Amodeo C

Incisional hernia in the elderly: Risk factors and clinical considerations

OBJECTIVE Ventral incisional hernia is a common complication of abdominal surgery. The marked improvements in medical technology and healthcare, lead to an increasing number of elderly patients to take advantage of even complex surgical procedures. The objective of this literature review was to analyze the risk factors for ventral incisional hernia in elderly patients and to identify measures that might decrease the incidence of this complication. MATERIALS AND METHODS An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with particular reference to elderly patients using the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia, and hernia prevention. RESULTS In our opinion the risk factors for incisional hernia should be separately considered. First those related to the patients and to the abdominal surgery and, in addition, those related to the surgery of the abdominal wall defects. CONCLUSIONS Reparative surgery of the abdominal wall, to date uniquely characterized by the use of the mesh, should be considered an additional risk factor for the occurrence of incisional hernia. However, the low incarceration risk, the risk of recurrence, the relevant rate of postoperative pain and discomfort and complications associated with mesh repair, as small bowel obstruction, mesh infection, and entero-cutaneous fistula, suggest that the general indication for surgical treatment of incisional hernias, in a symptomatic or oligosymptomatic elderly patients, should be critically reconsidered in order to avoid unnecessary surgery.

Dedifferentiated liposarcomas: evaluation of the prognostic and therapeutic factors in the elderly patient

BackgroundLiposarcomas (LPS) are rare tumors accounting approxi-mately for 19% of adult soft-tissue tumors [1]. The mostrecent classification of the WHO divides liposarcomasinto 3 main clinicopatological and genetic subtypes:myxoid/round cells liposarcoma, well differentiated /dedifferentiated liposarcoma and pleomorphic liposar-coma [2]. The importance of a total macroscopicalresection to perform an oncologically correct operationis well known, so that it is often necessary to removeone or more adjoining organs with the purpose of redu-cing the risk of local secondary recurrences [3].Materials and methodsWe present the case of an 88-year-old woman with alarge abdominal swelling. The TC of the abdomenshows the spleen moved upward (Figure. 1). The lefthemiabdomen is filled by an expansive formation almost20 cm wide in diameter, made partly of a solid compo-nent and partly cystic-like. The pancreas is totallyagainst the gallbladder. It does not seem possible toremove the back wall of the spleen from the swelling.(Figure 2).We decide to perform surgery. The neoplasia is incontinuity with the tail of the pancreas, so a distal pan-creasectomy and splenectomy is performed. Definitivehistological examination: dedifferentiated liposarcoma ofhigh degree.ResultsAfter surgical resection ofthe primitive liposarcoma,factors determining the probability of recurrence and

Laparoscopic Cholecystectomy in the elderly

Background Few studies have examined the results of laparoscopic cholecystectomy (LC) in the elderly. We reviewed our experience with the procedure in 194 patients age 65 and older.

Treatment of breast cancer in elderly patients

Objectives The number of elderly patients with breast cancer is increasing. The purpose of this study was to evaluate the outcome of treatment of elderly women with breast cancer. We have explored the clinical and biologic characteristics of a group of patients aged 65 years and over affected with breast cancer. We have also identified specific subsets of elderly patients with breast cancer who have survival similar to that expected in the general population irrespective of disease status.

Post-orchidectomy retroperitoneal seminoma: A case report.

Between 2 and 5% of malignant germ cell tumors in males arise at extragonadal sites. The origin of extragonadal retroperitoneal germ cell tumors remains controversial. Whether these develop primarily in the retroperitoneum or are metastases of a primary testicular tumor has long been debated. We report a 38-year-old male who presented with abdominal pain and was diagnosed with retroperitoneal seminoma. The patient gave a history of having undergone a right orchidectomy for an undescended testis via the inguinal route 10 years previously with a reported histology of benign inflammatory mass.

Total parenteral nutrition in major surgery: role in geriatric age

Objectives Many studies demonstrate that malnutrition in geriatric patient suitable for major surgery is an important risk factor for the onset of operating complications and for the increase of mortality range. The aim of this study is to value if an appropriate nutritional support allows a better metabolic recovery of the geriatric patient in order to decrease post-operating morbidity and mortality.