inflammation that some oral bacteria trigger. Regarding the mortality of PC, periodontitis considerably raises the chance of dying from PC. Microbiome alterations in the gut, oral cavity and pancreatic tissues of PC patients occur when compared to healthy flora, demonstrating a link between PC and microecology. Inflammation may also contribute to PC development, although the underlying pathway is not yet known. The function of the microbiome in PC risk has drawn more focus over the last decade. Future risk of PC has been linked to the oral microbiome, specifically increased levels of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and decreased relative abundance of Leptotrichia and Fusobacteria, suggesting that it may have an impact on the inflammatory condition by expanding, altering, and regulating the commensal microbiome. Patients who received periodontal treatment had significantly decreased incidence rate ratios for PC. By analyzing patterns in the microbiome composition throughout PC development and establishing strategies to enhance the cancer-associated microbial system, we can increase the efficacy of therapy and eventually find an application for the microbial system. The development of immunogenomics and gut micro-genomics in the life sciences will result in a significant advancement in our understanding of how microbial systems and immunotherapy interact, and it may also have intriguing therapeutic implications for extending the lifetime of PC patients.

Postoperative Pain after Inguinal Hernia Repair Using the Tension-Free Lichtenstein Procedure: A Retrospective Study.

Inguinal hernia surgery is a constantly evolving field, with ongoing research efforts aimed at enhancing surgical techniques and outcomes for patients. This retrospective study conducted between 2015 and 2020 in the First Surgical Clinic of Craiova Emergency Clinical Hospital focused on the occurrence and characteristics of postoperative pain following inguinal hernia repair using the tension-free Lichtenstein procedure. A total of 178 patients were included in the study, with 16.85% reporting postoperative pain. The average pain intensity was 6.4 on a scale of 1 to 10. Patients described the pain as numbness, burning sensation, stinging, pressure, and tingling sensations. Notably, 50% of patients reported pain related to weather changes. While the study explored potential relationships between patient demographics, hernia type, and postoperative pain, no statistically significant associations were found. Approximately 20% of patients with postoperative pain reported adverse effects on their work, and 10% used analgesics for pain management. This study highlights the multifaceted nature of postoperative pain following inguinal hernia repair, emphasizing the need for further research to identify individual risk factors and adherence to international guidelines for hernia management. The findings also underscore the importance of effective pain management strategies to improve patient comfort and quality of life post-surgery.

Anastomotic Leakage after Colorectal Surgery: Risk Factors, Diagnosis and Therapeutic Options.

Anastomotic leakage (AL) is the most severe and devastating complication of colorectal surgery. The objectives of this study were to identify the risk factors involved in the development of AL, evaluate diagnostic methods and explore therapeutic options in case of colorectal cancer surgery. MATERIAL AND METHODS: we conducted a retrospective study on 28 AL recorded after 315 elective colorectal cancer surgeries performed in 1st Surgery Clinic of Craiova over an 8-year period (2014-2022). RESULTS: The overall incidence of AL was 8.88%. The identified risk factors were rectal cancer (22.38%), low anterior rectal resection (50%), open approach, advanced age (82.15% over 60 years old), male sex (3:1), and the presence of two or more co-morbidities. Medical conservative treatment was the primary line of treatment in all cases. Leakage closure was achieved in 22 cases (78.56%), with exclusive conservative treatment in 15 cases (46.42%) and combined conservative and surgical treatment in 7 cases (25.0%). Overall morbidity was recorded at 64.28%, with 8 cases of general evolving complications and 10 cases of local complications. General mortality was reported at 6 (21.42%), with 3 (16.66%) occurring after conservative treatment and 3 after re-interventions (30%). CONCLUSIONS: our study identified advanced age, the presence of two or more co-morbidities, male sex, rectal surgery, and neoadjuvant chemoradiation as the most important risk factors for AL. Medical conservative treatment was the primary treatment modality, while reoperation was necessary in cases of uncontrollable sepsis and MODS. Mortality after re-intervention was nearly double compared to conservative treatment.

Intestinal Stomas in Abdominal Surgery: Etiological Circumstances, Indications, High Gravity Factors and Complications.

This is a retrospective study of 264 intestinal stomas performed in the surgical unit of the Emergency Clinical Hospital "Bagdasar Arseni", Bucharest, within a 7-year period (2015-2021) aiming to evaluate their evolutive complications, risk factors, management and prevention strategies. Material and method. Colostomies: 218 (82.57%) cases, ileostomies 46 (17.43%) cases. Temporary stomas (103 cases or 39.02%) were isolated stomas of discharge in 45 cases and associated with other colorectal procedures in 58 cases. Postoperative complications included general systemic complications in 60 (22.72%) cases and local complications specific to stomas in 84 (31.81%) cases and common to abdominal surgery in 94 (35.60%) cases, which were solved by reoperation in 51 cases, with a reintervention rate of 19.31%. Stoma closures were performed in 34 (33.0%) of the 103 patients with temporary stomas. Of these, 26 (25.24%) patients died in the early postoperative period (< 30 days), the remaining 60 patients refused reintervention or were lost to follow-up. Conclusions. Faecal diversion still represents a therapeutic option for a wide range of benign or malignant digestive or extra-digestive abdominal diseases performed in emergency or scheduled surgeries, mostly for colorectal cancer and its complications.

Therapeutic Options in Postoperative Enterocutaneous Fistula-A Retrospective Case Series.

OBJECTIVES: The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF). MATERIALS AND METHODS: We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014-31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21-94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn's disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded. RESULTS: The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%. CONCLUSION: PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy.

The Need for Oral Hygiene Care and Periodontal Status among Hospitalized Gastric Cancer Patients.

Poor oral hygiene leads to the accumulation of dental plaque, thus contributing to the initiation of periodontal disease (PD). Local infections can lead to systemic inflammatory responses, which are essential mediators for the evolution of systemic conditions or cancer tumorigenesis. Often, patients hospitalized with life-threatening and incapacitating disorders such as gastric cancer (GC) might lose interest in keeping their mouth healthy. This study evaluates oral hygiene, periodontal status, and the need for oral care and medical personnel to assist in achieving it in patients hospitalized with GC. This study was carried out on 25 patients with a diagnosis of GC, divided into two groups (GP-14 patients from the Gastroenterology Department, and SP-11 patients from the 1st Department of Surgery). Patients were examined on the day of admission (T0), the day of the medical procedure of endoscopy or surgery (T1), and the day of discharge (T2), recording the number of absent teeth, dental plaque (PI), bleeding on probing (BOP), probing depths (PPD), frequency of toothbrushing, and if the oral hygiene had been self-performed or assisted. Data were subjected to statistical analysis. Our results showed that, in both the GP and the SP group, there were strong and statistically significant correlations between PI and BOP measured on the last day of hospitalization and the period of hospitalization after the medical procedure. Longer hospital stays and the presence of surgery were risk factors for changing toothbrushing frequency. Results also highlight the need for a dentist to diagnose and eventually treat periodontal disease before and after hospitalization, and for a trained nurse who should help take care of the patient's oral hygiene during hospitalization.

Subgingival Periopathogens Assessment and Clinical Periodontal Evaluation of Gastric Cancer Patients-A Cross Sectional Pilot Study.

Oral microbiota have shown a higher bacterial diversity in patients with cancers of the digestive tract, with higher levels of periopathogens. Recent studies have shown that Fusobacterium links to gastro-intestinal neoplastic tissue and accelerates its progression, as well as worsening patient outcome. The present pilot study was carried out between February and December 2020 to evaluate the possible association between the abundance of some periopathogens (Fusobacterium nucleatum, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola and Tannerella forsythia) in subgingival plaque and periodontal status with characteristics of gastric cancer. The study was performed on a sample of 24 patients with gastric cancer from the 1st Department of Surgery and Department of Gastroenterology within the Clinical County Hospital of Emergency of Craiova, Romania. The patients' oral cavity was examined, gingival crevicular samples were collected, and signs of periodontal disease were recorded. On the histopathological exam, the differentiation grade and size of the tumour were registered. Our results showed that, from the periopathogens studied, the most abundant bacteria were F. nucleatum followed by T. forsythia in all groups. In our present study, the strong correlation between tumour dimension and all periodontal parameters but also between tumour dimension and F. nucleatum could suggest a positive association between periodontal disease, tumoral growth and periopathogens implication in this process.

Nonoperative Treatment of Abdominal Trauma Involving Liver and Spleen.

Introduction: The management of this type of trauma has evolved considerably, especially with the introduction of interventional radiology (angiography, splenic artery embolization - SAE) but also the concept of non-operative treatment (NOT), defined as a follow-up of injuries, without surgery. Material and Method: We have established a strategy for dealing with cases of abdominal trauma with injuries by non-operative treatment (NOT). We applied NOT to 13 patients in 50 (26%), of which 8 were patients with spleen injuries and 5 were patients with liver damage. Most of the lesions were grade II (8 cases), 2 cases were grade I and 3 cases were grade III. Results: There was only one case dealt by NOT, in which surgery was performed 48 hours after admission. In two patients with extravasation of the contrast agent on CT and angiography, angioembolization of the splenic artery was performed, with good results. Control CT was performed at a period that varied between 24 hours and 5 days after admission. The average period of hospitalization of patients approached by NOT was 6,6 days. Conclusions: Contrast-enhanced CT examination remains the basis for NOT initiation, providing the necessary data on the degree of liver or splenic lesion, the size of blood collections and extravasation of the contrast substance but is also the essential imaging exploration in assessing NOT efficacy. Angioembolization can be successfully performed in cases where CT examination and angiography show contrast extravasation. There was only one case included in the NOT, which was operated laparoscopically, but most authors emphasize that this should not be considered a failure of the method.

Intraoperative cardiovascular response of natural orifice transluminal endoscopic surgery versus laparoscopy: A comparative animal study.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) emerged as a new alternative method in minimally invasive techniques. Although a very small number of studies have compared the physiologic response in NOTES to laparoscopy, the results remain controversial. AIM: This experimental animal study aims to evaluate the intraoperative cardiovascular and respiratory effects of pure transluminal natural orifice surgery and conventional laparoscopy. MATERIALS AND METHODS: Twenty female pigs (Sus scrofa domesticus) equally divided into two study groups were assigned to either pure natural orifice transluminal endoscopic techniques (Group 1) or conventional laparoscopic surgery (Group 2) and monitored intraoperatively in terms of heart rate (HR), systolic blood pressure (SBP) and O2saturation (SpO2) for 1 h. Both groups underwent simple surgical procedures such as gastrojejunostomy, oophorectomy and adnexectomy. RESULTS: All procedures were successfully completed. The findings indicated statistically significant differences between SBP (P = 0.0065) and SpO2(P = 0.027) in the two groups at the beginning of the interventions. HR showed significant differences during the last 20 min of the interventions (min 40 and 45; P < 0.001). For the whole procedure (from the beginning of the intervention to 60 min interval), HR, SBP and SpO2values showed no statistical difference. CONCLUSIONS: Although significant differences in terms of HR, mean blood pressure and SpO2were noted at specific intervals during surgery, no real variance of the cardiovascular parameters was observed when considering the entire procedure. Therefore, NOTES seems to be a safe approach with minimally intraoperative cardiovascular and respiratory implications.

Peritoneal access, transgastric peritoneoscopy and oophorectomy - feasibility study on an experimental Swine model.

BACKGROUND/AIMS: Natural orifice translumenal endoscopic surgery (NOTES) still poses numerous challenges, even in cases of relatively simple surgical procedures. This study aims to assess the feasibility of transgastric resectional interventions using commonly available endoscopic equipment as well as to offer a safe closure method of the gastric access site. METHODOLOGY: Ten pigs underwent pure transgastric endoscopic oophorectomy using a single channel endoscope. The gastric defect was closed using over-the-scope clips (OTSC™, OVESCO Endoscopy). After 2 weeks the animals underwent autopsies. RESULTS: All procedures were successful. Transgastric access time varied from 4.46 to 33.24 minutes. The peritoneal exploration took 31 minutes and oophorectomy needed in average of 21 minutes (range 15-28 minutes). The animals for which the gastric access site was closed with OTSC™ survived for 2 weeks without complications. CONCLUSION: This study demonstrates the technical feasibility and safety of pure transgastric endoscopic oophorectomy using conventional endoscopic instrumentation in a porcine model. OTSC™ closure system is an easy to use and reliable gastric closure method.

Incidental intraoperative discovery of a pancreatic neuroendocrine tumor associated with chronic pancreatitis.

Pancreatic neuroendocrine tumors are a rare entity with an incidence between 2 per million to 5 per 100,000. Association with pancreatitis (acute or chronic) is rare and is considered to be determined by the tumoral obstruction of pancreatic ducts, but sometimes occurs without any apparent relationship between them. Non-functional neuroendocrine pancreatic tumors are usually diagnosed when either very large or metastatic. Small ones are occasionally diagnosed when imagery is performed for other diagnostic reasons. Intraoperative discovery is even rarer and poses problems of differential diagnosis with other pancreatic tumors. Association with chronic pancreatitis is rare and usually due to pancreatic duct obstruction by the tumor. We describe the case of a patient with a small non-functioning neuroendocrine tumor in the pancreatic tail accidentally discovered during surgery for delayed traumatic splenic rupture associated with chronic alcoholic pancreatitis. The tumor of 1.5 cm size was well differentiated and confined to the pancreas, and was resected by a distal splenopancreatectomy. CONCLUSIONS: Surgeons should be well aware of the rare possibility of a non-functional neuroendocrine tumor in the pancreas, associated with chronic pancreatitis, surgical resection being the optimal treatment for cure. Histopathology is of utmost importance to establish the correct diagnosis, grade of differentiation, malignancy and prognosis. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2114470176676003.