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Gastric mucosa is one of the most common epithelial heterotopia of the gastrointestinal tract (usually involving the upper GI); however, this pathological entity has been rarely reported to affect distal rectum. A case of 4-cm polypoid lesion of distal rectum associated with recto-anal bleeding underwent complete excision by open surgical submucosal resection is reported. We conducted a comprehensive search of PubMed, Medline, and Embase. All articles that described heterotopic gastric mucosa in the rectum and/or anus were included in this narrative review. Our reported case showed the presence of heterotopic gastric mucosa associated with focal vascular ectasia in the lower rectum. No signs of Helicobacter pylori were detected. The narrative review identified 47 case reports in the literature. Gastric heterotopia resulted more common in males 27 (57.45%) than females 20 (42.55%), with a median age of diagnosis of 32.5 years. Symptoms ranged from asymptomatic 8 (17.02%) to diarrhea 2 (4.25%), anal tenesmus 5 (10.63%), anal pain 7 (14.89%), abdominal pain 8 (17.02%), or GI bleeding 26 (55.32%). The lesions macroscopically appeared as polypoid neoformations 14 (29.79%), erythematous patches 13 (27.66%), rectal ulcers 6 (12.76%), rectal diverticulum 3 (6.38%), or hemorrhoid 1 (2.13%). Endoscopic mucosectomy was performed in 19 cases (40.43%); in 11 cases, no treatment was done (23.40%); and 7 patients proceeded to transanal diverticulectomy or mucosectomy (14.89%). Gastric heterotopia in the rectum is a very rare pathology that has to be considered in case of undetermined lower GI bleeding. The best diagnostic tool still remains endoscopy or open surgical exploration associated with lesion biopsy and histopathological exam. Once diagnosis is confirmed, a radical surgical excision is advised due to its life quality compromising symptoms and minimal risk of neoplastic degeneration.

Purpose: The effect of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in laparoscopic right hemicolectomy is controversial. The aim of this study was to evaluate the safety,...

Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure 50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

Treatment of Boerhaave's syndrome is controversial. Formal thoracotomy and laparotomy were considered the gold standard treatment in the past. However, these approaches are associated with significant surgical trauma, stress, and postoperative pain. Recently published studies reported the application of minimally invasive surgery in the setting of such esophageal emergency. However, the application of minimally invasive surgery in the setting of Boerhaave's syndrome is debated and evidence is puzzled. The aim of this study was to summarize the current knowledge on minimally invasive treatment of Boerhaave's syndrome. PubMed, EMBASE, and Web of Science databases were consulted. All articles that described the management of Boerhaave's syndrome in the setting of minimally invasive surgery (thoracoscopy or laparoscopy) were included. Sixteen studies and forty-eight patients were included. The age of the patient population ranged from 37 to 81 years old and 74% were males. The time shift period from symptoms onset to surgical treatment ranged from 5 to 240 hours with 10 patients (20.8%) having surgery more than 24 hours from symptoms onset. Vomiting (100%), chest/epigastric pain (88%), and dyspnea (62%) were the most commonly reported symptoms. The perforation size ranged from 6 to 30 mm with 96% of patients suffering from distal esophageal tear. Video-assisted thoracoscopy (VATS) was the most commonly reported surgical approach (75%), followed by laparoscopy (16.7%), and combined thoraco-laparoscopy (6.2%). In case of VATS, a left approach was adopted in 91% of patients with selective lung ventilation. Primary suture was the most commonly performed surgical procedure (60%) with interrupted single or dual-layer repair. Surgical debridement (25%), primary repair reinforced with gastric or omental patch (8%), esophageal repair over T-tube (6%), and endoscopic stenting combined with laparoscopic debridement (2%) were also reported. The postoperative morbidity was 64.5% with pneumonia (42%), pleural empyema (26%), and leak (19%) being the most commonly reported complications. The overall mortality was 8.3%. Boerhaave's syndrome is a rare entity. Minimally invasive surgical treatment seems promising, feasible, and safe in selected patients with early presentation and stable vital signs managed in referral centers. In the management algorithm of Boerhaave's syndrome, a definitive indication to adopt minimally invasive surgery is lacking and its potential role mandates further analysis.

The Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures for surgical weight loss. It has been shown that overweight may be associated with an increased risk of gastric cancer. However, the risk of remnant gastric cancer after RYGB has not been defined yet and the development of neoplasm in the excluded stomach remains a matter of concern. PubMed, EMBASE, and Web of Science databases were consulted. Articles that described the diagnosis and management of remnant gastric cancer after RYGB were considered. Seventeen patients were included. The age of the patient population ranged from 38 to 71 years. The most commonly reported symptoms were abdominal pain, nausea/vomiting, and anemia. Abdominal computed tomography was used for diagnosis in the majority of patients. The neoplasm was located in the antrum/pre-pyloric region in 70% of cases and adenocarcinoma was the most common tumor histology (80%). An advanced tumor stage (III–IV) was diagnosed in almost 70% of patients and 40% were considered unresectable. Gastrectomy with lymphadenectomy was performed in 9 cases (53%). Post-operative morbidity was 12%. The follow-up ranged from 3 to 26 months and the overall disease-related mortality rate was 33.3%. The development of remnant gastric cancer after RYGB is rare. Surgeons should be aware of this potential event and the new onset of epigastric pain, nausea, and anemia should raise clinical suspicion. Further epidemiologic studies are warranted to deeply investigate the post-RYGB-related risk of remnant gastric cancer development in high-risk populations.