Alberto Manzoni

Long-Term Outcome after Laparoscopic Bowel Resections for Deep Infiltrating Endometriosis: A Single-Center Experience after 900 Cases

Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed. Results. The median follow-up was 54 months (range 1–120). All the evaluated symptoms significantly improved over time, with P = 0.0001 for dyspareunia, constipation, and pelvic pain and P = 0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P = 0.452 and P = 0.097, resp.). Conclusions. The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage.

Selection criteria in resectable pancreatic cancer: A biological and morphological approach

Pancreatic ductal adenocarcinoma (PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.

Laparoscopic pancreatic resections in two medium-sized medical centres

To analyze the clinical outcomes of patients undergoing minimally invasive surgery for pancreatic neoplasms, in two medium-volume centers in Northern Italy, a retrospective chart review was performed in the operative registries, searching for patients who had undergone pancreatic surgery via laparoscopy, irrespective of the final pathological nature of the resected neoplasm. For each case, a standard data extraction form was completed and the following data was extracted: age and sex, type of resection, estimated blood loss, length of the operation, number of harvested nodes, post-operative pancreatic fistula, major post-operative complications, mortality and final pathological diagnosis. The systematic literature research was also undertaken and the reported results were analyzed. A total of 55 cases were recorded, including 39 distal pancreatectomies and 16 pancreaticoduodenectomies. The most frequent indications leading to surgery were ductal adenocarcinoma (26 pts) and cystic neoplasm (22 pts). No post-operative death occurred in this series; pancreatic fistula occurred in 64% of distal pancreatectomies and 22% of pancreaticoduodenectomies. The mean operating times were 178′ and 572′, respectively. Both distal pancreatectomy and pancreaticoduodenectomy proved to be feasible and were safely performed by laparoscopy, in two centers with medium-volume pancreatic caseload.

Extra peritoneal giant pelvic hibernoma: a case report

Abstract Abdominal hibernoma is a rare slow-growing tumor originating from brown adipose tissue. Due to its rarity, only a few case reports have been published so far. Pelvic localization is anedoctal and preoperative differential diagnosis with other malignancies may be challenging. We present the case of a woman who, due to a lower abdominal pain, underwent an abdominal ultrasonography with diagnosis of a 15 cm hyperechogenous pelvic mass. A subsequent MRI showed a 16 × 5.8 × 7.8 cm3 lesion anterior to the left iliacus muscle, with an intra- and extrapelvic component longitudinally extending from the left anterior superior iliac spine until the lesser trochanter. Surgical resection was performed and final histopathology was consistent with hibernoma. This report emphasizes the necessity to include hibernoma among differential diagnosis when a retroperitoneal abdominal mass is diagnosed and the difficulty to perform preoperatively this diagnosis due to the extreme rarity of these neoplasms.

The Biological Effects of Preconditioning Hyperbaric Oxygen Therapy in Pancreaticoduodenectomy: Results of a Randomized, Double-Blind Trial in Humans

Context Hyperbaric oxygen (HBO) therapy involves the intermittent inhalation of 100% oxygen in chambers pressurized between 1.5 and 3.0 atmosphere absolute (ATA). HBO attenuates the production of pro-inflammatory cytokines in response to the inflammatory stimulus such surgery and the subsequent modulation of immune response. The positive role of HBO in human surgery was demonstrated only in cardiovascular and orthopedic surgery and after liver transplantation. Pancreaticoduodenectomy (PD) represents one of the most important surgical procedures burdened by a considerable number of local and systemic complication, ranging between 30 and 60%. Objective The main objective of this study was to identify the possible presence of major differences between the concentration of inflammatory cytokines in two study groups depending on the receiving or not HBO before PD procedure. Secondary objective was the comparison of the complication rate and hospital stay between the two study groups. Materials and methods The study was a prospective, randomized double-blind study lasting 6 months. Ethics approval was obtained from local ethics committee (2176/2012). Thirty-two patients were recruited to this study. Twenty-four hours before PD, atients of group “A” were submitted to HBO session while patients of group “B” breathed air in an hyperbaric chamber pressurized to 1.15 ATA (placebo procedure). In all patients, blood was taken before (T0) and at the end HBO session or placebo procedure (T1), in the first post-operative day (T2) and in the seventh post-operative day (T3). It was used to measured IL-1, IL-6, IL-8, IL-10, IL-12p70 and TNF-α. For the evaluation of the post-operative outcome we considered the presence of postoperative pancreatic fistula (POPF), biliary fistula, fever, intra-abdominal collections, bleeding, pulmonary complications, delay gastric empty and the use of postoperative antibiotics. Result Significant differences in favor of HBO group were found regarding the pulmonary complications (none in HBO group versus 6 in the placebo group; P=0.023). The maximum concentration of cytokines is in T2 and HBO exposure can modulated the concentration of IL-6 and IL-10 (P=0.009 and P=0.030 HBO vs . placebo). Conclusions Preliminary data suggest that preconditioning hyperbaric oxygen therapy is safe and can be applied to all patients after careful clinical evaluation and identification of absolute contraindications with a potential role in decreasing the pulmonary complications.