[Feasibility and effectiveness of laparoscopic right colectomy with extracorporeal anastomosis]

AIM

Despite the laparoscopic right hemicolectomy has been validated by many randomized prospective trials, clear evidences on the validity of the totally mini-invasive technique, namely, through intracorporeal anastomosis, are still lacking. The aim of this study was the assessment of short-term outcome within three months from laparoscopic right colectomy with intra- or extra-corporeal anastomosis.

METHODS

With no exclusion, all patients undergoing laparoscopic right hemicolectomy at our institution have been enrolled in this study. Group A included patients undergoing laparoscopic right hemicolectomy with extracorporeal anastomosis (LAC) and Group B, included patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (TLC). Patients' data, surgery details, results of postoperative period and histological tests have been prospectively recorded in a database and analysed.

RESULTS

Between December 2006 and December 2008, 45 patients underwent right hemicolectomy, 21 with extracorporeal anastomosis and 24 had intracorporeal ones. As to patients' characteristics and histopathological results there are no difference between the groups. Anastomotic dehiscence occurred one in group A and one in group B (P>0.05). Both patients underwent reoperation. We recorded 6 postoperative ileus with vomiting in the LAC group and only 1 in the TLC group (P<0.05). The incidence of Non-Surgical Site Complications (NSSC) was of 4.54% in LAC group and 8.33% in TLC group (P>0.05). Hospitalization was of 5 days for both groups.

CONCLUSION

In conclusion, we believe that this technique is feasible in terms of safety; it doesn't significatively affect the length of surgical procedure and guarantees maintenance of oncological radicality standards of reference. Besides it significatively improves quality of the post-operative period.

Treatment of slow-transit constipation with sacral nerve modulation

AIM

Constipation is common and a selection of the best treatment is difficult, especially for slow-transit constipation (STC). The aim of the study was to assess the effect of sacral nerve modulation (SNM) on STC.

METHOD

A retrospective analysis of patients with STC, treated with SNM was undertaken. All were evaluated by cinedefecography, colon transit-time, Cleveland Clinic Constipation Score (CCS), SF-36 Quality of Life (QoL) and a bowel diary. Initially, all patients underwent a temporary implant for 4 weeks. The criteria of success were disappearance of necessity for laxatives or enema requirement, and improvement in QoL.

RESULTS

Fifteen patients with STC were treated from March 2003 to May 2006. Nine (60%) underwent permanent implantation. After SNM, the mean improvement of Wexner Constipation Score (CCS) and QoL was 10 and 6.2 respectively. There were no complications. The mean follow-up period was 42 months.

CONCLUSION

Sacral nerve modulation seems to be a useful option for STC.

[A new effective method to reduce pain after laparoscopic cholecystectomy]

BACKGROUND

The primary aim of this randomized controlled prospective study (www.clinicaltrials.gov NCT00599144) was assessing effectiveness on pain control after videolaparoscopic cholecystectomy (VLC) of 0.5% Bupivacaine-soaked sheet of regenerated oxidized cellulose positioned in the gallbladder bed.

PATIENTS AND METHODS

We randomized in three equal groups 45 patients that underwent elective videolaparoscopic cholecystectomy: group A - Bupivacaine-soaked sheet of regenerated oxidized cellulose positioned in the gallbladder bed; group B - Bupivacaine infiltrated in the muscular fasciae of the trocars' seat; group C - control group, not using local anesthetic. Six and 24 hours after the intervention we recorded the type of the pain and its intensity, using a visual analog scale (VAS).

RESULTS

We observed no statistically significant difference in pain intensity. Considering the type of pain, 55,56% of patients referred visceral pain, 62,22% parietal pain and 44,44% shoulder pain. Group A shows, at both endpoints, a statistically significant reduction (p < 0.05) of visceral and shoulder pain versus other groups. Moreover, the use of a local anesthetic significantly reduces the use of post-operative pain drugs, both for group A and B.

CONCLUSION

A Bupivacaine-soaked sheet of regenerated oxidized cellulose positioned in the gallbladder bed post-VLC is safe and not economically demanding, and can give advantages in increasing post-operative comfort.

[The development of a fast track surgery program after laparoscopic colonic surgery in a General Surgery Unit]

AIM

The aim of the "Fast-Track Surgery" program is to decrease the perioperative stress response to surgical trauma and thus to decrease the complication rates after elective surgery. Critics of the "Fast-Track"(FT) rehabilitation may argue that all reports of successful programs came from major specialised hospital units and that implementation in smaller or less specialised units may be difficult, if not impossible.

METHODS

We retrospectively studied 101 patients that, from November 2004 to October 2007, underwent laparoscopic colorectal surgery in our institute. A detailed "Fast-Track Surgery" protocol was prepared and given to patients, physicians and nurses, with the aim to create a standard treatment. Data about demographics, ASA score, preoperative complicating diseases, diagnosis, type of surgery and postoperative clinical data were analyzed. Univariate analysis of the relationship among all factors (patient characteristics, intervention characteristics, protocol compliance and presence of complications) described here and length of hospital stay was performed.

RESULTS

We compared our results to those of major trials previously published and observed no substantial differences in morbidity, mortality and length of postoperative hospital stay between the two. Univariate analysis showed that compliance to the elements of the FT protocol influences the length of postoperative period more significantly than the patient characteristics or surgical procedure.

CONCLUSION

Based on six comparative single-centre studies, the FT program was found to reduce length of hospital stay and was deemed safe for major abdominal surgeries. The present study shows that enhanced recovery or FT program can also be implemented safely in a General Surgery Unit.

[Laparoscopic approach in acute bowel obstruction due to ileal endometriosis: case report]

Endometriosis affects 10-20% of fertile women, and in 3-37% of them it extends to the bowel. Its location, in the ileal tract of the bowel, usually the end-part, is only the 7%; and the occurrence of intestinal obstruction is no more than 0.15% of patients affected by endometriosis. We present a case of acute bowel obstruction due to ileal endometriosis in a 39 years woman, diagnosed and treated by laparoscopic approach.