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

Experimental tests on a new harvesting system for Burley tobacco

The globalization of the tobacco production has led to a drop in competitiveness of the Italian tobacco on the world market. Burley is the main variety of tobacco cropped in Campania region of Southern Italy. Its leaves have to be sewn, in the curing phase. Aim of this work is to show the results of the implementation of a new harvest machine prototype. Basically, the machine used for Bright tobacco, totally mechanical harvested, which doesn’t need to be sewn because it requires an indirect-fire treatment into the curing furnaces. The machine was modified in order to mechanize harvesting of Burley tobacco, and tested on four cultivars of Burley tobacco under three different planting layouts. The Burley tobacco leaves can be harvested mechanically by pulling individual leaves off the stalk; leaves are then sorted and tied in bundles prior to sewing. A mechanical burley tobacco harvesting system was evaluated. This machine consists in realizing a leaves orientation system based on the different weight between the leaf blade and the stalk enhanced by an air flow. The measurements taken were harvest timing, work capacity, and quality standards of the work carried out. The results, in terms of user time, range from 6.67 h/ha to 7.80 h/ha while in terms of operational efficiency are between 88% and 89%. The average user capacity recorded for the four cultivars is equal to 0.14 ha/h, a value far from the one recorded for the same harvesting machine used for Bright tobacco (0.25 ha/h). The harvest timing capacity, range from 0.51 t/h to 0.99 t/h. The work productivity goes from 0.17 t to 0.33 t per hour of human unit respectively. The average number of detached leaves, depending on the cultivar, has been between 523 and 744. Concerning the leaf orientation, a general percentage of 73% was achieved

Stapled transanal rectal resection with contour transtar for obstructed defecation syndrome: lessons learned after more than 3 years of single-center activity.

BACKGROUND: Obstructed defecation syndrome (ODS) is a widespread and disabling disease. OBJECTIVE: We want to evaluate the safety and efficacy of Stapled Transanal Rectal Resection (STARR) performed with a new dedicated device in the treatment of ODS. DESIGN: A retrospective review of 187 STARR performed from June 2007 to February 2011 was conducted. SETTINGS: The whole study was conducted at a University Hospital. PATIENTS: All the patients with symptomatic ODS and the presence of a rectocele and/or a recto-rectal or recto-anal intussusception, in the absence of sphincter contractile deficiency, were included in the treatment protocol. INTERVENTIONS: All procedures were performed using Contur Transtar device. We analyze the functional results of this technique and the incidence and features of the surgical and functional complications and how you can prevent or treat them. MAIN OUTCOME MEASURES: Constipation was graded using the Agachan-Wexner constipation score; use of aids to defecate and patient satisfaction were assessed preoperatively and 6 months after surgery. Intraoperative and postoperative complications were also investigated. RESULTS: The constipation intensity was statistically reduced from the preoperative mean value of 15.8 (± 4.9) to 5.2 (± 3.9) at 6 months after surgery (p<0.0001). Of the 151 (80.3%) patients who took laxatives and 49 (26.2%) who used enemas before treatment, only 25 (13.2 %; p<0.0001) and 7 (3.7%; p<0.0001) respectively, continued to do so after surgery. None of the 17 (9.1%) patients who had previously helped themselves with digitation needed to continue this practice. Almost all patients showed a good satisfaction rate (3.87/5) after the procedure. LIMITATIONS: The retrospective design introduces potential selection bias. CONCLUSIONS: The results of this study shows that STARR performed using Contour Transtar is a safe and effective procedure to treat ODS

Total Laparoscopic reversal of Hartmann's procedure.

BACKGROUND Hartmann procedure is still performed in those cases where colorectal anastomosis might be unsafe. Reversal of Hartmann procedure (HR) is considered a major surgical procedure with an high morbidity (55-60%) and mortality rate (0-4%). In order to decrease these rates, laparoscopic Hartmann reversal procedure was successfully experienced. We report our totally laparoscopic Hartmann's reversal technique. METHODS Between 2004 and 2010 we performed 27 HR with totally laparoscopic approach. The efficacy and safety of this technique were demonstrated evaluating the operative data, the postoperative complications and the outcome of the patients. RESULTS There were no open conversions and major intraoperative complications. Anastomotic leaking occurred in one patient requiring an ileostomy; one patient needed a blood transfusion and one had a nosocomial pneumonia. The mean postoperative hospitalization was 5.7 days. CONCLUSIONS Laparoscopic HR is a feasible and safe procedure and can be considered a valid alternative to open HR