Resección laparoendoscópica de tumor de la unión gastroesofágica

Atypical gastric resection has proved to be beneficial to treat submucosal tumors. The technique is more difficult when these tumors develop next to the gastroesophageal junction (GEJ). Intragastric resection combining endoscopic and laparoscopic approach was proposed to solve this limitation. There are no publications about this technique in our environment. A 42-year-old female patients with a 2-mm subepithelial tumor below the cardia evaluated by upper gastrointestinal (UGI) videoendoscopy and endoscopic ultrasound suggestive of a gastrointestinal stroma tumor (GIST) underwent resection using the combined laparo-endoscopic approach. Under laparoscopic guidance, balloon-tipped trocars were introduced in the abdominal cavity and then into the stomach using endoscopic view. The balloons were inflated to fix the gastirc wall to the abdominal wall. The lesion was resected using mechanical stapler. The combined approach is safe and efficient, and simple to perform for trained professionals, constituting a reproducible option in selected cases

Early and long-term results after Soave-Boley operation as the surgical treatment of colon agangliosis in children

Introduction. Сolon agangliosis (CA) belongs to a group of severe congenital malformations of the colon that can only be treated by surgical approach. The Soave-Boley technique is one of the most physiological and technically acceptable among pediatric surgeons from from all over the world. Aim – evaluate the early and long-term results of surgical treatment of CA in children by Soave-Boley method. Materials and methods. We analysed surgical treatment of 774 children with various forms of CA aged from birth to 18 years for the period from 1980 to 2020, using the Soave-Boley method by the formation of the primary colo-anal anastomosis by manual (suture) and mechanical (stapler) method. Results. All patients survived. Early postoperative surgical complications were seen in 19 (2.45%) of 774 children operated by Soave-Boley method: in 15 – after the formation of the primary colo-anal anastomosis by manual (sutures) method and 4 – after the imposition of a colo-anal anastomosis by mechanical (stapler) method. Long-term postoperative complications were noted in 15 (1.94%) of 774 children operated by Soave-Boley method: 14 – with a manual (suture) and 1 – with a mechanical (stapler) colo-anal anastomosis. Re-operation was successfully performed in 30 (3.87%) patients with reconstructing colo-anal anastomosis manually with Soave-Boley method after initial correction of CA in other clinics by other methods. Periodic episodes of soiling were seen in the remote period in 47 (6.07%) of 774 operated children which was treated conservatively. The success of the Soave-Boley technique is confirmed by a much lower number of early (2.45%) and long-term (1.94%) postoperative surgical complications, compared with those after the use of other methods of open surgical correction – 17.52% and 16.35%, respectively. Conclusions. Soave-Boley operation with colo-anal anastomosis by manual (suture) and mechanical (stapler) methods in comparison with other methods is the most effective method of radical correction of CA as open surgical approach in children of different age groups as single staged or double staged interventions. According to the technical capabilities and results of the early and long period, the Soave-Boley technique with colo-anal anastomosis by manual (ligature) method is the operation of choice for both primary and re-surgical correction of CA compared to any other methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interest was declared by the authors. Key words: agangliosis, colon, children, surgical treatment, results.

Barbed suture and gastrointestinal surgery. A retrospective analysis

Although minimally invasive surgery is recognized as the gold standard of many surgical procedures, laparoscopic suturing is still considered as the most difficult skill in laparoscopic surgery.The introduction of barbed sutures facilitates laparoscopic suturing because it is not necessary to tie a knot. The efficacy of this method has been evaluated in different types of surgery; however, less is known about general surgery.We retrospectively analysed data from 378 patients who had undergone bariatric or surgical treatment for colic or gastric malignancy requiring a closure of gastroentero, entero-entero or enterocolotomy from January 2014 to January 2019, admitted to the General Surgery Unit and Operative Unit of Surgical Endoscopy of the University Federico II (Naples, Italy).We registered 12 anastomotic leaks (3.1%), 16 anastomotic intraluminal bleedings (4.2%) and 7 extraluminal bleedings. Other complications included 23 cases of postoperative nausea and vomit (6%), 14 cases of postoperative ileus (3.7%) and 3 cases of intra-abdominal abscess (0.8%). Overall complications rate was 19.8% (75/378). No postoperative death was registered.Thus, by pooling together 378 patients, we can assess that barbed suture could be considered safe and effective for closure of holes used for the introduction of a branch of mechanical stapler to perform intracorporeal anastomosis.

Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2,076 patients

Background. Intra-abdominal abscesses (IAA) may develop after laparoscopic appendectomies (LA) for acute appendicitis. The identification of risk factors for postoperative IAA could lead to a decrease in the readmission rate and surgery redoes after LA for acute appendicitis. Materials and methods. We reviewed 2,076 patients managed via a LA for acute appendicitis between 2001 and 2017. Male gender accounted for 53.5% of patients. Mean age was 29.5 (SD ± 18.47) years. Thirty-seven patients (1.8%) developed a postoperative IAA. Comparison between groups was made via univariate and multivariate analyses. Results. Male gender (p<0.05), ASA score ≥ 2 (p<0.05), a gangrenous or perforated appendicitis (p<0.0001), abscess or pelvic peritonitis (p<0.0001), clipping the mesoappendix (p<0.0001), appendix division by mechanical stapler (p<0.05), and prolonged antibiotic therapy (p<0.01) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p < 0.005), a perforated appendicitis (p <0.05), and clipping the mesoappendix (p < 0.0001) were independent predictive factors for postoperative IAA Conclusion. Patients with peritonitis or a perforated appendicitis, and those who had their mesoappendix clipped showed a higher likelihood of developing an IAA. At-risk patients should be provided with careful follow-up for the early detection and management of this complication.

Evaluation of the Surgery Wound Healing Process Using Self–Adaptive Skin Suture or Mechanical Stapler

Wound healing is a complex and time-phased process. The occurrence of numerous negative conditions as well as external factors have a significant influence on the risk of potential complications. Preparing the patient for surgery, attention should be paid to a number of factors determining the proper healing process.The aim of the study was to compare the results of the early period of surgical wound healing process with access via laparotomy using techniques, which are self-adaptive sutures and mechanical staplers used for skin closure.Material and methods. The study included 120 patients divided into three groups, according to the degree of wound continence, in accordance with the CDC (Center for Disease Control and Prevention). Exclusion criteria based on objective analysis were applied for patients with a higher risk of complications. In all cases the skin layer was closed with monofilament suture or single-patient use stapler. A ten-day observation of the wound healing process was implemented. The study was randomized.Results. In the case of patients groups identified as a “Clean Wound” and “ Clean / Infected Wound” no significant differences were discovered. In the group “Contaminated/Infected Wound” significantly higher percentage of wound-healing complications were reported (p < 0.05) for which monofilament sutures was used.Conclusions. The study showed, that mechanical stapler is recommended for contaminated/infected surgical wounds due to significantly lower risk of complications. In the case of wounds divided as a “Clean” and “Clean/Infected” type of suturing material has no significant effect on wound healing.