Congenital Lung Malformations: Shifting from Open to Thoracoscopic Surgery.

Background Over the years the need for surgical treatment, timing of intervention, and the type of surgical approach have been discussed, but the treatment of congenital lung malformations remains controversial. The aim of this study was to compare the thoracotomy approach with the thoracoscopic technique by evaluating different surgical outcomes (duration of surgery, postoperative hospital stay, and complications). Methods All patients operated from January 2011 to March 2015 for suspected congenital cystic lung were included in the study. Patients treated for congenital lobar emphysema and tracheobronchial neoplasms were excluded from the study. Results In the analyzed period, 31 asymptomatic patients were treated: 18 lung resections were performed with thoracotomy (Group A) and 13 with the thoracoscopic approach (Group B). No significant differences were observed between the age and weight at surgery, length of the procedures, complications, and the need for postoperative intensive care between the two groups. The postoperative hospital stay in Group A was twice that for Group 2 ( p = 0.0009). Conclusion Comparing thoracoscopic surgery with the traditional open approach, we confirmed the superiority of minimally invasive treatment in terms of postoperative hospital stay. Common technical recommendations can help pediatric centers to develop the thoracoscopic approach for the treatment of congenital pulmonary malformations

ESTIMATED BREED ADDITIVE EFFECTS AND DIRECT HETEROSIS FOR GROWTH AND CARCASS TRAITS OF HEAVY PIGS

A trial was carried out using 290 pigs of 16 genetic types, 128 gilts and 162 barrows, produced from Italian Large White (LW), Belgian Landrace (BL) 7 LW, Duroc (DU) 7 LW and Spotted Poland (SP) 7 LW sows inseminated by LW, BL, DU and SP boars. The aim of the research was to estimate direct heterosis and breed additive effects on growth performance, carcass traits and wholesale cuts when slaughter weight averaged 145 kg; the breed additive effects are expressed as differences from purebred LW. The BL breed had a negative effect on postweaning growth rate ( 1242 g/d, P<0.10), but favourably affected commercial carcass composition (+2.7% lean joints, P<0.05) and wholesale cuts (+1.4% ham, P<0.01) compared to LW. The DU breed additive effect improved average daily gain (+34 g/d, P<0.10) and positively influenced carcass composition, with higher yield and incidence of total lean joints (+1.9%, P<0.10) and ham (+1.6%, P<0.01). The SP breed additive effect did not affect growth, but gave less percentage weight of total lean joints ( 123.7%, P<0.01) and more total percentage weight of fatty joints (+4.1%, P<0.01) than LW. Direct heterosis positively influenced postweaning growth rate (+34 g/d, P<0.05) but was small and not significant for most carcass traits. The DU breed offers some advantages in crossbreeding plans involving LW to produce heavy industrial pigs; BL can also be utilized for this purpose, with less favourable results, while the SP breed does not seem suitable for heavy pig production

Breed and crossbreeding effects on weight, yield an quality of heavy Italian dry-cured hams

The aim of this study was to estimate direct heterosis and breed additive effects of Belgian Landrace (BL), Duroc (DU) and Spotted Poland (SP) in comparison with Italian Large White (LW) on weight, losses and percentage yields during processing, and qualitative traits of heavy dry-cured hams. Hams from 290 pigs of 16 genetic types, produced by LW, BL 7 LW, DU 7 LW and SP 7 LW gilts mated with LW, BL, DU and SP boars, were controlled during industrial processing; a sub-sample of 116 dry-cured hams were deboned and chemical composition, colour and organoleptic properties were assessed. Technological processing traits were slightly influenced by additive effects and the imported breeds gave yields of dry-cured hams comparable to those of LW. BL crossbred pigs reduced the incidence of bone on the weight of seasoned ham (P < 0.01), but tended to have a higher percentage of ham discarded during processing than LW and a lower ham flavour score (P < 0.05). These findings suggest a lesser dry-curing suitability of BL-derived hams, even though no pigs gave PSE meat. DU decreased the incidence of bone (P < 0.05), protein content (P < 0.05) and flavour score (P < 0.10) and increased dry matter and sodium chloride (P < 0.05) of dry-cured hams with respect to LW. SP gave lighter boned hams than LW (P < 0.01), but with higher trimming discards (P < 0.05), and did not exert any influence on quality traits of seasoned hams. Direct heterosis never affected weight, losses and quality traits of seasoned hams, suggesting a negligible effect of crossbreeding on processing traits of pork meat

Cone-like resection, fistulectomy and mucosal rectal sleeve partial endorectal pull-through in paediatric Crohn's disease with perianal complex fistula

Background: Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse.Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment. Methods: Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed. Results: 20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n= 5), intersphincteric (n= 4) and suprasphincteric (n= 2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up. Conclusions: Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion

Transperitoneal Laparoscopic Approach to the Perinephric Area in Children: Technical Report and Lessons Learned

reserved8noPurpose: This study presents a technical report of a standardized approach to the perinephric area in a series of pediatric patients, demonstrating that whatever renal or suprarenal surgery is planned, this can be approached and accomplished laparoscopically with an identical or very similar port triangulation, thus facilitating the learning curve within the same surgical team. Patients and Methods: All patients undergoing renal and adrenal gland surgery with a minimally invasive approach in the period from October 2008 to November 2013 were retrospectively reviewed and included in the study. Technical details and clinical outcomes are described. Results: In total, 68 patients matched the inclusion criteria and were therefore retrospectively examined. No major intraoperative complication occurred. Two patients developed recurrent pelvic-ureteric junction obstruction and were managed with double J stent positioning and laparoscopic dismembered pyeloplasty, respectively. Two patients presenting with adrenal mass experienced a moderate bleeding that could be treated conservatively. Conclusions: Thanks to the reproducibility of the procedure and on the grounds of the presented experience, we support the proposal that the transperitoneal laparoscopic approach to the kidney and the adrenal gland could represent a relatively easy and safe way to quickly achieve confidence and skill in the management of related diseases.mixedMattioli, Girolamo; Avanzini, Stefano; Pio, Luca; Costanzo, Sara; Faticato, Maria Grazia; Montobbio, Giovanni; Disma, Nicola; Buffa, PieroMattioli, Girolamo; Avanzini, Stefano; Pio, Luca; Costanzo, Sara; Faticato, MARIA GRAZIA; Montobbio, Giovanni; Disma, NICOLA MASSIMO; Buffa, Pier

A provisional experience with robot-assisted Soave procedure for older children with hirschsprung disease: Back to the future?

Hirschsprung disease is a congenital disease characterized by intestinal aganglionosis of various extents. Most patients are younger than 1 year of age. Though, a minority of cases can be older or even adult. Older the patient the more difficult and prolonged is the endorectal dissection required for the pull-through procedure. Longer surgery leads to longer anal dilatation and trauma with subsequent higher likelihood of continence impairment. The article aims at describing the first case series of robot-assisted Soave procedure, which was adopted as an alternative minimally invasive approach to older patients with Hirschsprung disease. The technical principles are represented by intraoperative seromuscolar leveling biopsies, intracorporeal endorectal cranial dissection, and endorectal pull-through with colo-anal anastomosis. The authors report three procedures that were carried on without complication with a limited requirement for anal dilatation and trauma, given the reduced need for endorectal caudal dissection. The results demonstrate the feasibility of the proposed approach. The robotic approach should be considered as an alternative minimally invasive approach for older children or adults with Hirschsprung disease