Primary omental torsion (POT): a review of literature and case report

Eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Although omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon because it mimics the common causes of acute surgical abdomen. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of intra-abdominal inflammation, postsurgical wounds or scarring, and hernial sacs, omental torsion still can represent a surprise. Explorative laparotomy represents the diagnostic and definitive therapeutic procedure. Presently laparoscopy is the first choice procedure

Nuovo metodo di fissaggio per i materiali protesici sperimentato su modello animale.

Nuovo metodo di fissaggio per materiali protesici sperimentato su modello animale M. Chiaretti, J. Andreuccetti, A. I. Chiarettia, G.A.Carrub, D. Tuscano, Paolo Negro Chirurgia Generale e Day Surgery, Dipartimento Chirurgia Generale, “Paride Stefanini”, Università degli Studi di Roma “La Sapienza”. a Ospedale S. Andrea, II Facoltà di Medicina e Chirurgia, Università degli Studi di Roma b Ospedale Policlinico Umberto I, Università degli Studi di Roma La chirurgia dei difetti della parete addominale utilizza materiali protesici leggeri, resistenti, biocompatibili, economici, per ridurre il rischio di recidiva, migliorare il confort postoperatorio, abbreviare la degenza. La “Protesi Ideale” dovrebbe anche essere applicabile rapidamente, bioadesiva, e utilizzabile sia nella chirurgia open sia in laparoscopia. Dovrebbe poter prevenire il rischio di neuropatia dolorosa cronica, [5,6] e proteggere dalle teoriche ma possibili infezioni, non ancora conosciute e quindi non diagnosticabili, trasmissibili con i materiali biologici usati per confezionare le colle di fibrina [6]. Abbiamo studiato un nuovo materiale, il Buckypaper di nanotubi di carbonio (BP), nato per altri impieghi ma lavorabile con forbice, sterilizzabile in autoclave [1,3], superleggero, flessibile, bioadesivo e biocompatibile. Il BP risulta utile per il fissaggio di tutti i materiali protesici attualmente esistenti in commercio, compresi cateteri ed elettrodi, ai tessuti biologici viventi; è d’uso semplice, versatile, efficace, economico, affidabile e sicuro sul modello animale, permettendo di velocizzare la procedura chirurgica. Abbiamo eseguito la sperimentazione in vivo su ratti Sprague_Dawley e la sperimentazione di banco su conigli New Zeeland. Stiamo valutando l’ipotesi di utilizzare il BP in sostituzione dei mezzi di sintesi e collanti biologici attuali. [5, 6], proteggendo il paziente da teoriche ma possibili infezioni trasmissibili e neuralgia cronica legata ad eventuale “entrapment”. Il BP sembra essere un materiale protesico bioadesivo migliore di tutti quelli attualmente in commercio e pone una seria ipoteca sui sistemi di fissaggio protesico, che potrebbero cambiare radicalmente, qualora il BP confermasse la sua perfetta biocompatibilità . 1.Chiaretti, M.; Mazzanti, G.; Bosco, S.; Bellucci, S.; Cucina, A.; Le Foche, F; Carru, G A; Mastrangelo, S; Di Sotto, A ; Masciangelo, R; Chiaretti, A M; doi:10.1088/0953- 8984/20/47/474203. J. Phys.: Condened Matters 2008, 20, 47-57. 2.Chiaretti, M.; Cucina, A.; Bellucci, S.; Di Sotto A; Mazzanti G.; www.icact.com Abstract book of 20th International Congress on Anti-Cancer Treatment 2009, 438-439. 3.Bellucci S, Chiaretti M., Onorato P. Rossella F., Simone M. 2009, september 21-22 Micro-Raman study of effect of sterilization on carbon nanotubes for biomedical applications. Poster Session 2nd. National Nanomedicine Conference Padova. 4.Multi Walled Carbon Nanotube buckypaper: toxicology and biological effects in vitro and in vivo.; Bellucci, S.; Chiaretti, M..Cucina, A.; Carru, G A; Chiaretti, A I. Nanomedicine (2009) 4(5); 531-540 ISSN 1743-5889 5.Sunderland S.: Nerves and nerve jniury. Livingstone, Edinburg.1968. 6.Olmi S.Addis A: Experimental comparison of type of Tissucol dilution and composite mesh (Parietex) for laparoscopic repair of groin and abdominal hernia: observational study conducted in a university laboratory. Hernia. 11:211-215 (2007)

New fixing method for open and laparoscopic surgical prosthetic materials tested on animal models

Abstract text Introduction: the abdominal wall defects surgery needs of prosthetic light, resistant, biocompatible and economic materials, to reduce recurrence risks, shorten recovery length and improve the patients postoperative comfort. The Ideal prosthesis would be simply implantable, biocompatible and usable both in open and laparoscopic surgery. The material we tested is also bioadhesive. Methods&Materials: we studied a new material, the Buchypaper of Carbon Nanotubes (BP). About BP we observed that it can be tailored with scissors, it can be sterilized, it is superlight, flexible, bioadhesive and biocompatible. The BP can be linked to any kind of prosthetic material and employed to fix the prosthesis to biological alive tissues. We tested on Sprague Dawley rat model and bench tests on New Zeeland female rabbits. The measurement of the bioadhesivity was realized by peeling test at 90° with INSTRON 4502. Results: we compared BP Fmax=4.1 N versus Parietene Progrip® “self gripping” Fmax=0.01 N. Infinity GORE Fmax=0,3 N, were fixed to the biological support with fibrin glue Tissucol® Baxter. Test show the adhesion strength of new dry BP sample applied on biological support. As peel force is applied we measure the displacement of self-gripping BP from fascia and muscular layer. For the samples of BP tested on the smooth surface (BPs), BP tested on the rough surface. We compared these results with the peeling test of Parietene Progrip® “self gripping”. The bio-adhesiveness of the side coated with polyglactin is very low, showing maximum peel strength of only 0.001 N/mm, 100 times lower than that recorded for BPr sample. Conclusions: the tests showed a significant performance difference among the prosthetic samples. At the light of our experience we think that the BP can replace any kind of suture and biologic glues in the fixing prosthesis materials in the alive tissues, avoiding theoretically but possible infections and chronic pain due to nerve “entrapment”. The BP showed a bioadhesivity 100 times bigger than the best self gripping actually marketed prosthetic material. We believe that the modifiable BP bioadhesivity, if largely employed, can radically change the fixing surgical technique.URL LAVORO: https://link.springer.com/article/10.1007/s00464-012-2198-3#citeas GRANT_NUMBER: ERDF DI9_20 2011-2013 URL: http://www.regione.abruzzo.it/xEuropa/docs/beneficiariPor/beneficiari23022016.pdf GRANT_NUMBER: C26A10HCNR/2010, Project 349/2012 URL: http://www.uniroma1.it/sites/default/files/PROGETTI_UNIVERSITà_1.pd

Laparoscopically assisted treatment of entero-atmospheric fistula following abdominal wall repair of complex incisional hernia: Case report

Introduction: Entero-atmospheric fistula (EAF) is an uncommon complication. Its timing and surgical management could be extremely challenging because extensive adhesions may heavily affect the approach to the abdominal cavity. Presentation of case: We hereby report a case of EAF in a 70 year-old man. In order to control the fistula output and the surrounding tissue damage from enteric content, the patient was managed conservatively using different technical solutions. Finally, the patient underwent surgery that started with a laparoscopic approach in order to avoid the hostile abdomen. Discussion: Due to the lack of guidelines, treatment of EAF requires a multidisciplinary approach and different technical options based on the experience and inventiveness of the surgeon. Among others, the vacuum assisted wound management proved to be a useful support andlaparoscopy demonstrated to be valuable in approaching the abdominal cavity. Conclusion: According to our experience the success of the treatment of EAF may be improved adopting a multidisciplinary approach and well-planned surgery in referral centers

Is intraoperative ultrasonography useful in pancreatic cancer surgery?

Preoperative staging of pancreatic cancer represents a major challenge for a suitable surgical management of the disease. In a consistent number of patients laparotomy is still necessary in order to decide whether the tumor is resectable or not. In the present paper the Authors report their experience with intraoperative ultrasonography (IOU) in evaluating pancreatic cancer resectability. Very important data for intraoperative decision making were obtained in 37.9% of the patients, useful information in 31%, while in 31% IOU may be looked forward to as an important aid in decision making and for a safely guided dissection