Atypical epigastric pain: Case Report

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Robotic-assisted approach to Median Arcuate Ligament Syndrome with left gastric artery originating directly from the aorta. Report of a case and review of the current mini-invasive treatment modalities

Background: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. Methods: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. Results: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). Conclusions: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours. Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge