The effectiveness of Hemopatch™ in preventing postoperative distal pancreatectomy fistulas.

OBJECTIVES: Postoperative fistula after distal pancreatectomy (DP) is still a significant complication, although many tools and tips have been utilized to try to reduce its elevated frequency. This paper focuses on the role of a sealing hemostatic device, Hemopatch™, to prevent postoperative pancreatic fistula (POPF) after DP. METHODS: Retrospectively we divided our sampling of 57 patients submitted to DP into two groups according to the availability of the device: 18 patients without Hemopatch™ and 39 patients using Hemopatch™. RESULTS: Significant difference was observed in leak occurrence (p < 0.05). No significant association was observed between the number of blood transfusions, the frequency of postoperative complications, associated splenectomy and POPF. CONCLUSION: This is a preliminary study and the first focused on the prevention of POPF after DP using Hemopatch™. Thanks to its double function of hemostasis and sealant, Hemopatch™ can be taken into consideration as an efficacy tool to prevent pancreatic POPF.

Total colectomy for cancer: analysis of factors linked to patients' age.

Total colectomy (TC) is a valid option for cancer treatment in selected cases. Emergency presentation, association to familial adenomatous polyposis (FAP) or intestinal bowel disease (IBD), hereditary non-polyposis cancer (HNPCC), and synchronous tumors are the common indications to TC for cancer. Despite potential high morbidity and mortality rates for worse general health conditions of the advanced age it has even suggested for elderly patients. We reviewed our experience to analyze the current role of TC comparing different results between young and elderly patients. During the period 1990-2012, 76 patients were operated on TC for cancer. Patients were divided in two groups according to the age [<65 - group A (young) and >65 years old - group B (elderly)] and were compared their systemic and surgical complication, considering the presence of comorbidities, ASA score, lifestyle habits, elective or emergency presentation. Morbidity rate was 7.7% and 38.8% in young and elderly patients respectively. 21 systemic complications (3 in group A and 18 in group B) occurred in 17 patients (22.36%) (with the coexistence of two complications in 4 patients belonging to the group B. There were 6 surgical complications (7.9%) (3 in group A and 3 in group B): anastomotic leakage 3, major wound infections 2, postoperative bleeding 1; no intra-abdominal abscess were observed. In 2 cases (2.6%) (1 anastomotic leak and 1 intra-abdominal postoperative hemorrhage) was needed a reoperation. We observed only 2 deaths in the elderly. High ASA score and emergency were associated with worst results. Systemic complications were more frequent in elderly patients cause of significant comorbidities, while the incidence of surgical complications was similar and according to literature. Besides the classic indications, it is a viable surgical option also in cancer associated with complicated diverticulitis. Our data show that TC is a safe and effective procedure providing good results even in elderly patients, when combined with a careful preoperative evaluation and age is not an absolute controindication to this procedure.

Simultaneous quadruple carcinoma of colon Case report and literature review.

INTRODUCTION: Multiple primary malignancies can arise in the large bowel as simultaneous, synchronous and/or metachronous. All tumors must be distant from each other to be considered as primitive, none have to be the result of metastasis from other tumors. CASE REPORT: We present a case of a 71 years old woman who was admitted to our hospital for a 3-year history of not well defined abdominal pain and hematochezia. The patient had no family history of cancer. Colonoscopy revealed 4 simultaneous tumors located at 4 and 20 cm from the ileocecal valve and at 23,2 and 19 cm from the anal verge. At CT scan there were no distant metastases, neither lymphonode node involvement. A quadruple adenocarcinoma of the colon was confirmed by the pathologist. Patient was operated on total colectomy with ileo-rectal anastomosis. DISCUSSION: Two or three synchronous tumors of the colon have been already described in literature in about 1,8-14% of cases, but the presence of four simultaneous cancers, as in our case, is very interesting and unusual without an history of FAP or familiar cancer. CONCLUSION: Comprehensive preoperative study, extensive intraoperative exploration, and radical resection can improve surgical results and survival rate, remaining unquestioned the cause.