[Self expandable metal stent as bridge-to-surgery in acute bowel obstruction]. / Le protesi colorettali come bridge to surgery nelle occlusioni intestinali acute.

AIM: Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresectable tumor on subsequent workup. For low-risk patients with resectable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery. METHODS: From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120). RESULTS: Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case. CONCLUSION: In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.

[Complications due to mechanical sutures in laparoscopic surgery: bowel obstruction caused by staple. Case report and literature review]. / Complicanze da suture meccaniche in chirurgia laparoscopica: occlusione intestinale da clip. Segnalazione di un caso clinico e revisione della letteratura.

Bowel obstruction after laparoscopic surgical operation is reported only in few cases. The incarceration of bowel loop occurs into the port site more frequently. The case of a young woman, subjected to laparoscopic appendectomy is reported: bowel obstruction occurs on the third postoperative day caused by a staple of the mechanical suture on the caecum, hooked to bowel mesentery. This complication can occur for staples partially formed, spilled in the peritoneum or put to the extremity of mechanical sutures: they can hook to fixed structures and strangle a bowel loop. It may occur in 1.8% of surgical laparoscopic procedures. It can be solved by the simple laparoscopic lysis, above all if an early diagnosis and surgical operation are performed. It is recommendable to remove all the free spilled staples in the peritoneum and close or remove those partially formed to the extremities of the suture.

[A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique]. / La dissociazione della colecisti dal letto epatico durante colecistectomia laparoscopica. Tecnica personale.

BACKGROUND: Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissection of the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures. METHODS: During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy. RESULTS: Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses. CONCLUSIONS: Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.