GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome.

BACKGROUND: The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy. In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed. Functional evaluations performed on pre and post – surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier. METHODS: 45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with: • 24 hours pHmetry, • esophageal manometry, The same evaluation was repeated 1 month and 6 months after surgical intervention. RESULTS: In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms. CONCLUSIONS: The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric

Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts

Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) – true population of interest, anastomosis performed with a three-row circular stapler; group (B) – control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15–0.73; P = 0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17–0.87; P = 0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24–0.91; P = 0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage

Clinical features and prognosis of gastrointestinal stromal tumors (GIST) in elderly patients: A 5-year retrospective study

Aim. GastroIntestinal stromal tumors (GISTs) are mesenchymal neoplasm arising in the abdomen: stomach is the most common site of origin accounting for 50-60% of these tumors. The aim of this study was to assess the clinical features and the factors influencing the prognosis of elderly patients affected by abdominal GIST. Methods. Patients were divided into two groups for age: group 1 (patients < 70 years old) and group 2 (patients ≥70 years old). Since January 2004 to December 2005, thirty patients were admitted to the study: 18 patients in group 1 and 12 patients in group 2. Results. In group 2 there was a higher rate of gastric (66% vs. 56%) and jejuna GIST (17% vs. 0%); in group 1 we had a greater incidence of ileal GIST (44% vs. 17%). In group 1 the initial symptoms were GI hemorrhage or intestinal occlusion, while in group 2 severe sideropenic anemia was the first clinical sign of GIST. Group 2 patients had a greater incidence of high-risk GIST and histological analysis showed in this group a prevalence of spindle cell GIST (58% vs. 44%). Dimensional analysis showed that in group 2 GIST had greater dimensions (6.5 cm vs. 4.5 cm) and presented more frequently mucosal ulceration (67% vs. 33%). Adjuvant therapy with imatinib was performed in 8 patients of group 1. GISTs-related 5-year mortality was 33% in group 2 and 11% in group 1. Conclusion. In our study elderly patients affected by GISTs have a poorer prognosis than younger patients with a 5-year mortality of 33%. This is due to several factors: the silent clinical course and the greater dimensions at diagnosis, more frequent presence of high-risk histotype and the presence of mucosal ulceration. Elderly patients with GIST need a closer follow-up for the higher risk of recurrence

Perianal abscess and fistula caused by toothpick ingestion three years before... an unexpected discovery!

Gastrointestinal tract (GIT) foreign body (FB) ingestion is a significant clinical problem. Most of the times, the ingested body will pass through the gastrointestinal (GI) tract uneventfully or it will impact in the appendix, cecum or in the terminal ileum. The anal canal is an unusual site of FB impaction. Toothpick perforations of the gastrointestinal tract are uncommon, but they are associated with a high mortality rate of 20% to 80%. The most common site of injury is the duodenum followed by the sigmoid colon and ileum. We report the case of a man with a 3-years history of perianal abscess and fistula caused by a toothpick ingested three years before

Diverticular disease hospital cost impact analysis: evaluation of testings and surgical procedures in inpatient and outpatient admissions.

BACKGROUND: Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD’s impact on budget and activity in hospitals. METHODS: The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals. Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds. RESULTS: A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was € 1.656.802 or 0.2% of the total budget of the hospital. € 1.346.218, were attributable to the department of general surgery, 0.9% of the department’s budget . CONCLUSIONS: The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department

Robotic liver surgery: Early experience from a single surgical center

The use of robotic surgery in liver resection is still limited. Our aim is to present our early experience of robotic liver resection