Extra-mucosal enucleation of a giant circular leiomyoma of the middle esophagus

.IntroductionAlthough being the most frequent benign neoplasm of the esophagus, leiomyoma represents only 1%of all esophageal masses. In the vast majority of cases it measures less than 5 cm, is asymptomaticand requires no treatment (if < 2 cm in diameter) or enucleation (if up to 8 cm) through minimally toinvasive techniques (endoscopy, videothoracoscopy, videolaparoscopy or robotic-assisted excision).Only 5% of lesions is larger than 10 cm and causes frank symptoms: such tumors go under the nameof giant esophageal leiomyomas (GELs). Performing enucleation for GELs, although feasible, provedto be less safe than for smaller leiomyomas. In GELs, in fact, the tract of mucosa left exposed bythe iatrogenic muscular defect is often too large: on the one hand, if left uncovered, it is likely todevelop pseudo-diverticulum and dysphagia, on the other hand, if treated with a primary closureof the muscular edges, this is supposed not to be tension-free thereby resulting in achalasia anddysphagia. To obviate such and other complications, two surgical options are generally recommendedfor GELs: esophageal resection and extra-mucosal enucleation combined with several techniques ofplastic surgery for covering and buttressing the muscular defect

Extra-mucosal enucleation of a giant circular leiomyoma of the middle esophagus

.IntroductionAlthough being the most frequent benign neoplasm of the esophagus, leiomyoma represents only 1%of all esophageal masses. In the vast majority of cases it measures less than 5 cm, is asymptomaticand requires no treatment (if < 2 cm in diameter) or enucleation (if up to 8 cm) through minimally toinvasive techniques (endoscopy, videothoracoscopy, videolaparoscopy or robotic-assisted excision).Only 5% of lesions is larger than 10 cm and causes frank symptoms: such tumors go under the nameof giant esophageal leiomyomas (GELs). Performing enucleation for GELs, although feasible, provedto be less safe than for smaller leiomyomas. In GELs, in fact, the tract of mucosa left exposed bythe iatrogenic muscular defect is often too large: on the one hand, if left uncovered, it is likely todevelop pseudo-diverticulum and dysphagia, on the other hand, if treated with a primary closureof the muscular edges, this is supposed not to be tension-free thereby resulting in achalasia anddysphagia. To obviate such and other complications, two surgical options are generally recommendedfor GELs: esophageal resection and extra-mucosal enucleation combined with several techniques ofplastic surgery for covering and buttressing the muscular defect

Colonic-type appendiceal adenocarcinoma. an intermediate prognosis between mucinous and signet ring cell adenocarcinoma

Colonic-type appendiceal adenocarcinom

Conservative management of pneumoperitonitis after percutaneous transhepatic insertion of metallic biliary stents

The occurrence of pneumoperitoneum after a percutaneous transhepatic intervention is an exceptionally rare event. Generally it resolves spontaneously or with minimally invasive management even in symptomatic conditions (pneumoperitonitis); resorting to surgical approach is exceptional. What is still unclear is the question as to whether the airflow has an intestinal or atmospheric source. Our report lends support to the former hypothesis, as argued hereafter

Update on Robotic Rectal Prolapse Treatment

Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates

Impact of sarcopenia on outcomes after pancreatectomy for malignancy. Preliminary results

INTRODUCTION: Sarcopenia, a subclinical loss of skeletal muscle mass, is commonly observed in patients with malignancy. Few studies have examined the association between sarcopenia and out- comes after pancreatic surgery. The aim of this study was to deter- mine the prevalence of sarcopenia among patients who underwent pancreatectomy for cancer and its correlation with morbidity and mortality. METHODS: Skeletal muscle index (SMI) was measured on preop- erative CT imaging in 75 patients undergoing pancreatectomy for cancer between 2010 and 2014. Sarcopenia was defined using pre- viously published sex-adjusted SMI cut-offs. The impact of sarco- penia on morbidity and mortality was assessed relative to other clinico-pathologic factors. RESULTS: Mean age was 66.35 years and 56% were female. Pancreatic adenocarcinoma represented 68% of all cases. Pancrea- ticoduodenectomy was performed in 77.3%. Fifty patients (66.7%) were sarcopenic, 37 (49.4%) were overweight/obese, and 21 (42%) were both (p1⁄4 0.044). Mean SMI among men (46.47 cm2/m2) was greater than among women (36.63 cm2/m2, p1⁄40.001). Univariate analysis found BMI (p1⁄40.001), female sex (p<0.001), and preoperative serum albumin (p1⁄40.004) as predic- tors of sarcopenia. On multivariate analysis, preoperative serum al- bumin was confirmed to be an independent predictor of sarcopenia (p1⁄40.0268). Sarcopenia was associated with a difference, although not significant, in terms of overall morbidity and 90-day mortality (p1⁄40.131 and p1⁄40.735, respectively). CONCLUSIONS: Sarcopenia was present in two-thirds of patients who underwent pancreatectomy for cancer. It is an occult condi- tion in overweight/obese patients, easily identified using CT scans. Preoperative serum albumin is a predictor of sarcopenia. This con- dition is not associated with increased risk of complications or 90- day death

A new fixation-free 3D multilamellar preperitoneal implant for open inguinal hernia repair

Between September 2014 and December 2015, 32 patients with inguinal hernia were treated using a new 3D mesh in our department. This mesh is characterized by a multilamellar flower-shaped central core with a flat, large-pore polypropylene ovoid disk that has to be implanted preperitoneally. Compared with the traditional Lichtenstein procedure, we observed a shorter mean duration of surgery and a significantly lower mean visual analogue scale (VAS) postoperative pain score recorded immediately after the procedure in the 3D mesh group. The mean VAS score recoded after 4 and 8 postoperative days showed better results in the 3D mesh group than the control group. Moreover, there was reduced postoperative morbidity in the 3D mesh group than the control group, even if no patients experienced severe complications

Is a preoperative assessment of the early recurrence of pancreatic cancer possible after complete surgical resection?

Background/Aims: The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC. Methods: A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators. Results: A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245). Conclusions: PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice