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BackgroundExternal hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.MethodsThis mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.ResultsTraditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.ConclusionThe management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.

Laparoscopic Sleeve Gastrectomy (LSG) is associated with serious complications, such as staple line leaks and bleeding. This paper presents a novel approach aimed at the successful consolidation of the suture by the use of the cyanoacrylate, here compared to the use of fibrin glue. Fifty consecutive patients, recruited from October 2015 to March 2016, were submitted to laparoscopic sleeve gastrectomy by standardized surgical technique. The staple line was reinforced with cyanoacrylate or fibrin glue. There were no post-operative complications and no operative time prolongation. An early removal of the draining and a reduction of the average hospitalization were observed. The results suggest that staple line reinforcement with cyanoacrylate during laparoscopic sleeve gastrectomy is as easy, safe and cost-saving as with fibrin glue. Furthermore, cyanocrilate allows a chemical omentoplasty with the result of restoring the anatomy. Therefore, this approach is viable and useful for future trials on the efficacy in preventing surgical post-operative complications.

Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects.In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded.The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75 ± 17.51 vs 28.05 ± 10.23 cm(2), P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0-2, vs 2-5, P0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients.Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse.

The thyroglossal duct cyst is the most common anomaly in thyroid development. To date, approximately 250 cases have been reported, the majority being papillary thyroid carcinomas. In most cases the diagnosis is established only after excision of a clinically benign thyroglossal duct cyst. Controversies exist in relation to a rational and effective therapeutic approach. A further case of thyroglossal duct papillary carcinoma affecting a 52 years-old man is presented to highlight the clinicopathological features of this condition. FNAC resulted false negative. Surgery consisted in a Sistrunk procedure, followed by total thyroidectomy and central lymphectomy after definitive histological diagnosis. In view of the prolonged course of papillary carcinoma, long-term follow-up is mandatory.

Papillomatosis of the biliary tract is characterised by multicentric papillary lesions of intra and extrahepatic biliary epithelium. It's a rare benign neoplasm of the biliary tract that causes obstructive jaundice with a high rate of malignant transformation. We described a case of papillomatosis of the biliary tract in a woman of 75-years-old, who came to our observation with jaundice, pruritus and fever. The surgical treatment consisted of cholecystectomy, choledochotomy and positioning a definitive T-Tube. We described our experience and the evolution of this disease.

Objective: To evaluate a particular form of weight-related amenorrhea occurring in severely obese patients after biliopancreatic diversion, a surgical procedure designed to cause weight loss. Design: Prospective, open, controlled clinical trial. Setting: Department of Gynecology and Obstetrics, University of Naples "Federico II", Naples, Italy. The surgical procedures were performed in various hospitals in the Naples metropolitan area. Patient(s): Eight severely obese women (mean [±SD] age, 26.9 ± 5.3 years) who underwent biliopancreatic diversion (group A) and eight healthy women of normal weight (mean [±SD] age, 25.8 ± 5.6 years) (group B). Intervention(s): Biliopancreatic diversion, hormonal evaluation, and LH pulsatility evaluation. Main Outcome Measure(s): Weight parameters, hormone levels, and LH pulsatility amplitude and frequency before surgery and at the onset of amenorrhea after surgery, and the response of LH pulsatility to the infusion of naloxone at the onset of amenorrhea. Result(s): All patients lost weight after surgery and became amenorrheic after 3 months, when they had lost 25% of their basal weight but were still obese. The hormonal picture at that time was one of hypothalamic amenorrhea with significantly reduced LH pulsatility frequency and amplitude. The alterations in LH pulsatility were not modified by naloxone infusion. Conclusion(s): Obese patients who undergo dramatic weight loss may be affected by hypothalamic amenorrhea when still obese. Endogenous opioid activity does not play a significant role in this kind of hypogonadotropic hypogonadism.