Laparoscopic treatment of a carcinoma of the cecum incarcerated in a right groin hernia: report of a case.

A carcinoma in a groin hernia is uncommon. We herein report a case of an intrasaccular carcinoma of the cecum in a right inguinoscrotal hernia with a simultaneous left inguinal hernia treated by a laparoscopic approach. A 70-year-old man presented with a painful, not completely reducible bilateral hernia. Blood examinations showed severe anemia. A computed tomography scan of the abdomen confirmed the presence of the cecum in the hernia sac, showing a round wall thickening of the herniated portion of the colon. A standard laparoscopic right colectomy with radical oncological purpose was performed. An incarcerated inguinal hernia is a relatively common surgical problem. In the case of anemia or other signs suggestive of malignancy, a specific preoperative work-up should be assessed. This case demonstrates that it is possible to perform an oncologically correct laparoscopic resection when the presence of malignancy is confirmed while performing an open traditional hernioplasty to avoid any possible contamination of the mesh.

Unusual ulcerated Merkel cell carcinoma of the skin: report of a case.

Merkel cell carcinoma is an aggressive skin cancer, usually related to a severe prognosis. Treatment consists of wide surgical excision, adjuvant radiotherapy and/or polychemotherapy, but local-regional and distant relapses are common. Detection of histopathological and biological factors may select subgroups of patients suitable for different treatments. Herein we report the case of a patient treated for a wide bleeding and ulcerated Merkel cell carcinoma. Ulceration represents an uncommon feature because the tumor usually spreads from the dermis into subcutaneous fat, so it may be added to poor prognostic indicators. After surgical excision and postoperative radiotherapy, the patient recurred at regional nodes. Axillary lymphadenectomy was followed by courses of polychemotherapy. We obtained a satisfactory survival (31 months) by timing these different therapeutic possibilities.

[Endoscopic-laparoscopic treatment of neoplastic occlusion of the left colon]. / Il trattamento endoscopico laparoscopico dell'occluslone neoplastica del colon sinistro.

About a third of patients with colorectal carcinoma have acute colonic obstruction requiring emergency surgery. The surgical options are: intraoperative lavage and resection of the colonic segment involved with primary anastomosis; subtotal colectomy with primary anastomosis; colostomy followed by resection; and resection of the colonic segment involved with an end colostomy (Hartman's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and are associated with a poor quality of life. Endoscopic colonic stent insertion effectively decompresses the obstructed colon allowing bowel preparation and elective resection. In this article we present 2 cases successfully treated with the use of stents followed by a laparoscopic resection. We also describe technical details concerning the endoscopy and laparoscopy procedure, discuss the advantages of this treatment and present a review of the literature. One patient underwent a left hemicolectomy; while the other was treated with splenic flexure resection. No complications occurred after surgery. Histological staging revealed a pT3 pNO pMx G2 and a pT4 pN1 pM1 G2 adenocarcinoma, respectively. This initial experience shows that endoscopic colonic stent insertion can effectively resolve the neoplastic obstruction, allowing safe elective surgery. The use of stents does not prevent a laparoscopic approach.

[Congenital esophageal cyst: a case report]. / Le cisti congenite dell'esofago: segnalazione di un caso.

Congenital oesophageal cysts are extremely rare findings in the context of masses developing in the mediastinum. The embryogenetic and physiopathological aspects of these lesions have yet to be fully clarified. Preoperative diagnostic investigations may be only partly successful in indicating the correct diagnosis. Surgical excision is always indicated, via either the thoracoscopic or thoracotomic routes. We report here on case of a duplication oesophageal cyst which we diagnosed and treated successfully in our department. The clinical and therapeutic aspects of these lesions are discussed and compared with other cases reported in the literature.

Incisional hernia: laparoscopic or open repair?

PURPOSE: To compare laparoscopic and open repair of incisional hernia in terms of complications and failure rates. METHODS: Between June 2005 and April 2012, 252 patients underwent incisional hernia repair. Of these, 126 underwent laparoscopic and 126 open repair. The median follow-up was 38.7 months. RESULTS: Baseline characteristics [age, body mass index, American Society of Anesthesiologists (ASA) score, comorbidities, hernia size, and follow-up] did not differ significantly. Mean operative time was similar (72 vs. 83 min). Laparoscopic repair was associated with less postoperative pain, less postoperative complications (3.9% vs. 13.4%, P=0.012), and shorter hospital stay (3.5 vs. 4.3, P=0.002). Recurrence occurred in 6 patients of group 1 and in 7 patients of group 2 (4.7% vs. 5.5%, P=not significant). CONCLUSIONS: In this study, the trend in favor of laparoscopic treatment for incisional hernias is remarkable. Fewer postoperative complications and shorter hospital stay with similar operative time may balance the higher costs associated with the technique.

Robotic splenectomy for mesothelial cyst: a case report.

Cystic lesions of the spleen represent a rare entity with an overall incidence of 0.5% among splenectomies. They can remain asymptomatic in 30% to 60% of patients or may cause symptoms for secondary compression of adjacent structures. Peripheral cysts may be suitable for conservative treatment whereas splenectomy is the accepted procedure for bulky and/or central lesions. Laparoscopy is the standard approach for elective splenic surgery, but in the last decade, introduction of the da Vinci robotic system has represented a further improvement in minimally invasive surgery, thanks to 3-dimensional vision and more accurate motion control. Herein, we report a case of a mesothelial splenic cysts successfully treated by robotic splenectomy; some anatomical considerations and technical aspects of robotic procedures have been discussed: it is a feasible and safe approach, particularly indicated in the presence of anatomic features such as an enlarged pancreatic tail and a type II vascular pattern of splenic pedicle. In such patients, the choice of a robotic approach may decrease the risk of intraoperative bleeding, thereby representing a further improvement in laparoscopic techniques.