Search

Hepatocellular carcinoma (HCC) is the sixth most common cancer. Spontaneous rupture of HCC is an acute complication with a high mortality rate. The HCC principally arises in the background of chronic liver disease and cirrhosis of the liver. In the last few years, the rising incidence of HCC in noncirrhotic liver suggests the presence of other factors that may play a role in liver carcinogenesis.

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors originating primarily from the stomach and small intestine. Preoperative diagnosis of GIST relies on improved computed tomography (CT), endoscopy, and endoscopic ultrasonography (EUS), but despite these tests, there is a high rate of misdiagnosis. The aim of this study was to review the literature focusing on diagnostic methods for such lesions by analyzing preoperative contrast-enhanced CT, endoscopy, EUS, and other tests. A systematic search of articles using electronic databases (MEDLINE, and Embase) was conducted in the last 10 years and 106 items were filtered from the search list. Finally, we report our experience of "difficult diagnosis" in which several diagnostic methods were needed and a definitive diagnosis could only be made after surgical resection. Results: After a review of all papers, 95 studies were excluded, due to incorrect study design, wrong population, non-English language, or other reasons. Finally, 41 studies were included, with a total of 2860 analysis cases. Conclusions Difficult diagnosis when dealing with GIST is particularly notable. Our study emphasizes how the need to reach the correct diagnosis may lead to performing countless preoperative examinations without arriving at the goal. Our case presentation reports a GIST mimicking pancreatic cyst. [ABSTRACT FROM AUTHOR]

Retrograde approach (“fundus first”) is often used in open surgery, while in laparoscopic cholecystectomy (LC) is less frequent. LC, with antegrade access, is done by putting in traction the infundibulum and going up to the fundus before to clip the cystic. Our study analyzes a number of surgical procedures performed by experienced surgeons in laparoscopy.

Aim:Sleeve gastrectomy has been increasingly successful in recent years and the laparoscopic procedure has become the most common for the treatment of morbid obesity, thanks to its feasibility, safety and excellent results. RSG is still expanding, as an alternative surgical option. The aim of the study is to analyze if there are differences between laparoscopic and robotic techniques. Materials and methods: From May 2017 to February 2022, we selected 209 patients suffering from morbid obesity. We analyzed patients who underwent laparoscopic sleeve gastrectomy (LSG) and patients who underwent robotic sleeve gastrectomy (RSG), which were treated at the Department of Medical and Surgical Sciences of the University of Foggia. Results:We studied 209 patients, 153 female and 56 male, who underwent sleeve gastrectomy. The mean age was 41.3 years. The mean weight was 129.7 kg and the mean BMI was 46.4 kg/m2. 67 patients underwent the robotic technique and 142 the laparoscopic one. The mean length of hospitalization was 5.47 days and was the same for both patient groups (p = 0.89). The mean operative time was 63,1 min for the laparoscopic approach and 97,4 min for the robotic technique (including the docking time (p = 0.041). The conversion rate and mortality are zero. There was only 1 case of re-do surgery in a patient undergoing the robotic approach after gastric band failure. We found 3 cases of post-operative complications: 2 leaks treated surgically and one bleeding underwent to medical treatment. Conclusions: There aren't significant differences between the robotic and laparoscopic groups in terms of length of stay, EWL and complications, except for the mean operative time that is slightly higher in the robotic group and this difference is statistically significant. RSG proved to be a safe and efficient procedure, with satisfactory results comparable to LSG. Longer and larger studies are needed for a better comparative evaluation. [ABSTRACT FROM AUTHOR]

Background: Bile duct injuries is the primary concern of general surgeons during and after cholecystectomy, with an incidence ranging from 0.08% to 0.4%. Through the description of two cases we intend to discuss the management of most frequent types of bile duct injuries after cholecystectomy and examine some possible sources of error. Case reports: We have treated 2 cases previously operated by other surgical teams. Case report 1: patient undergoing laparoscopic cholecystectomy with lesion of the main bile duct, treated with its reconstruction with positioning of a T-drainage tube. Case report 2: patient with jaundice previously treated for incarcerated incisional hernia and gallbladder stones. We verified the presence of a stenosis of the main bile duct which was resolved with the positioning of a T-tube drainage. Discussion: Many descriptions and classifications regarding iatrogenic lesions of the bile duct after cholecystectomy have been described, although some of them represent a good guide on the surgical approach to be adopted, but the surgical skills possessed by the operator remain the most important variables. Conclusions: All possible precautions must be considered in order to avoid the possibility of damaging the biliary tree. In our opinion an anterograde approach during cholecystectomy offers greater safety. [ABSTRACT FROM AUTHOR]