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Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives. Materials and Methods: We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. Results: The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. Conclusions: Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure.

In 1826, Lisfranc practiced a perineal circular incision, without opening the peritoneum. 50 years later, Verneuil and then Dolbeau and Denonvilliers practiced more extensive resections. In 1907, Lockart-Mummery described the operation that bears his name. In 1875, Kocher and Volkmann used the sacral approach that has been popularized by Kraske. Later, it became well known in the whole world and, with some little changes, it has been used in Europe by Bardenhaver, Hochenegg, Billroth, Rehn, Heinike and Rygidier and in the USA by Harrison Cripps, Edwards, Bevan and Grey Turner. Almost all of them resected the rectum and reestablished the continuity with a primary anastomosis. It seems that Volkmann practiced the combined abdominal and perineal approach for the first time in 1877, followed by Czerny and Köenning. Between 1896-1899, Quenu popularized this technique. In 1908, Ernest Miles began to use the technique and in 1914 he published the results. The resection of the posterior wall of the vagina in a rectum cancer has first been made by Hildebrant in 1879. The abdominal approach has been used by Hartmann in 1923. In 1930, Dixon together with Mayo, Waugh, Black and Judd described the “Mayo clinic operation”, meaning the resection of the rectal tumor with extraperitoneal anastomosis. They called that “anterior resection” and in 1948 they published their 20 years’ experience results and they definitely popularized the technique.

Introduction: Tumors of ileo-caecal valve are most clinically manifested either through transit disorders or anemic syndrome. The 88-year-old patient is admitted for abdominal pain in the left flank, vomiting, asthenia and lack of intestinal transit for faeces, with a progressive onset of one week. Clinical examination: generalized affected state, wide abdomen, painful left flank and hypochondrium, lack of intestinal transit and pallor. Paraclinic: severe hypochromic microchrome anemia (hemoglobin: 5.8 g / dl). Plain radiography: hydro-aeric levels in the left hypochondrium. Abdominal CT: ileo-colic intussusception that completely occupies the ascending colon to the hepatic flexure, with no visible tumoral lesions. After hydroelectrolytic and hemodynamic balancing with restoration of intestinal transit, colonoscopy is performed: 5 cm ulcer-vegetative tumor formation at the ileo-caecal valve level - biopsy with histopathological examination: moderately differentiated adenocarcinoma. Patient refuses surgery. After 3 weeks, the patient returns to the clinic for the recurrence of digestive symptoms and emergency surgery is performed: laparotomy by median suprasubombilical incision, finding: ileo-ceco-appendico-colic invagination up to the middle third of the transverse colon, defective attachment of ascending colon, ileum dilated with thick wall. The invagination is reduced, the tumor formation is discovered. Right hemicolectomy with ileotransversoanastomosis is performed. Postoperatively, the patient shows a simple evolution with discharge of the 9th postoperative day. Conclusions: The ileocolic invagination in adults is most often the appearance of a tumor located on mobile segments of the intestine. The right colon invagination is possible when there is a defect of acolation, anatomical peculiarity encountered in the presented case.

The paper presents an intelligent tutoring system which provides a Student Model using the “overlay method”. The system’s tasks are distributed among the intelligent agents (software agents), each having clearly specified individual roles as following: administrator (Cerberus Agent); interface (InterfaceAgent); tutor (TutorAgent); student (StudentAgent). Moreover, the system is a “three-tier” architecture application and was implemented in Java language.

Background: Mucosal perforation during laparoscopic esocardiomyotomy is quite frequent, and its consequences cannot always be neglected. The purpose of the study is to investigate the risk factors for intraoperative mucosal perforation and its implications on the postoperative outcomes and the functional results three months postoperatively. Material and methods: We retrospectively identified the patients with laparoscopic esocardiomyotomy performed at Sf. Maria Hospital Bucharest, in the period between January 2017–January 2022 and collected the data (preoperative—clinic, manometric and imaging, intra-and postoperative). To identify the risk factors for mucosal perforations, we used logistic regression analysis. Results: We included 60 patients; intraoperative mucosal perforation occurred in 8.33% of patients. The risk factors were: the presence of tertiary contractions (OR = 14.00, 95%CI = [1.23, 158.84], p = 0.033206), the number of propagated waves ≤6 (OR = 14.50), 95%CI = [1.18, 153.33], p < 0.05), the length of esophageal myotomy (OR = 1.74, 95%CI = [1.04, 2.89] p < 0.05), the length of esocardiomyotomy (OR = 1.74, 95%CI = [1.04, 2.89] p < 0.05), and a protective factor—the intraoperative upper endoscopy (OR = 0.037, 95%CI = [0.003, 0.382] p < 0.05). Conclusions: Identifying risk factors for this adverse intraoperative event may decrease the incidence and make this surgery safer. Although mucosal perforation resulted in prolonged hospital stays, it did not lead to significant differences in functional outcomes.

Esophageal stenosis is one of the most common sequels of caustic injury. After the ingestion, in the acute phase, the life support is sometimes critical, and the treatment varies from observation to esophagectomy. During the first 6 months, endoscopic dilation can be necessary in order to maintain the patency of the esophageal lumen. Usually, endoscopic dilation is the treatment of choice for caustic stenosis of the esophagus. Sometimes this procedure is not possible or too risky and then reconstruction surgery is needed, but no earlier than 6 months. We present the case of a 57 years old male who was referred to our clinic for the treatment of a mid-esophageal caustic stenosis, after the accidental ingestion of a concentrated alkaline substance 6 months before. After an initial successful endoscopic dilation, in the second attempt, due to the asymmetric position of the stenosis and the high risk of perforation, we decided to perform an esophageal by-pass. We chose to use the left colon for interposition, with the left branch of middle colic artery as the feeding source and the sigmoid trunk as the second arcade. The surgical procedure went uneventful, with restoration of normal oral feeding.

Encompassing a group of complex and heterogeneous diseases, cancer continues to be a challenge for patients and healthcare systems worldwide. Thus, it is of vital importance to develop advanced treatment strategies that could reduce the trends of cancer-associated morbidity and mortality rates. Scientists have focused on creating performant delivery vehicles for anti-cancer agents. Among the possible materials, cyclodextrins (CDs) attracted increasing interest over the past few years, leading to the emergence of promising anti-tumor nanomedicines. Tackling their advantageous chemical structure, ease of modification, natural origin, biocompatibility, low immunogenicity, and commercial availability, researchers investigated CD-based therapeutical formulations against many types of cancer. In this respect, in this paper, we briefly present the properties of interest of CDs for designing performant nanocarriers, further reviewing some of the most recent potential applications of CD-based delivery systems in cancer management.