The impact of experience on short- and long-term outcomes on gastric ESD: a western series.

Endoscopic submucosal dissection (ESD) represents the standard of care for early gastric cancer in Eastern countries. Nevertheless, in the West, this procedure is not widespread. Aim of the study was to confirm the feasibility and the efficacy of ESD in the West. A total of 60 ESD were performed between January 2005 and December 2014 by two expert endoscopists. The analysis, based on a retrospective collected database, was conducted by dividing the study period in three subgroups. Clinical and technical outcomes have been compared. Rates of complete, curative and en bloc resection did not significantly change among the study periods. Three cases of perforation occurred (5%), one in each period. The operation time significantly decreased from the second to the third period (p < 0.001). When adjusting for gender, tumor size and site in multivariable analysis, operation time decreased by nearly 90 min from the first to the second period, and by more than 3 h from the first to the last period. The median follow-up was 33 months. No cases of local or lymphnodal recurrence were detected during the study period. One patient presented a synchronous lesion, whilst four metachronous lesions have been discovered after a median follow-up of 11 months. Our experience supports the feasibility and safety of ESD in the West, if an adequate learning curve is accomplished. Long-term outcomes are comparable to the Eastern series.

Severe necrotic and septic pancreatitis. Indications to endoscopic, surgical, and nutritional therapy.

Severe acute pancreatitis (SAP) management has changed over the last fifteen years, and from too aggressive behaviour, we moved to a cautious one. In every case, we can appreciate defect of extremist conceptual position. We reviewed our strategy on disease treatment, and we analyzed treatment of single cases. We collected 4 SAP cases from January 2009 to January 2010. All patients were septic, and we adopted the same approach for all of them, avoiding surgery without peritoneal infection. In all patients we placed jejumostomy and, after cleaning of septic site, we started immediate enteral nutrition (EN). Antibiotic therapy against Gram+, Gram- and antifugal drug had been started. No one died and all patients were back to an active life even if social costs are considerably high especially due to very long hospital stay.

[Inguinal endometriosis. Case report and review of the literature]. / L'endometriosi inguinale. Case report e revisione della letteratura.

Endometriosis is a common gynaecological condition which affects women during their reproductive years. It is characterized by ectopic endometrial tissue responding to hormonal changes associated with menstrual cycle. Aetiology is unknown and symptoms are quite aspecific (dysmenorrhoea, pelvic pain, infertility or pelvic mass). Ultrasonography (US) and Magnetic Resonance Imaging (MRI) are accurate diagnostic exams but laparoscopy represents the gold standard in diagnosis and therapy (excision or ablation). Medical treatment pre or postoperatively may be useful prolonging the symptom free interval. In this paper we report the case of a young woman affected by an inguinal mass: diagnostic examinations and histological specimen revealed to be an endometrial focus. We review the literature focusing the diagnostic techniques and relationships between endometriosis and ovarian cancer (endometrioid and clear cell subtypes).

[Mesenteric cyst: case report and review of the literature]. / Cisti mesenteriale: case report e revisione della letteratura.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumours with an incidence of 1/140.000 in surgery departments and 1/20.000 in paediatric departments. There are no pathognomonic signs or symptoms for the cysts. In the differential diagnosis lymphangiomas, sarcomas, adenocarcinomas and intestinal duplications should be considered. Diagnostic includes abdominal computed tomography, ultrasound and MRI. Barium enema examination or intravenous pyelogram may be used in special cases. Surgical treatment is indicated also in asymptomatic patients; laparoscopic approach is the "gold standard". Laparotomic approach should be used in the cases of impossibility of total enucleation or in the cases of malignant degeneration. Complete enucleation is the treatment of choice for retroperitoneal and mesenteric cysts. If this cannot be accomplished, the alternative should be the excision of the cyst or the marsupialization. In this paper we present a case of young man with a mesenteric cyst mimicking acute appendicitis.

Antimicrobial prophylaxis with ceftriaxone in laparoscopic cholecystectomy: a 7-year clinical experience involving 3,603 patients.

This study is one of the first in the literature with the aim of assessing the effectiveness of antimicrobial prophylaxis with a single preoperative dose of long-acting ceftriaxone in a retrospective analysis of 3,603 patients undergoing laparoscopic cholecystectomy. All patients who underwent laparoscopic cholecystectomy between October 1990 and December 1997 were reviewed. Antimicrobial prophylaxis with a single dose of ceftriaxone (1 g) was given intravenously at the induction of anesthesia. Patients were closely monitored for infections until 4 weeks after surgery. Postoperative infections occurred in 44 of the 3,603 patients undergoing laparoscopic cholecystectomy, with an infection rate of 1.22%. The infectious complications mainly comprised wound infections (n=13) but also included intra-abdominal abscesses (n=3), pneumonia (n=9), urinary tract infections (n=3) and other infections (n=16). The results of this retrospective and non-randomized study, show that a single-shot regimen containing ceftriaxone may be a cost-effective measure in preventing postoperative infections in patients undergoing laparoscopic cholecystectomy.

Congenital choledochal cyst: video-guided laparoscopic treatment.

We report our first experience with a laparoscopic treatment of congenital choledochal cysts involving the total cyst resection and the reconstruction of the biliary and gastrointestinal tracts through a transmesocolic hepatic-jejunal Roux-en-Y loop anastomosis. The procedure was carried out in a 14-kg 6-year-old girl with a congenital choledochal cyst of the first type, according to the Alonso-Lej classification. The cyst was divided using a Multifire EndoGIA 30 stapler. Hepatic-jejunal and jejunojejunal anastomoses were made with 4.0 chrome catgut interrupted sutures. Intestinal recanalization occurred on the 2nd postoperative day and the postoperative course was uneventful. The laparoscopic approach affords several advantages: excellent intraoperative visualization of tiny structures and, therefore, great surgical accuracy; early resumption of peristalsis; no postoperative pain; no laparocele; prevention of adhesions; excellent esthetics; and quicker resumption of school and sports activities.

[Laparoscopic cholecystectomy for gallbladder stones]. / Trattamento della calcolosi colecistica con colecistectomia laparoscopica.

The authors describe the technique for the treatment of gallbladder stones using a laparoscopic approach and discuss the diagnostic and operative flow chart stressing complications and ways to avoid them. A total of 2517 non-selected patients underwent surgery since october 1990 up to september 1995. 252 were affected by acute cholecystitis (10%); 172 underwent emergency laparoscopic cholecystectomy. ERCP was performed in 278 patients (11.04%): 177 underwent endoscopic sphincterotomy and laparoscopic cholecystectomy, 21 underwent laparoscopic cholecystectomy before sphincterotomy, 8 laparoscopic cholecystectomy and ESWL. Laparoscopic cholecystectomy was converted into laparotomy in 37 patients (1.4%); surgery was abandoned in 3 patients following to onset of intense bradycardia. Major complications were observed in 0.63%; bile duct injury occurred in four patients (0.15%). One patient died following a massive intraoperative myocardial infarction. Average operative time was 21 minutes. Only 22.8% of patients required mild analgesia on the first day after surgery. The average hospital postoperative stay was 2.6 days. Return to work took place in 98% of non complicated patients within one week of being discharged from hospital.

[Choledochoduodenal anastomosis by laparoscopy]. / L'anastomose cholédoco-duodénale par voie laparoscopique.

Eleven patients underwent choledochoduodenostomy under laparoscopic control: 5 for adenocarcinoma of head of pancreas, including 2 with extension into duodenum, 3 for chronic pancreatitis. 1 for gastric carcinoma with pancreatic infiltration 1 for carcinoma of ampulla and 1 for stenosing papillitis. Mean duration of operation was 97.9 minutes and mean hospital stay 7.8 days. No immediate or delayed postoperative complications were reported. The advantages of this method are the marked reduction in recovery time, especially in severely debilitated elderly patients, and the absence of postoperative pain.

[Laparoscopic cholecystectomy using argon bistoury]. / La colecistectomia laparoscopica con il bisturi ad Argon.

A total of 92 patients were submitted to laparoscopic cholecystectomy during the period Autumn 1990-Spring 1991. The dissection of the gallbladder from the hepatic bed was performed in 40 patients using the Argon beam coagulator, in 25 using the monopolar electrocoagulator and in 27 using the Holmio laser beam. In average, with the Argon beam coagulator time procedure was respectively 2.7 and 5.4 minutes shorter than monopolar electrocoagulator and Holmio laser. Only one complication (pneumomediastinum) was correlated with the use of the Argon beam coagulator.

[Mechanical duodenopancreatectomy]. / La duodenocefalopancreatectomia meccanica.

Pancreaticoduodenectomy with stapler devices is presented. Three patients affected by pancreatic malignant neoplasm were successfully treated, and the technique used is here reported.

[Arterial aneurysms of the upper limbs (our experience and review of the literature)]. / Gli aneurismi delle arterie degli arti superiori (nostra esperienza e revisione della letteratura).

The authors discuss about the very low incidence of the upper extremities aneurysms and about their post-traumatic etiology. They show their experience in 6 cases with a Follow up from 2 to 17 years. All the patients were operated on; in 2 cases the authors performed aneurysmectomy only and in 4 cases an axillo-brachial by-pass. The results are very good in every patient.

[Primary gastric lymphoma: our experience (clinical contribution)]. / Il linfoma gastrico primitivo: nostra esperienza (contributo clinico).

The authors analyze a personal study population (11 cases) of primary gastric lymphoma. Whenever possible, more radical surgery was carried out even in severely debilitated patients. Polychemotherapeutic treatment was given after discharge. The mean postoperative survival was 35 months, and the 5-year survival rate was 27.2%.

[Biliary pathology in chronic pancreatitis]. / La patologia biliare nella pancreatite cronica.

The authors expose in a very accurate discussion the biliary pathology during chronic pancreatitis. They divide the biliary lesions into associated with pancreatitis and secondary to chronic pancreatitis. They emphasize the necessity to practise a detailed study of the biliary tract in all patients affected by chronic pancreatitis and the good results showed by a very simple surgical act.