Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low Risk of Common Duct Stones: Can It Be Beneficial?

Gallstone disease affects 15\u201320% of the general population and up to 20% of these patients present common bile duct stones. Aim. This observational study reports our experience on routine cysticotomy and flushing of the cystic duct in patients with low risk of common duct stones. Materials and Methods. We analyzed 731 patients who underwent laparoscopic cholecystectomy between September 2013 and September 2015. Results. Patients were preoperatively stratified on the clinical risk; those presenting with low preoperative risk of common bile duct stones were referred to undergo laparoscopic cholecystectomy and routine cysticotomy with bile duct flushing. Patients presenting thick bile sludge, solid debrides, and/or increased tension of bile outflow underwent unplanned cholangiography. No intraoperative complications or conversion to open technique occurred. Average follow-up time was 22,8 months (range 12 to 37). Rate of retained ductal stones accounted for 0,3%. Conclusions. Routine cysticotomy and bile flushing in our experience is a valid, simple, and not time consumingmanoeuvre that can help decompressing and flushing CBD.Moreover, it is a valid tool for extending selective IOC approach in a focused manner. Further evaluations have to be conducted to evaluate risks and effectiveness of this manoeuvre

Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case-control analysis of 7-years' experience

According to many Societies' guidelines, patients presenting with clinical T4 colorectal cancer should conventionally be approached by a laparotomy. Results of emerging series are questioning this attitude

Nerve-sparing Technique in Rectal Cancer

Attention to nerve identification in rectal cancer surgery began in Japan in the 1970s, but it was an American surgeon [1, 2] between the 1970s and 1980s who proposed a combination of the nerve-sparing principle with the TME technique. The result was the preservation of urogenital function in 90% of the patients treated, without affecting the oncological outcome. Subsequently, the effectiveness, implementation and safety of the technique were confirmed by Moriya\u2019s group [3], and the long-term functional results were documented by the famous Dutch TME trial

Surveillance after Curative Resection of Rectal Cancer

In the natural history of colorectal cancer, recurrence involves 30 to 50% of patients who have undergone curative surgical treatment [1] and occurs, in over 90% of cases, in the first 5 years following exeresis of the primitive tumor [2]. The risk of tumor recurrence is greater in patients presenting at diagnosis with a higher tumor stage (according to the commonly used TNM staging proposed by the American Joint Committee on Cancer, AJCC). The most common sites of colorectal recurrence are, in order

Surgical Strategy: Indications

This chapter relates about surgical strategies in rectal cancer. Laparotomy, laparoscopy, SILS and robotics are detailed as the respective indications for all them. Then are described the different approaches to early cancers, to cancers requiring operation at the first diagnosis, and finally for cancer that are considered as nonresectable at the first evaluation, suggesting multidisiplinar treatments. Downstaging and downsizing are described

Diverting Stoma

The role of a protective stoma is to divert the flow of the feces externally, thus protecting a low colorectal anastomosis which is potentially at risk. The impact of the stoma on the incidence of anastomotic leakage and related leak mortality is still the object of much debate in literature

3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared with 2D Vision

Abstract BACKGROUND: The aim of this study is to evaluate if 3-dimensional high-definition (3D) vision in laparoscopy can prompt advantages over conventional 2D high-definition vision in hiatal hernia (HH) repair. STUDY DESIGN: Between September 2012 and September 2015, we randomized 36 patients affected by symptomatic HH to undergo surgery; 17 patients underwent 2D laparoscopic HH repair, whereas 19 patients underwent the same operation in 3D vision. RESULTS: No conversion to open surgery occurred. Overall operative time was significantly reduced in the 3D laparoscopic group compared with the 2D one (69.9 vs 90.1 minutes, P = .006). Operative time to perform laparoscopic crura closure did not differ significantly between the 2 groups. We observed a tendency to a faster crura closure in the 3D group in the subgroup of patients with mesh positioning (7.5 vs 8.9 minutes, P = .09). Nissen fundoplication was faster in the 3D group without mesh positioning ( P = .07). CONCLUSIONS: 3D vision in laparoscopic HH repair helps surgeon's visualization and seems to lead to operative time reduction. Advantages can result from the enhanced spatial perception of narrow spaces. Less operative time and more accurate surgery translate to benefit for patients and cost savings, compensating the high costs of the 3D technology. However, more data from larger series are needed to firmly assess the advantages of 3D over 2D vision in laparoscopic HH repair

Conjunctival and limbal transplantation from the same living-related bone marrow donor to patients with severe ocular graft-vs-host disease

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Indocyanine green fluorescence angiography during liver and pancreas transplantation: a tool to integrate perfusion statement’s evaluation

International audienceBackground:Indocyanine green (ICG) fluorescence imaging is a promising tool for intraoperative decision-making during surgical procedures, in particular to assess organs perfusion.Methods:We used the ICG fluorescence during liver transplantations in six cirrhotic patients to help assessing the graft biliary duct perfusion in order to identify the appropriate level to perform the anastomosis. We also used ICG fluorescence also in five patients receiving kidney-pancreas transplantation to evaluate the perfusion levels of the duodenal stump of the pancreas graft.Results:Follow-up period for the patients was 12 months. The perioperative period was uneventful, no biliary complications such as leaks or stenosis were reported after liver transplantation, no complications of the entero-enteric anastomoses occurred after pancreatic transplantation.Conclusions:ICG fluorescence seems to safely provide important objectifiable perfusion information during organ transplantation procedures that can integrate surgeon's expertise. In fact, detecting intra-operatively perfusion defects, it allows real time modifications on technical strategies potentially useful to reduce the feared risk of anastomotic leakage and consequent severe complications