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OBJECTIVE The aim of this prospective clinical study is to compare short-term outcome of laparoscopic right hemicolectomy using the Complete Mesocolic Excision (CME group) with patients who underwent conventional right-sided colonic resection (NCME group). SUMMARY BACKGROUND DATA Although CME with central vascular ligation in laparoscopic right hemicolectomy is associated with a significant decrease in local recurrence rates and improvements in cancer-related 5-year survival, there may be additional risks associated with this technique because of increased surgical complications. As a result, there is controversy surrounding its use. METHODS In this randomized controlled trial, several primary endpoints (operative time, intraoperative blood loss, other complications, conversion rate, and anastomotic leak) and secondary endpoints (overall postoperative complications) were evaluated. In addition, we evaluated histopathologic data, including specimen length and the number of lymph nodes harvested, as objective signs of the quality of CME, related to oncological outcomes. RESULTS The CME group had a significantly longer mean operative time than the NCME group (216.3 minutes vs 191.5 minutes, P = 0.005). However, the CME group had a higher number of lymph nodes (23.8 vs 16.6; P < 0.001) and larger surgical specimens (34.3 cm vs 29.3 cm; P = 0.002). No differences were reported with respect to intraoperative blood loss, conversion rate, leakage, or other postoperative complications. CONCLUSIONS In this study laparoscopic CME were a safe and feasible technique with improvement in lymph nodes harvesting and length of surgical specimens with no increase of surgical intraoperative and postoperative complications.

Introduction Postoperative adhesions represent the most common cause of acute small bowel obstruction (80%) and are usually a consequence of abdomino-pelvic surgery performed with open technique. Presentation of case A 45-year-old black man arrived at the emergency room with abdominal pain and distension three months after laparoscopic distal gastrectomy with Roux-en-Y anastomosis performed for benign pyloric stenosis. CT abdominal scan revealed some air-fluid levels in the center of the abdomen with distension of proximal jejunal loops caused by intestinal adhesions. Laparoscopic adhesiolysis was performed to restore the intestinal transit. Discussion The formation of adhesions is more frequent after abdomino-pelvic surgery. CT abdominal scan is very useful tool to identify the level and the aetiology of obstruction and it may predict the need for surgery, the location of different adhesive bands in order to identify wich patients are likely candidates for laparoscopic treatment. Conclusion In selected cases, laparoscopic approach for small bowel obstruction is a good surgical option. In patients with adbominal dense adhesions or clinical signs of intestinal ischemia, conversion to laparotomy should be considered an alternative.

Highlights • We describe a case report of congenital Diaphragmatic relaxation treated with totally laparoscopic plication of the left hemidiaphragm with nonresorbable sutures. • In our case report the diaphragmatic relaxation seemed to be congenital and the laparoscopic approach resulted the most appropriate technique to obtain the repositioning of abdominal organs and diaphragmatic placation. • A brief review of literature was performed to identify outcomes and potentially surgical advantages of laparoscopic approach for diaphragmatic relaxation. Laparoscopic approach can only be practiced in selected cases., Introduction Diaphragmatic relaxation is an infrequent condition characterized by a permanent elevation of all or part of an hemidiaphragm which maintains its insertions on the ribs and which does not have continuous solutions but a reduced thickness. Presentation of case We studied a 65 years old male patient with mild dyspnea and chest pain occurred during the last 12 months after moderate efforts. He underwent a contrast enhanced CT thorax scan that showed a left diaphragmatic relaxation with the transposition in the cranial sense of the hypochondriac abdominal organs associate with an ipsilateral subtotal atelectasia. A laparoscopic plication of the diaphragm was performed to repair the congenital defect. Discussion The relaxatio diaphragmatica is probably caused by a congenital defect, but there are also idiopathic causes or cases of acquired relaxation due to phrenic nerve damage because of neoformations, traumas, thoracic and cardiac surgery. In cases of asymptomatic relaxatio nothing is necessary, but in symptomatic cases it is possible the plication of the diaphragm with a remission of symptoms. Conclusion The plication can be performed through thoracotomy or laparotomy and recently also in thoracoscopy or laparoscopy. In our experience the laparoscopic repair of the relaxatio was accomplished successfully with a left pneumothorax compatible with the intervention, but the operative strategy should be always individualized with attention on diagnosis, patient characteristics, availability of resources and experience of surgical team.

Key Clinical Message In the presence of suggestive clinical picture (high eosinophil count and multiple CT scan granuloma‐like lesions), schistosomiasis should be taken into account in case of suspected bowel perforation even if common risk factors are not identified through anamnesis.