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Background Early postoperative small bowel obstruction (EPSBO) is a common complication after colorectal cancer surgery. Few studies have specifically studied risk factors for early small bowel obstruction after right colectomy, especially in establishing predictive models. The purpose of the current study was to establish an effective nomogram to predict the incidence of EPSBO after right colectomy. Methods The current study retrospectively analyzed data from a total of 424 patients who underwent right colectomy in a local hospital from January 2014 to March 2021. A logistic regression model was used to identify potential risk factors for EPSBO after right colectomy. A nomogram was established by independent risk factors, and the prediction performance of the model was evaluated using an area under the receiver operating characteristic (ROC) curve and calibration chart. Results A total of 45 patients (10.6%) developed early small bowel obstruction after right colectomy. Male sex, history of abdominal surgery, open surgery, long operative time, anastomotic leakage, and preoperative albumin were closely related to EPSBO. Analysis of postoperative rehabilitation indices showed that EPSBO remarkably slowed the postoperative rehabilitation speed of patients. Multivariate logistic regression analysis showed that male sex, open surgery, operative time, and anastomotic leakage were independent risk factors (P < 0.05), and the operation time had the greatest impact on EPSBO. On the basis of multivariate logistic regression, a nomogram was constructed, which showed moderate accuracy in predicting EPSBO, with a C-statistic of 0.716. The calibration chart showed good consistency between the predicted probability and ideal probability. Conclusion The current study constructed a nomogram based on the clinical data of patients who underwent right colectomy, which had moderate predictability and could provide reference value for clinicians to evaluate the risk of EPSBO.

BackgroundsThough better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches.MethodsWe retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization.ResultsThe IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm,p= 0.010) and nearest resected margin (7.51 vs. 5.40 cm,p= 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%,p= 0.604) and disease-free survival (75.0% vs. 75.7%,p= 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%,p= 0.580).ConclusionsThe overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.

Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure.

BACKGROUND: Primary anastomosis is considered the standard strategy after right emergency colectomy. The present study aimed to evaluate alternative treatment strategies when primary anastomosis is not possible to prevent definitive ostomy. METHODS: This retrospective study included all consecutive patients who underwent right emergency colectomy between July 2006 and June 2013. Demographics, surgical data, and postoperative outcomes were entered in an anonymized database. Comparative analysis was performed between patients with primary anastomosis (PA group) and those where alternative strategies were employed (no-PA group). Outcomes were 30 days complications rate and rate of bowel continuity restoration. RESULTS: One hundred forty-eight patients (57 % male) with a median age of 65 years (15-96) were included. One hundred and sixteen patients underwent PA (78 %) and 32 were in the no-PA group (22 %). No-PA group patients had more comorbidities (Carlson comorbidity index >3: 98 % vs. 54, p

Background The objective of this meta-analysis was to compare the clinical safety and efficacy of robotic right colectomy (RRC) with conventional laparoscopic right colectomy (LRC). Methods A literature search was performed for comparative studies reporting perioperative outcomes of RRC and LRC. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed effects model or the random effects model were used for the meta-analysis. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated. Results Seven studies, including 234 RRC cases and 415 conventional LRC cases, were analyzed. The meta-analysis showed that RRC had longer operative times (P

BackgroundRight colectomy is the surgical treatment for malignantpathologies involving the intestinal tract between theileocecal Bahuino valve and the colic hepatic flexure.Laparoscopic resection must respect the same oncologi-cal criteria as the open approach including:‘’no-touchisolation technique’’, isolation and ligation of the vascularpedicles at the origin, oncological lymphadenectomy and‘’distal and radial clearance’’ of the neoplasm from resec-tion margins.Two major procedures have been described for thetreatment of right colon tumors: Open right colectomy(ORC) and Totally Laparoscopic resection (TL) in whichvascular ligations, intestinal resection and anastomosis areperformed by laparoscopy (Figure 1).In ORC technique, there is an abdominal right sidelaparotomy; in TL there is a minilaparotomy used only forendobag colon extraction and it is located in parapubicregion.MethodsFrom May 2004 to march 2013, we performed in HighSpecialistic Surgical Centers (Aosta “Parini” Hospital andNaples “Federico II” University) 132 laparoscopic rightcolectomies and 127 open right colectomies of which wehave selected 75 laparoscopic cases of these 11 for benignpathologies and 64 for neoplastic diseases and 75 OpenCases. The M/F rate was 1/1. The mean age was 64.7 ± 7.2.Colonic preoperative washout was performed to allpatients with 2 L for a day of polyethylene glycol (PEG) inthe two days before the operation, associated with a fiber-free diet. The day before operation, we positioned in allpatient antalgic peridural catheter with 0.5% levobupiva-caine (4 ml/h); on the following day, in the operatingroom, after anesthetic induction, we also positioned naso-gastric tube (NG tube) and urinary catheter (UC) and nodrain according to Kehlet protocols (in the last 23 cases).In the TL colectomy, the sovrapubic minilaparotomy of6 ± 2 cm is necessary only for the specimen extractionfrom the parapubic minilaparotomy performed by a 15-mm Endocatch, preventing the peritoneal spreading ofneoplastic cells.The procedures were considered curative only whenthere was no intraoperative evidence of secondarylocations.NG tube was removed after the operation and UC in themorning after surgery. The patients were allowed to drinkliquids with oral assumption of medicines the evening ofthe operation (Table 1) [1]. All the patients underwent acycle of postoperative physiokinesis therapy. Patients weredischarged when they became autonomous in movementsand walking with a restored bowel function without feverand pain.They were followed-up at least 1 year, starting on the30

Carcinoids are the most common tumours of the appendix. These tumours show prevalence in white children. The clinical presentation of the appendiceal carcinoids is similar to that of acute appendicitis, although in many cases the tumour is diagnosed incidentally during an operation. The diagnosis should be confirmed histologically. The prognosis in patients with local disease is excellent. In small lesions isolated appendicectomy is considered as the most appropriate treatment, while in larger lesions right colectomy should be performed. We report a case of a carcinoid tumour in the tip of the appendix of a thirteen year old girl which was diagnosed intraoperatively. The patient received isolated appendicectomy due to the small size of the lesion. Ten years after the operation there is no evidence of recurrence or metastases, and the patient is considered free of disease.