Anastomosi coliche manuali con sutura continua monostrato. La nostra esperienza

L’utilizzo delle suturatrici meccaniche ha determinato una ridu - zione dei tempi operatori nella chirurgia del grosso intestino che non si è però accompagnata ad un concomitante decremento delle complican - ze anastomotiche. Per questi motivi, dagli inizi degli anni ’90, si è assi - stito ad una riproposta, sia pur non assoluta, delle anastomosi manuali. Presentiamo la nostra esperienza sulle anastomosi coliche (ileocoliche, colo-coliche e colo-rettali ‘alte’ o ‘intraperitoneali’) eseguite in modalità continua, monostrato, extramucosa con monofilamento a lento assorbimento. Dal gennaio 2000 al gennaio 2003 ne abbiamo eseguite 113 in altrettanti pazienti, su un totale di 157 interventi consecutivi sul gros - so intestino. Abbiamo avuto 1 decesso e 5 complicanze anastomotiche. Risultati così incoraggianti, del tutto sovrapponibili a quelli delle migliori casistiche in letteratura, hanno fatto sì che questo tipo di sutu - ra manuale costituisca attualmente la nostra tecnica abituale nel confe - zionamento delle anastomosi del grosso intestino

Una grave complicanza in chirurgia colorettale: la fistola anastomotica. Nostra esperienza

Anastomotic leakage is a severe complication in colorectal surgery with a lot of generic and specific risk factors. There are still controversies about the possibility to prevent it or to limit its severity with the use of faecal diversions. We report our experience on 189 patients operated in five years on colon-rectum, in election and emergency, whit manual or mechanical anastomoses in the last 20 cm from the anal verge. We have had 21 anastomotic leakages (11%), symptomatic in 10 cases (5.5%), and 5 deaths (2.6%), 3 directly correlated to the leakage. In the patients (n 98) with loop-ileostomy there wasn?t anastomotic leakages reduction, but only of clinical impact. We prefer loop-ileostomy in cases of extraperitoneal anastomoses, always in emergency and in anastomoses at risk

Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum

Meckel’s diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature

International expert consensus on primary systemic therapy in the management of early breast cancer: highlights of the Fourth Symposium on Primary Systemic Therapy in the Management of Operable Breast Cancer, Cremona, Italy (2010).

A panel of international breast cancer experts formulated a declaration of consensus regarding many key issues in the use of primary systemic therapy (PST) either in clinical routine or research practice. The attainment of pathological complete response (pCR), defined as no residual invasive tumor in the surgical specimens both in breast and in axillary nodes, is one of the main goals of PST, and pCR can be used as the primary objective in prospective clinical trials. However, pCR is not a reliable endpoint with all treatment approaches, and alternatives such as Ki67 index of the residual invasive disease or after 2 weeks of PST are also potential endpoints. PST has several advantages: breast conservation and the unique opportunity to obtain information on the interaction between treatment and tumor biology. Changes in tumor biology after PST are an early phenomenon; so, an additional core biopsy performed after 14 days from treatment start should be considered in clinical trials.Consensus Development ConferenceJournal ArticleSCOPUS: ar.kinfo:eu-repo/semantics/publishe