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Summary Background We evaluated the frequency of incidental papillary thyroid microcarcinomas (mPTC) in thyroidectomies performed for benign diseases, to better characterize this nosologic entity and to assess the best treatment. Methods Between 2009 and 2017, a total of 1777 patients underwent surgery for benign thyroid disease. Patients with preoperative undetermined or positive for malignancy cytology were excluded, as well as incidental thyroid cancer larger than 1 cm. Results Total thyroidectomy was performed in 1649 patients (92.7%) and hemithyroidectomy in 128 (7.2%). Papillary thyroid cancer, sized between 2–10 mm, was found in 89 patients (5%), which were all by definition microcarcinomas (mPTC). In 11 patients mPTCs were multifocal and in 7 bilateral. Just 6 patients received hemithyroidectomy and later underwent radical surgery without complications. No tumor-related morbidity or mortality was observed. The χ2 test showed a statistically significant association between mPTC and non-toxic multinodular goiter. Discussion In the literature, the rates of incidental mPTC vary, due to various factors such as histopathological examination and sampling numbers. Regarding surgical treatment, some authors support a “conservative” approach for the positive prognosis, but considering that it can be associated with mortality, lymph node recurrence and metastasis, its treatment is still controversial. Conclusions Our experience confirms that total thyroidectomy in multinodular goiter is a safe procedure, which ensures endocrine control and oncologic complete tumor resection, in case of mPTC. In uninodular goiter, we recommend hemithyroidectomy; if mPTC is discovered, we suggest radical surgery especially in patients older than 50 years and with familial disposition for thyroid cancer and peripheral tumors larger than 5 mm and aggressive variants.

In the common clinical practice the perioperative risk assessment of an acute surgical patient with advanced chronic comorbidities is carried out independently by surgeon and anesthesiologist, usually in two different steps. While the surgeon evaluates the risk mainly in relation to the surgical outcome, the perioperative risk assessment regarding the weight of the coexisting medical condition on the quality of recovery in the short- mid- and long-term is all about the anesthesiologist evaluation. When frailty and/or comorbidities are so serious that will make surgery seem futile, the patient's assessment on one hand, and the decisions regarding the further clinical waypoint on the other, have to be discussed firstly between surgeons and anesthesiologists before being shared with the patients and their relatives. This is mostly true in the event of an emergency surgical procedure. In regard, a consensus conference attended by a panel of experts respectively from the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) and the Italian Society of Surgery (SIC) was called for developing a shared clinical pathway aimed to select the best care option - operative vs palliative - in the best interest of the surgical patient with advanced chronic comorbidities, in emergency or elective condition. After two years, the panel of experts developed a position paper recommending, in case of potentially futile surgery, to assess the patient verifying two coexisting conditions ("Two Steps method"): Palliative Performance Scale50%, and at least one of the following general clinical criteria: 1) more than one hospital admission within the last 12 months; 2) hospital admission from or awaiting admission to long-term care facilities, home care service, hospice; 3) chronic renal failure requiring weekly dialysis sessions; 4) home oxygen use and/or non-invasive ventilation. Under these conditions, the surgeon together with the anesthesiologist can share with the patient and/or his relatives the decision between palliative surgery or palliative care taking into account his wishes and preferences.

Background Patients on peritoneal dialysis treatment represent 15% of the global dialysis population. The major complication of peritoneal dialysis is catheter and peritoneal infection. Peritoneal dialysis patients who receive kidney transplants are at increased risk of infection because of immunosuppressive therapy. Aim The purpose of this study is to show our ideal timing to remove peritoneal catheter after kidney transplant, which gives adequate security on renal function recovery and reduction of septic risk. Method of Study We analyzed the outcomes of 65 patients on peritoneal dialysis who underwent kidney transplant between 2000 and 2016. Results In 61 cases there was an immediate graft functional recovery. In 4 cases there was a delayed graft function (DGF), and we performed a hemodialysis with temporary placement of a venous catheter. In all patients we removed peritoneal dialysis catheter 30 to 45 days after transplant. There has been 1 case of catheter infection, which was treated with antibiotic therapy. Discussion Our average time to remove the peritoneal dialysis catheter was shorter than times in previous studies, between the 30th and 45th postoperative day. In the 4 cases in which there has been a DGF, we performed hemodialysis treatment to avoid, in the immediate postoperative period, direct insults to the peritoneum by local dialysis procedures. Conclusion Our experience show that the 30th to 45th postoperative day is a good time frame, better yet a good watershed between the safe removal of peritoneal catheter when patients have a stabilized renal function and the possibility of leaving it in situ, to resume peritoneal dialysis in case of persistent DGF.

Introduction Wound complication frequently arises after kidney transplantation and its risk factors are well known. In a previous paper we analyzed these factors, and in this new retrospective study we evaluate the influence of lymphocele in the development of wound complications. Patients and methods From January 2000 to December 2018, 731 consecutive kidney transplants have been performed in our center. We have analyzed the incidence of wound complication and lymphocele and their risk factors. Results Out of 731 kidney transplants, we have observed wound complications in 115 patients (15.7%) and lymphocele in 158 patients (21.7%). Of these, 70 patients developed both complications (9.5%), but 6 patients have been excluded because they were in therapy with mammalian target of rapamycin inhibitors. Twenty-nine patients (45.3%) presented a first level and 35 patients (54.7%) showed second level wound complications. Lymphocele was the only present factor in just 3 cases (4.6%). The other patients showed diabetes in 28 cases (43.7%), overweight/obesity in 38 (59.3%), delayed graft function in 17 (26.5%), and 60 years or more in 38 (57.8%). The association has been found in 30 out 64 patients treated with tacrolimus (46.8%) and in 34 with cyclosporine (53.1%); 40 patients did not receive muscular layer’s reconstruction (62.5%). Conclusion Our experience shows that lymphocele alone is not a predisposing factor for wound dehiscence after kidney transplantation, and they often coexist because they share the same risk factors, the most important being obesity, diabetes and delayed graft function, older age, and surgical techniques. No relation has been observed with calcineurin inhibitor therapy.

Angiomyolipomas (AMLs) are among the most common benign renal tumors, typically consisting of varying proportions of 3 components: blood vessels (angio), smooth muscle cells (myo), and fatty tissue (lipoma), and are thus called triphasic. Occasionally, AMLs may present atypical histologic features consisting almost exclusively of one component (monophasic) or containing numerous epithelioid muscle cells with small amount of fat, as in the rare epithelioid variant (E-AMLs). AMLs occur as a sporadic entity in 80% of cases; more rarely, they are related to hereditary diseases such as tuberous sclerosis complex (TSC). Hereditary AMLs can reach huge dimensions and may present unusual imaging features determining diagnostic pitfalls. Few cases of giant sporadic AMLs are reported in literature, and even fewer regarding the epithelioid variant. We present a case of a 36-year-old man suffering from anemia and fever, whose contrast-enhanced computed tomography (CT) depicted the presence of a huge (14 x 21 x 30 cm) retroperitoneal fat-containing mass.

Background: Prostate cancer (PCa) represents a common disease in men aged >65 years. The role of physical activity (PA) in patients at risk or diagnosed with PCa represents an evolving issue. We aimed to summarize available evidences about the impact of PA on the pathophysiology and clinical outcomes of PCa. Methods: We performed a narrative review. Evidences about the role of PA in elderly patients in terms of PCa biology, epidemiology, oncological and functional outcomes, as well as in terms of impact on the outcomes of androgen deprivation therapy (ADT) were summarized. Results: Potential pathophysiological pathways hypothesized to explain the benefits of PA in terms of prostate carcinogenesis include circulating levels of Insulin-like growth factor-1 (IGF-1), oxidative stress, systemic inflammation, sex hormones, and myokines. Clinically, emerging evidences support the hypothesis that PA is associated with decreased PCa risk, improved PCa-related survival, improved functional outcomes, and reduced ADT-related adverse events.

Introduction SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era Patients and Methods The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic Results From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic All the transplanted patients remained COVID negative during the follow-up The number of transplants performed has been constant compared to the same months of 2018 and 2019 In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy Conclusion Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients [ABSTRACT FROM AUTHOR] Copyright of BioMed Research International is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Kidney transplantation is the surgical operation by which one of the two original kidneys is replaced with another healthy one donated by a compatible individual. In most cases, donors are recently deceased. There is the possibility of withdrawing a kidney from a consenting living subject. Usually, living donors are direct family members, but they could be volunteers completely unrelated to the recipient. A much-feared complication in case of kidney transplantation is the appearance of infections. These tend to arise due to immune-suppressor drugs administered as anti-rejection therapy. In this review, we describe the gastrointestinal complications that can occur in subjects undergoing renal transplantation associated with secondary pathogenic microorganisms or due to mechanical injury during surgery or to metabolic or organic toxicity correlated to anti-rejection therapy. Some of these complications may compromise the quality of life or pose a significant risk of mortality; fortunately, many of them can be prevented and treated without the stopping the immunosuppression, thus avoiding the patient being exposed to the risk of rejection episodes., Graphical abstract

Background: More than 50% of patients with Colorectal cancer (CRC) present or develop hepatic metastases (HM). The intraoperative use of the Habib 4X® radio frequency probe device is safe in resetting HM and allows a one-stage resection of both CRC and HM with a similar mortality rate than a two-stage surgical treatment. Methods: After an exhaustive residential training at the reference center for hepato-biliary surgery of the Imperial College of London, we treated at our unit of general surgery 40 consecutive patients with CRC and HM with the one-stage resection, using the Habib 4X® intraoperative radiofrequency probe device to reset HM. Results: None of the 40 patients died during the intra-operatory and post-operatory periods, none presented liver failures during the postoperative course nor complication related to the Habib's resection procedure (e.g. bleeding, abscess, bile leak). The amount of intra-operative liver bleeding was minimal. New HM arose in 10 (25%) cases, with a mean disease-free interval of 13 months, but the hepatic tissue close to previous resections remained cancer-free. The 69.7 % of patients were disease-free at month 24 of the post-operative follow-up and 5-year rate was about 70%. Conclusions: The data suggest that surgeons well trained at a reference center for hepato-biliary surgery may perform with excellent results the one-stage CRC and HM resection with the Habib 4X® device even in a unit of general surgery.

Aims. We aimed to summarize available evidence about intraoperative and postoperative donors’ and recipients’ outcomes following stone surgery in renal grafts from living donors performed either before donation or as ex vivo bench surgery at the time of living-donor nephrectomy. Methods. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in September 2020. We included full papers that met the following criteria: original research, English language, human studies, and describing the results of stone surgery in renal grafts from living donors performed either before transplantation or as ex vivo bench surgery. Results. We identified 11 studies involving 106 patients aged between 22 and 72 years. Predonation and bench stone surgery was performed in 9 (8.5%) and 96 (90.6%) patients, respectively. Predonation stone surgery involved extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy in 8, 1, and 1 patient, respectively. The overall success rate of predonation stone surgery was 78%, and the complication rate was 0%. Bench stone surgery involved ureteroscopy, pyelolithotomy, or a combination of both in 79 (82.3%), 10 (10.4%), and 7 (7.3%) cases, respectively, with an overall success rate of 95.8% and an overall complication rate of 9.37%. Conclusions. Predonation and bench stone surgery in grafts from living donors represents efficacious and safe procedures. Further studies on wider series with a longer follow-up are required.

Kidney transplantation is the treatment of choice for patients with end-stage disease. To expand the donor reserve, it is necessary to use marginal/sub optimal donors that provide marginal organs. We retrospectively evaluated the short and long-term outcome of elderly kidney transplantation using allografts with vascular abnormalities. Between January 1999 and December 2018, 740 transplants from cadaveric donors were performed. Thirty-four elderly patients received a kidney transplantation with vascular anatomical variants (Group 1) were compared with 34 patients who received a kidney transplantation with single renal artery (SRA) (Grroup2) pair-matched by age, dialysis age, donor age, comorbidity. All participants completed the Long Form International Physical Activity Questionnaire (IPAQ) at baseline and after 4, 8, and 12 weeks after transplantation. The overall rate of surgical complications was 17.6% in Group 1 and 20.6% in Group 2, indicating that kidney with vascular anatomical variant might be successfully transplanted. Our data also emphasizes the importance of individualized physical activity in kidney transplantation with multiple arteries. Physical activity should be considered as an essential part of the medical care for renal-transplanted recipients.

The goal of thermal ablation is to destroy cancerous cells by increasing the temperature of the target tissue. Among the ablative techniques, radiofrequency (RF) ablation is the most widespread since it can be used in both percutaneous and surgical settings, in safety and with relative ease of use. However, efforts to optimize the RF treatment are needed, considering that the size of necrotized lesions remains a central issue in the application of the ablative procedure. In this work we aimed to evaluate the temperature distribution around the RF probe during radiofrequency ablation (RFA) of ex-vivo animal livers. Temperature maps in the ablated area are obtained by equipping a commercial RF probe with 27 Fiber Bragg Grating sensors (FBGs). The experiments demonstrate the ability of the proposed setup to conduct multi-point measurements in tissues undergoing RFA and the dependence of temperature and thermal damage on insertion depth of the RF probe.

Conventional pancreatic resections for pancreatic neck and body diseases include pancreaticoduodenectomy, distal pancreatectomy with or without splenectomy, and total pancreatectomy. Recent studies have reported encouraging results of non-traditional pancreatic resections, including central pancreatectomy (CP), for central pancreatic disease. This surgical approach offers the potentials of low postoperative morbidity and preservation of metabolic functions. This study performs a systematic review on CP. A comprehensive literature search was conducted, for the period 1992-2015, on three worldwide databases: PubMed, Scopus, ISI-Web of Knowledge. We focused on indications, morbidity and mortality of this surgical procedure. The review shows that CP is particularly suitable for small-medium size diseases localized into the pancreatic body. This procedure is associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. CP is a safe and effective procedure when performed following the right indications.

Aims. We aimed to summarize available lines of evidence about intraoperative and postoperative donor outcomes following robotic-assisted laparoscopic donor nephrectomy (RALDN) as well as outcomes of graft and recipients.Methods.A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2018. The following search terms were combined: nephrectomy, robotic, and living donor. We included full papers that met the following criteria: original research; English language; human studies; enrolling patients undergoing RALDN.Results. Eighteen studies involving 910 patients were included in the final analysis. Mean overall operative and warm ischemia times ranged from 139 to 306 minutes and from 1.5 to 5.8 minutes, respectively. Mean estimated blood loss varied from 30 to 146 mL and the incidence of intraoperative complications ranged from 0% to 6.7%. Conversion rate varied from 0% to 5%. The mean hospital length of stay varied from 1 to 5.8 days and incidence of early postoperative complications varied from 0% to 15.7%. No donor mortality was observed. The incidence of delayed graft function was reported in 7 cases. The one- and 10-year graft loss rates were 1% and 22%, respectively.Conclusions.Based on preliminary data, RALDN appears as a safe and effective procedure.

Background There is currently no standard treatment for desmoid tumors (DTs) associated with familial polyposis coli (FAP). Familial adenomatous polyposis in DT patients is sometimes a life-threatening condition. Methods We enrolled all consecutive patients with FAP treated at Unit of General Surgery and Transplant, University of Naples Federico II and evaluated the incidence of DTs on FAP between 1996 and 2016. Results We observed 45 consecutive patients with FAP; of these 5 were DT-FAP-associated. All 5 cases with FAP were young women, age 25 to 65 years, previously treated by colectomy. Of these, 4 patients presented a parietal localization and had been treated with a wide surgical exeresis; one patient had an intra-abdominal, mesenteric tumor that was unresectable at laparotomy. We performed CT-guided drainage, ureteral stenting, medical therapy (sulindac+tamoxifene), and chemotherapy (dacarba-zine+doxorubicine). All patients were alive and underwent follow-ups for 5 years post-surgery; only 1 patient with parietal localization showed a local relapse after 2 years. Conclusions We propose a modulated approach to the single patient with FAP, with surgery as treatment of choice for parietal localization disease and integrating different kinds of therapies (surgery alone or associated with RT, CT) for the intra-abdominal tumor.

Hepatitis C virus (HCV) infection unfavorably affects the survival of both renal patients undergoing hemodialysis and renal transplant recipients. In this subset of patients, the effectiveness and safety of different combinations of interferon-free direct-acting antiviral agents (DAAs) have been analyzed in several small studies. Despite fragmentary, the available data demonstrate that DAA treatment is safe and effective in eradicating HCV infection, with a sustained virologic response (SVR) rates nearly 95% and without an increased risk of allograft rejection. This review article analyzes the results of most published studies on this topic to favor more in-depth knowledge of the readers on the subject. We suggest, however, perseverating in this update as the optimal DAA regimen may not be proposed yet, because of the expected arrival of newer DAAs and of the lack of data from large multicenter randomized controlled trials.

In this work, we report on the integration of fiber Bragg gratings sensors in a commercial radio frequency probe for real-time temperature monitoring during thermal ablation of biological tissues. The experiments were conducted on ex-vivo pig liver and bovine kidney tissues and the results confirm that the proposed setup is able to conduct a multi-point real-time temperature monitoring during the RF discharges with a temperature resolution of 0.1 °C and a minimum spatial resolution of 1 mm. During these experiments the blood perfusion was implemented by injecting water at a temperature of 37 °C inside the organ under examination. This solution aimed at simulating the Radio Frequency Thermal Ablation (RFTA) treatments made in clinical practice. © 2018 IEEE.

In this work, it is proposed the integration of fiber optic sensors with commercial medical instrumentation, for temperature monitoring during tumor radiofrequency thermal ablation (RFTA) treatments. The heat propagation over the area under treatment is measured by means of a specific configuration, consisting of several Fiber Bragg Grating (FBG) sensors properly bounded to the RFTA probe and being positioned close to the region reached by RF electrodes. Our ex-vivo experiments on ex vivo animal liver and kidney, confirm that we were able to monitor in real time the temperature increase during different and consecutive RF discharges performed with the laparoscopic bipolar device Habib 4x, with a temperature resolution of 0.1C and a spatial resolution of 5mm.

Approximately five percent of all breast cancer patients in developed countries present with distant metastases at initial diagnosis. Due to its incurability, metastatic breast cancer is generally treated with systemic therapies to achieve disease control and reduce tumor-related symptoms. Primary treatments for metastatic breast cancer are chemotherapy, endocrine- and biologic therapy, whereas surgery with or without radiotherapy is usually performed to treat impending wound issues. Since 2002, several retrospective non-randomized clinical studies have shown that extirpation of the primary tumor correlates with a significantly improved survival in patients with primary metastatic breast cancer. Others have argued that this survival benefit associated with surgery may be due to selection biases. Therefore, in the absence of published results from randomized controlled trials carried out in India and Turkey and completion of a trial in the United States, there is no clear conclusion on whether surgical excision of the primary breast cancer translates into a survival benefit for patients with de novo metastatic disease. Furthermore, timing and type of surgical procedure, as well as selection of patients who could benefit the most from this approach, represent additional points of uncertainty. Despite the epidemiological burden of this condition, there are no guidelines on how to manage breast cancer patients presenting with de novo metastatic breast cancer; and decisions are often left to provider and patient preferences. Here, we present a critical overview of the literature focusing on the rationale and potential role of primary tumour excision in patients with de novo metastatic breast cancer.

Temperature mapping is a key asset in supporting the clinician during thermal ablation (TA) treatment of tumors without adding additional risk to the TA procedure. Herein we report our experiments on multidimensional thermal mapping during radio frequency (RF) thermal ablation treatments of an ex-vivo animal organ. The temperature was monitored using several arrays of fiber Bragg gratings properly positioned around the RF applicator. The results show the effectiveness of our proposed method at assessing the TA probe depth and demonstrating how the insertion depth directly influences the maximum temperature and the treated area of the radio frequency ablation. © 2018 Optical Society of America.

Fiber Bragg Grating (FBG) sensors applied to bio-medical procedures such as surgery and rehabilitation are a valid alternative to traditional sensing techniques due to their unique characteristics. Herein we propose the use of FBG sensor arrays for accurate real-time temperature measurements during multi-step RadioFrequency Ablation (RFA) based thermal tumor treatment. Real-time temperature monitoring in the RF-applied region represents a valid feedback for the success of the thermo-ablation procedure. In order to create a thermal multi-point map around the tumor area to be treated, a proper sensing configuration was developed. In particular, the RF probe of a commercial medical instrumentation, has been equipped with properly packaged FBGs sensors. Moreover, in order to discriminate the treatment areas to be ablated as precisely as possible, a second array 3.5 cm long, made by several FBGs was used. The results of the temperature measurements during the RFA experiments conducted on ex-vivo animal liver and kidney tissues are presented herein. The proposed FBGs based solution has proven to be capable of distinguish different and consecutive discharges and for each of them, to measure the temperature profile with a resolution of 0.1 °C and a minimum spatial resolution of 5mm. Based upon our experiments, it is possible to confirm that the temperature decreases with distance from a RF peak ablation, in accordance with RF theory. The proposed solution promises to be very useful for the surgeon because a real-time temperature feedback allows for the adaptation of RFA parameters during surgery and better delineates the area under treatment.

In this work, we propose the use of fiber Bragg grating (FBG) sensor arrays for real-time temperature monitoring during RadioFrequency Thermal Ablation (RFTA) tumor treatment. Real-time temperature monitoring of RF-treatment to the tumors lesion of an organ could prove to be highly beneficial for intra-operative surgical planning and subsequently ensure a successful outcome of a thermo-ablation procedure. An adequate configuration was designed in order to create a thermal multipoint map. In particular, the RF probe of a commercial medical device was properly packaged with FBG sensors. In order to discern the treatment areas as accurately as possible, a second 3.5 cm long array, consisting of several FBGs was also employed. The experiments were conducted on ex vivo animal liver tissues and results confirm that we were successfully able to conduct a multipoint measurement and to distinguish between different and consecutive RF discharges with a temperature resolution of 0.1 °C and a minimum spatial resolution of 5mm.

Background. Colorectal cancer (CRC) is one of the most spread neoplasia types all around the world, especially in western areas. It evolves from precancerous lesions and adenomatous polyps, through successive genetic and epigenetic mutations. Numerous risk factors intervene in its development and they are either environmental or genetic.Aim of the Review. Alongside common screening techniques, such as fecal screening tests, endoscopic evaluation, and CT-colonography, we have identified the most important and useful biomarkers and we have analyzed their role in the diagnosis, prevention, and prognosis of CRC.Conclusion. Biomarkers can become an important tool in the diagnostic and therapeutic process for CRC. But further studies are needed to identify a noninvasive, cost-effective, and highly sensible and specific screening test for their detection and to standardize their use in clinical practice.

Background: Lynch syndrome, the most frequent form of hereditary colorectal cancer and involves mutations in mismatch repair genes. The aim of this study was to identify mutations in MSH6 from 97 subjects negative for mutations in MLH1 and MSH2. Methods: By direct sequencing, we identified 27 MSH6 variants, of which, nine were novel. To verify the pathogenicity of these novel variants we performed in silico and segregation analyses. Results: Three novel variants were predicted by in silico analysis as damaging mutations and segregated with the disease phenotype. While, a novel frameshift deletion variant that was predicted to yield a premature stop codon, did not segregate with the LS phenotype in 3 of 4 cases in the family. Interestingly, another frame-shift variant identified in this study, already described in the literature, also did not segregate with the LS phenotype in 1 of 2 affected subjects in the family. In all affected subjects of both families, no mutation was detected in other MMR genes. Therefore, it is expected that within these families other genetic factors contribute to the disease either alone or in combination with MSH6 variants. Conclusion: We conclude that caution should be exercised in counseling for MSH6-associated LS family members.

Background: Lynch syndrome, the most frequent form of hereditary colorectal cancer and involves mutations in mismatch repair genes. The aim of this study was to identify mutations in MSH6 from 97 subjects negative for mutations in MLH1 and MSH2. Methods: By direct sequencing, we identified 27 MSH6 variants, of which, nine were novel. To verify the pathogenicity of these novel variants we performed in silico and segregation analyses. Results: Three novel variants were predicted by in silico analysis as damaging mutations and segregated with the disease phenotype. While, a novel frameshift deletion variant that was predicted to yield a premature stop codon, did not segregate with the LS phenotype in 3 of 4 cases in the family. Interestingly, another frame-shift variant identified in this study, already described in the literature, also did not segregate with the LS phenotype in 1 of 2 affected subjects in the family. In all affected subjects of both families, no mutation was detected in other MMR genes. Therefore, it is expected that within these families other genetic factors contribute to the disease either alone or in combination with MSH6 variants. Conclusion: We conclude that caution should be exercised in counseling for MSH6-associated LS family members.

Total colectomy (TC) is a valid option for cancer treatment in selected cases. Emergency presentation, association to familial adenomatous polyposis (FAP) or intestinal bowel disease (IBD), hereditary non-polyposis cancer (HNPCC), and synchronous tumors are the common indications to TC for cancer. Despite potential high morbidity and mortality rates for worse general health conditions of the advanced age it has even suggested for elderly patients.We reviewed our experience to analyze the current role of TC comparing different results between young and elderly patients.During the period 1990–2012, 76 patients were operated on TC for cancer. Patients were divided in two groups according to the age [65 years old – group B (elderly)] and were compared their systemic and surgical complication, considering the presence of comorbidities, ASA score, lifestyle habits, elective or emergency presentation.Morbidity rate was 7.7% and 38.8% in young and elderly patients respectively.21 systemic complications (3 in group A and 18 in group B) occurred in 17 patients (22.36%) (with the coexistence of two complications in 4 patients belonging to the group B. There were 6 surgical complications (7.9%) (3 in group A and 3 in group B): anastomotic leakage 3, major wound infections 2, postoperative bleeding 1; no intra-abdominal abscess were observed. In 2 cases (2.6%) (1 anastomotic leak and 1 intra-abdominal postoperative hemorrhage) was needed a reoperation.We observed only 2 deaths in the elderly.High ASA score and emergency were associated with worst results. Systemic complications were more frequent in elderly patients cause of significant comorbidities, while the incidence of surgical complications was similar and according to literature.Besides the classic indications, it is a viable surgical option also in cancer associated with complicated diverticulitis. Our data show that TC is a safe and effective procedure providing good results even in elderly patients, when combined with a careful preoperative evaluation and age is not an absolute controindication to this procedure.

Background: Significant and sustained excess weight loss (EWL) appears to reduce the risk of obesity-related comorbidities (insulin resistance, hyperlipidemia, and inflammation), but this has been primarily shown in adult diabetic obese patients. We evaluated whether the EWL obtained 3 years after laparoscopic adjustable gastric banding (LAGB) improves the metabolic phenotype in nondiabetic morbidly obese (NDMO) individuals from south Italy. Methods: Serum and subcutaneous adipose tissue (SAT) samples from 20 obese individuals (median BMI = 41.5 kg/m2) before (T0) and after LAGB (T1) and from 10 controls (median BMI = 22.8 kg/m2) were taken. Serum leptin, adiponectin, C reactive protein (CRP), and main analyte levels were evaluated by routine methods or immunoassay. In SAT, adipocyte size was measured by hematoxylin/eosin staining, cluster of differentiation 68 (CD68) macrophage infiltration marker by immunohistochemistry, and adiponectin, adiponectin receptors 1 and 2, and interleukin 6 (IL6) messenger RNAs by qRT-PCR. Results: The average EWL was 66.7 %, and CRP, triglycerides, hepatic markers, leptin levels, homeostasis model assessment, and the leptin/adiponectin ratio were lower (p < 0.05) at T1 than at T0. The expression of small adipocytes and adiponectin was increased (p < 0.05), and inflammation markers (CD68 and IL6) decreased (p < 0.05) at T1 vs. T0. At linear regression multivariate analysis, over 90 % (R2 = 0.905) of EWL (dependent variable) was explained by CD68, adiponectinemia, triglyceridemia, CRP, and total protein levels. Conclusions: The EWL obtained 3 years after LAGB resulted in an improvement of lipid metabolism and a reduction of inflammation in NDMO patients, thereby decreasing the risk of obesity-associated diseases.

Background. Laparoscopic adjustable gastric banding (LAGB) results in significant lasting weight loss and improved metabolism in obese patients. To evaluate whether epigenetic factors could concur to these benefits, we investigated the subcutaneous adipose tissue (SAT) microRNA (miRNA) profile before (T0) and three years (T1) after LAGB in three morbidly obese women. Case Reports. SAT miRNA profiling, evaluated by TaqMan Array, showed four downexpressed (miR-519d, miR-299-5p, miR-212, and miR-671-3p) and two upexpressed (miR-370 and miR-487a) miRNAs at T1 versus T0. Bioinformatics predicted that these miRNAs regulate genes belonging to pathways associated with the cytoskeleton, inflammation, and metabolism. Western blot analysis showed that PPAR-alpha, which is the target gene of miR-519d, increased after LAGB, thereby suggesting an improvement in SAT lipid metabolism. Accordingly, the number and diameter of adipocytes were significantly higher and lower, respectively, at T1 versus T0. Bioinformatics predicted that the decreased levels of miR-212, miR-299-5p, and miR-671-3p at T1 concur in reducing SAT inflammation. Conclusion. We show that the miRNA profile changes after LAGB. This finding, although obtained in only three cases, suggests that this epigenetic mechanism, by regulating the expression of genes involved in inflammation and lipid metabolism, could concur to improve SAT functionality in postoperative obese patients.

There are not guidelines for surgical management of malignant bowel obstruction (MBO) caused by peritoneal carcinomatosis (PC), mainly when it involves elderly; so its treatment is still debated. AIM: To outline indications and benefits of palliative surgery for obstructive carcinomatosis and determine what prognostic factors, including age, have independent and significant association with outcome. METHODS: We conducted English-language MEDLINE and EMBASE searches of articles published between 1998 and 2016, which reported outcome data after palliative surgery for MBO due to PC. We excluded all articles lacking of surgical cohort and those with main interest in conservative treatment. Of 1275 articles identified, 12 satisfied selection criteria and were included in our analysis. RESULTS: Overall, these studies involved 548 patients undergoing palliative surgery for MBO caused by PC. The median age was 58 (range 19-93). Relief of symptoms was achieved in 26.5-100% of cases. Postoperative morbidity ranged between 7 and 44%. Mortality was high (6-22%). The median survival was longer in surgical patients than in those receiving conservative therapy (8-34 vs 4-5 weeks). Factors associated with surgery failure were poor performance status, diffuse carcinomatosis, previous radiotherapy, and obstruction of small bowel. Old age was significantly associated with a poor prognosis upon univariate analysis, while this association vanished upon multivariate analysis. CONCLUSIONS: Surgical palliation can provide relief of obstructive symptoms as well as improved survival in well-selected patients, even if elderly.

In this study we focus on kidney-transplanted patients in order to investigate the correlation between immunodeficiency (ID) induced by immunosuppressive treatments and the incidence of solid multiple primary malignancies (MPM). Material of Study: From 1980 to 2010 we followed up 1000 kidney-transplanted patients (637M, 363F). This group was homogeneous for age, immunology (e.g. miss-match index), number of rejection events and for immunosuppressive therapy. Results: Out of 1000 kidney-transplanted patients we observed 70 patients (53M, 17F) with cancer disease and in 22 of them a multiple cancer has been found. Most of multiple cancers were synchronous and the association between cancer and rejection episodes were not significant. Discussion: In general population 1 out of 9 patients with a cancer would develop a second neoplasia during the course of his life, so, it would be logical to conclude that, from a merely theoretical and statistical point of view, long term transplanted patients potentially have a higher risk to develop MPM. But our series and literature review did not confirm it, probably because these patients die before the appearance of a second primary malignancy. Conclusions: Despite many observations regarding different types of tumors/precancerous lesions and their increased incidence in ID patients and despite the fact that immune suppression is a predisposing factor for the multicancer syndrome, at least theoretically, nowadays there are no significant statistical data favouring a correlation between ID and MPM in kidney transplanted patients.

In this paper we report on the application of Fiber Bragg gratings (FBGs) for temperature monitoring during radiofrequency ablation (RFA) for tumor treatment. A proper configuration with several FBG sensors deployed close to the region reached by RF discharges has been developed to monitor the necrotized area. Our ex-vivo experiments on animal kidney and liver confirm that we were able to monitor the temperature with a resolution of 0.1 °C during a series of different and consecutive RF discharges with the laparoscopic bipolar radiofrequency device Habib 4x.

Background and aim Ideally, day-surgery laparoscopic cholecystectomy (DLC) combines patient satisfaction with cost-effectiveness. However, DLC has not yet been widely applied in the elderly. Thus, to challenge the current perception of DLC as a contraindication, several parameters were investigated for the feasibility of DLC within the general and elderly population. A retrospective study was conducted to analyse age, along with other relevant patient characteristics, as factors leading to successful 24-h discharge. Methods Data were collected from 207 patients who underwent laparoscopic cholecystectomy (LC) between 2010 and 2013. Of these patients, 154 were aged 75 years, with a median age of 59.3 years. Comparisons of the length of post-surgical hospital stay were made. Further, the parameters influencing the surgeon's decision to discharge patients within a 24-h period were investigated: demographic data; patient characteristics such as age, sex and concomitant diseases; disease presentation; surgical experience; intraoperative complications; and post-operative course. The numbers of hospital readmissions and reoperations were established as parameters of failure. Results Forty-five (21.7%) patients remained hospitalized up to 24 h. The majority of them had no co-morbidities, low American Society of Anesthesiologists (ASA) grades, adenomas and uncomplicated gallstone disease. Eleven patients were aged >75 years. None of the patients died, whereas one patient was readmitted following DLC. Considerations Age itself did not prove to be a contraindication for DLC. The patient's general health, disease presentation and the surgeon's attitude were the main factors favouring early discharge. Patient selection and patient-care facilities were crucial for successful outcomes. Some problems due to the logistical organization of the hospital and the surgical approach, which may impede DLC acceptance, are described herein.

INTRODUCTION: Surgical management of left-sided large bowel emergencies has been evolving toward single-staged procedures. Selection for single or staged resection remains the most controversial issue. METHODS: The results from a series of 336 emergency colorectal procedures performed between January 1990 and December 2000 for cancer and diverticular disease by two different surgical units in one hospital are reported: one with a specific interest in colorectal surgery, and one specialized in upper gastrointestinal surgery. RESULTS: A primary anastomosis was performed in 142 (64.3 percent) patients by colorectal surgeons and in 42 (36.5 percent) by noncolorectal surgeons (P < 0.0001). The overall morbidity and mortality rates were lower for colon and rectal surgeons (14.5 vs. 24.3 percent and 10.4 vs. 17.4 percent, respectively). Trainees were more likely to perform anastomoses when assisted by colorectal consultants (72.1 percent of cases) than when a noncolorectal consultant was present (47.5 percent of cases; P < 0.05). The 30-day mortality for patients with primary anastomosis was 6 percent, and anastomotic dehiscence occurred in nine (4.9 percent) patients. The mortality for patients undergoing staged resections (21.1 percent) was significantly higher than those who had primary resections performed (P < 0.001). CONCLUSIONS: Primary anastomosis for left-sided colorectal diseases can be performed with low morbidity and mortality in selected patients. Specialization increased anastomotic rates and reduced morbidity. This study suggests that colon and rectal surgeons should manage colorectal emergencies, and trainees should not be left unsupervised.

Introduction Complete abdominal wall infiltration with neoplastic gastrocutaneous fistula is an unexpected and out of the ordinary presentation of locally advanced gastric cancer. It is very rare to encounter case reports presenting diffuse abdominal wall invasion, but a complete parietal destruction is an exceptional event. Case presentation Here we describe the case of an 81-year-old Caucasian woman presenting a carcinoma perforating her anterior gastric wall and infiltrating all layers of her abdominal wall. The gastric tumor infiltrated her transverse mesocolon, the rectus abdominis muscles bilaterally and overran them anteriorly, causing a large parietal deficit and a complete external fistula. Treatment consisted of a complex surgical procedure requiring general and reconstructive surgery cooperation in order to perform an en bloc gastric resection including colon and abdominal wall, followed by a parietal reconstruction through positioning of prosthesis and reverse abdominoplasty. Conclusions Clinical presentation, histology and therapeutic options are discussed. The importance of a multidisciplinary approach when encountering extremely rare clinical presentations is emphasized. Electronic supplementary material The online version of this article (doi:10.1186/1752-1947-9-13) contains supplementary material, which is available to authorized users.

Multiple primary malignancies can arise in the large bowel as simultaneous, synchronous and/or metachronous. All tumors must be distant from each other to be considered as primitive, none have to be the result of metastasis from other tumors.We present a case of a 71 years old woman who was admitted to our hospital for a 3-year history of not well defined abdominal pain and hematochezia. The patient had no family history of cancer. Colonoscopy revealed 4 simultaneous tumors located at 4 and 20 cm from the ileocecal valve and at 23,2 and 19 cm from the anal verge. At CT scan there were no distant metastases, neither lymphonode node involvement. A quadruple adenocarcinoma of the colon was confirmed by the pathologist. Patient was operated on total colectomy with ileo-rectal anastomosis.Two or three synchronous tumors of the colon have been already described in literature in about 1,8-14% of cases, but the presence of four simultaneous cancers, as in our case, is very interesting and unusual without an history of FAP or familiar cancer.Comprehensive preoperative study, extensive intraoperative exploration, and radical resection can improve surgical results and survival rate, remaining unquestioned the cause.

Immunodeficiency is associated with higher cancer incidence. However, it is unknown whether there is a link between immunodeficiency and development of multiple primary malignancies. In the present study we analyse this link focusing on kidney-transplanted patients, as they are at higher risk of developing cancer due to the chronic assumption of immunosuppressants. We followed up 1200 patients who underwent kidney transplantation between 1980 and 2012. A total of 77/1200 kidney-transplanted patients developed cancer and 24 of them developed multiple cancers. Most multiple cancers were synchronous with a nonsignificant association between cancer and rejection episodes. In the general cancer population, one-ninth of patients are at higher risk of developing a second tumor over a lifetime; hence it would be reasonable to conclude that, from a merely theoretical and statistical viewpoint, long-term transplanted patients potentially have a higher risk of developing MPMs. However, data did not confirm this assumption, probably because these patients die before a second primary malignancy appears. Despite many observations on the increased incidence of different tumor types in immunodeficient patients and despite immunosuppression certainly being a predisposing factor for the multicancer syndrome, data so far are not robust enough to justify a correlation between immunodeficiency and multiple primary malignancies in transplanted patients.

Introduction This study aims to investigate possible risk factors for diverticulitis in kidney transplant recipients affected by colonic diverticulosis. Methods and Results We investigated 717 patients transplanted between 2000 and 2010. Diverticular disease was endoscopically diagnosed in 17 of 717 examined patients. Eight patients were diagnosed with autosomal dominant polycystic kidney disease (ADPKD); 9 of 17 patients underwent emergency surgery. We performed Hartmann's procedure on all patients, with a second stage performed at least 6 months later. Discussion Although the incidence of colonic diverticular perforation in kidney transplanted patients is similar to that observed in the general population, perforation in immunosuppressed patients is associated with a higher morbidity/mortality rate. In our study, the incidence of perforation is 1.25% (9 of 717), with almost half of the cases observed in patients with ADPKD (4 of 9). Such an observation is consistent with published data, in which patients with ADPKD are reported to more frequently develop colonic diverticulosis and its complications. One possible explanation might be related to a belated diagnosis of diverticulitis, which could initially simulate an inflammatory disease as a consequence of renal cysts. Also, steroids seem to be a predisposing factor for colonic perforation in these patients. Conclusions A timely surgery can significantly reduce mortality. In cases of elective surgery, mortality and morbidity are similar to those of immunocompetent patients; accordingly, this is the goal to be pursued. Early signs and symptoms are often masked by immunosuppressive therapy. In these patients, surgeons should always perform (1) abdominal computed tomography scanning and, in the presence of diverticulitis, reduce or withdraw immunosuppressive therapy; and (2) early surgery, with Hartmann's procedure being, in our opinion, the best choice. Before transplantation, elective surgery for colonic resection should be considered in patients with ADPKD or with a history of 1 or more episodes of acute diverticulitis who then regressed with medical therapy.

Laparoscopic cholecystectomy (LC) has now become the “gold standard” treatment for symptomatic gallstone disease. Thanks to its advantages (i.e., smaller scars, reduced postoperative pain), patients enjoyed a shorter hospital stay and consequently, many healthcare providers have started to explore the feasibility of offering LC as a day-case procedure, and in 1990 some authors had already reported the first experiences of ambulatory surgery. Nowadays day-case LC (DLC) has been adopted with different rates and it is not fully accepted by all surgeons. The main question concerns whether the DLC might be feasible for all or just for selected cases. It is common opinion that DLC is indicated for selected cases and the selection may concern medical and logistic criteria. Some exclusion criteria may be considered advisable: common bile duct stones, acute cholecystitis, pancreatitis, patient’s age, and intraoperative complications. Some authors pointed out the importance of anesthesia and postoperative control of pain, nausea, and vomiting as strongly needed elements to allow patients’ early discharge. In conclusion DLC seems to be a safe and effective intervention in selected patients (with no or minimal systemic disease and within easy reach of the hospital) with symptomatic gallstones.

Classical outcome measures (mortality and complications) have to be considered to compare surgical treatments. As no significant differences between laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) were found in classical outcome measures, it is justified to consider health-related quality of life (HRQoL) an important secondary outcome measure. Indeed quality of life (QoL), symptoms resolution, duration of convalescence, and patient satisfaction and well-being are at least as important as the classical outcomes from a patient’s point of view. Instruments for measuring HRQoL may be disease specific or generic. We pointed out our attention to QoL considering these main topics: effectiveness of LC, comparison to OC, comparison to small-incision laparotomic cholecystectomy (SC), and impact of iatrogenic bile duct injury (BDI). In conclusion LC is an effective operation for the treatment of biliary disease-related symptoms in patients with cholelithiasis. LC improves QoL faster than OC, while long-term results are quite similar. When comparing QoL after LC and SC, the perception of health immediately after surgery is slightly better for patients treated with laparoscopic procedure, but the gain in QoL is small and of a very limited duration.

Background Fluid effusion (blood, lymph, or urine) in kidney transplantation may give rise to several complications, directly, such as hematoma, seroma, lymphocele, and/or urinoma, or consequently, such as increased infection risk, longer hospital stay, graft compression—with or without functional impairment—and necessity of further hospitalizations. The aim of this study was to evaluate effectiveness of hemostatic biomaterials in prevention of fluid effusions, especially lymphocele in kidney transplant patients. Methods We selected 40 patients who underwent kidney transplantation from 2009 to 2012 in which we used hemostatic biomaterials, and compared their results with those of other transplant patients from our center in which we did not used these biomaterials. Evaluated parameters were: fluid effusion, graft function, quality and quantity of drainage, blood count, and operative time. Results There was no difference in operative time. The incidence of complications on which biomaterials can have a role decreased; particularly, we observed a reduction from 24.21% to 7.5% of fluid effusions (lymphocele). There was no evidence of complications due to biomaterials. Conclusions Hemostasis is important in surgery, and in kidney transplantations lymphostasis also has a significant role. In addition to the traditional hemostatic methods, recently some biomaterials, with the purpose of providing atraumatic hemostasis, were added. In our experience they are easy to use, and their use has proved to be effective for both hemostasis and lymphostasis with consequent reduction of fluid effusions.

XLVI CONGRESSO DELLA SOCIETÀ SICILIANA DI CHIRURGIA “LA CHIRURGIA TRA ARTE, TECNOLOGIA, ECONOMIA ED ETICA.”CEFALU’, 26-28 SETTEMBRE 2002.

We report on the integration of fiber optic sensors with commercial medical instrumentation for temperature monitoring during radio frequency ablation for tumor treatment. A suitable configuration with five fiber Bragg grating sensors bonded to a bipolar radio frequency (RF) probe has been developed to monitor the area under treatment. A series of experiments were conducted on

Laparoscopic cholecystectomy (LC) is a well standardized technique. There are two main approaches, proposed by French and American Schools. They have similar operative times, but different arrangements for site ports insertions and for patients and operators' position at operative bed. Although we can foresee new scenarios for the next future (robotics, SILS, NOTES, minilaparoscopy), it seemed interesting to describe a simple variation to LC introduced in the last years in our experience relative to the positioning of operators and patient during standard American technique.In a retrospective analysis of 140 patients operated on for LC in the last two years (70 with French technique and 70 with "American modified" technique) we compared the following parameters: laparotomic conversion, duration of operation, hospital stay, morbidity and mortality rates.Conversion to laparotomy, length of operative time and hospital stay were similar. Morbidity rates were slightly different, but it did not show statistically significant differences between the two groups. Mortality was nil.Our variant to LC seems to be almost a compromise between the two main techniques. Our operators' arrangement gave a greater comfort for surgeons during LC and our results were similar to those reported with adoption of French and American approaches. These considerations led us to judge our variation safe and reliable.

The use of synthetic mesh in transplant patients is still under debate. In this paper the authors report their preliminary experience on biological prosthesis for surgical treatment of incisional hernias in transplant patients.Between 2009-2010, 10 patients with incisional hernia underwent surgery using a biological prosthesis (porcine dermis collagen). All patients were transplanted: 9 kidney transplants and 1 liver transplant.In all patients postoperative course was uneventful and were not observed complications related to surgery, kind of prosthesis or transplanted organs. At follow up, laparoplasty was associated with good functional outcome.Transplant patients are at risk for use of synthetic prostheses, as immunosuppressed. In our preliminary experience biological prostheses compared to synthetic ones showed a greater ability to integrate into tissues, to resist bacterial colonization and to reduce cytotoxic or allergenic reactions, providing similar functional results. Moreover it must be added that biological prostheses did not require reductions/suspensions of immunosuppressive therapy and resulted to be versatile. All these features are particularly sought in incisional hernias surgery of transplanted patients.Surgery of incisional hernias in transplanted patients requires a prosthesis with characteristics as close as possible to the ideal one and, in this sense, biological prostheses would seem to outweigh synthetic ones. In our experience, biological prostheses have shown to be safe, effective and reliable; therefore they seem to be able to open new horizons in the treatment of wall defects in this group of patients.

AIM: The purpose of this study is to analyze a "rare" complication on the management of abdominal surgical drains: abdominal drainage's retention. Starting from our experience we reviewed literature on this topic MATERIAL OF STUDY: We report two cases (occurred on 2004 and 2010) of retained intraperitoneal drain occurred in the immediate postoperative period after laparoscopic cholecystectomy. RESULTS: Both patients were successfully treated by early laparoscopic removal. DISCUSSION: We compared our experience with literature. Incidence, ethiology, prevention, diagnosis and treatment of this rare complication are analysed. We also considered the guidelines in the placement of intraperitoneal drains, the different fixation techniques, the causes of fragmentation of the drainage and removal techniques. CONCLUSIONS: Retained intraperitoneal drain secondary to fracture and adhesion in the immediate postoperative period is rare but probably underestimated surgical complication. It is impossible to know its real incidence. The role of laparoscopy is emphasized because this approach is cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in worsening doctor-patient relationship. KEY WORDS: Abdominal drainage, Drain-related complications, Laparoscopy, Retained intraperitoneal drain.

Crohn's Disease (CD) occurs in the elderly in 5 - 25% of cases. Aim of our study: to define the features of clinical presentation, diagnostic tools and therapy of CD in old age.In the last ten years we observed in our Department 47 patients affected by CD. We divided them into two groups: A (42 patients65 years old) and B (5 patients ≥ 65 years old). A retrospective survey evaluated the clinical presentation, diagnosis and treatments with relative outcomes.Group A: 23/42 patients (54,76%) were operated on. The most important indication for surgery was intestinal obstruction (15/42 pts, 65,2%). Small bowel resection was the most frequent surgical procedure (13/42 pts, 56,2%). Overall, 2/23 (8,7%) of the patients developed postoperative complications. There was no postoperative mortality. 8 pts (34,7 %) developed recrudescence of CD. Group B: 3 of 5 pts were operated on. Intestinal obstruction was the indication for surgery in all cases (100%). Two patients underwent small bowel resection (66,6%) and the third patient was submitted to an ileo-colic resection (33,3%). There was no mortality in the aftermath of surgery. In 2/3 operated patients (66,6%) recurrence occurred. All operations in the old patients were performed in urgency.Surgery of CD in the elderly appears in our experience to have the same indications and procedures as in young patients. The postoperative morbidity, mortality and recurrence rates are similar in two groups even if we observed slightly higher postoperative morbidity rates in elderly due to the presence of comorbidity.

Materials and methods A retrospective study was conducted on 204 patients affected by symptomatic cholelithiasis and other diseases of the gallbladder observed during the last four years (from January 2006 to December 2009). Patients were divided into two groups according to their age :a) = 75 y. o., to compare operative time, conversion rate to open cholecystectomy, complication rate and length of stay. Other parameters were evaluated such as sex, comorbidity (cardiovascular and respiratory diseases, hypertension, diabetes), previous abdominal surgery, diagnosis of acute cholecystitis and lithiasis of the common bile duct, biochemistry (leukocytosis, hyperbilirubinemia, transaminase) and ultrasonography.