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Background : The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases' short-term and oncological outcomes to a historical cohort of open cases. Methods : Data were collected in a prospective database between 2016 and 2024; complications were graded using the ISGPS definition for the specific pancreas-related complications and the Clavien-Dindo classification for overall complications. Furthermore, the Comprehensive Complication Index was calculated. All patients undergoing pancreaticoduodenectomy were included, except those with acute or chronic pancreatitis, vascular tumour involvement or multi-visceral resections. Only the subset of patients with malignancy was regarded for the oncologic outcome. Results : In total, 100 robotic and 102 open pancreaticoduodenectomy cases are included. Equal proportions of patients have a main pancreatic duct ≤3 mm ( p = 1.00) and soft consistency of the pancreatic remnant ( p = 0.78). Surgical time is longer for robotic pancreaticoduodenectomy ( p < 0.01), and more patients have delayed gastric emptying (44% and 28.4%, p = 0.03). In the robotic group, the number of patients without any postoperative complications is higher ( p = 0.02), and there is less chyle leak ( p < 0.01). Ninety-day mortality, postoperative pancreatic fistula, and postpancreatectomy haemorrhage are similar. The lymph node retrieval and R0 resection rates are comparable. Conclusions : In conclusion, after robotic pancreaticoduodenectomy, remembering all cases during the learning curve are included, less chyle leak is observed, the proportion of patients without any complication is significantly larger, the surgical duration is longer, and more patients have delayed gastric emptying. Oncological results, i.e., lymph node yield and R0 resection rate, are comparable to open pancreaticoduodenectomy.

Objective: To provide a nationwide description of postoperative outcomes and analysis of prognostic factors following adrenalectomy for metastases., Background: Adrenal glands are a common site of metastases in many malignancies. Diagnosis of adrenal metastases is on the rise, leading to an increasing number of patient candidates for surgery without consensual management., Methods: We conducted a population-based study between January 2012 and December 2022 using the French National Health Data System (SNDS) and the Eurocrine registry (NCT03410394). The first database exhaustively covers all procedures carried out in France, while the second provides more clinical information on procedures and tumor characteristics, based on the experience of 11 specialized centers., Results: From the SNDS, we extracted 2515 patients who underwent adrenalectomy for secondary malignancy and 307 from the Eurocrine database. The most common primary malignancies were lung cancer (n=1203, 47.8%) and renal cancer (n=555, 22.1%). One-year survival was 84.3% (n=2120). Thirty-day mortality and morbidity rates were, respectively, 1.3% (n=32) and 29.9% (n=753, including planned intensive care unit - stays). Radiotherapy within the year before adrenalectomy was significantly associated with higher 30-day major complication rates ( P =0.039). In the Eurocrine database, the proportion of laparoscopic procedures reached 85.3% without impairing resection completeness (R0: 92.9%). Factors associated with poor overall survival were the presence of extra-adrenal metastases (hazard ratio =0.64; P =0.031) and incomplete resection (≥R1; hazard ratio=0.41; P =0.015)., Conclusions: The number of patients who can receive local treatment for adrenal metastases is rising, and adrenalectomy is more often minimally invasive and has a low morbidity rate. Subsequent research should evaluate which patients would benefit from adrenal surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Primary arterial dissection in peripheral arteries of the extremities is exceedingly rare. Isolated dissection of peripheral arteries (femoropopliteal or popliteal) primarily has been reported in aneurysmal arteries. Spontaneous dissection limited to a non-aneurysmal popliteal artery was first described in 1999 by Rabkin et al., Methods: We report a case of a non-aneurysmal popliteal artery dissection to emphasize its rare condition., Results: A 61-year-old man consulted because of sudden onset of pain and cramps in his left leg after walking 60 metres. A high-resolution duplex ultrasonography could identify a dissection of a non-aneurysmal popliteal artery. Computed tomography angiography could confirm the diagnosis. An operative repair was scheduled 3 weeks later and the patient was put on antiplatelet medication (acetylsalicylic acid 80 mg 1x/day) in the meantime. After 3 weeks the dissection was resolved spontaneously and the patient didn't undergo surgery. Check-ups remained reassuring and we scheduled a duplex ultrasonography within one year. Antiplatelet medication was continued., Conclusions: Spontaneous dissection limited to a non-aneurysmal popliteal artery is extremely rare. Diagnosis can be made by duplex ultrasonography and/or CT angiography. Treatment options consist of conservative management or operative treatment. Operative treatments consist of an open repair with bypass or interposition graft or minimal invasive endovascular stent grafting. A standardized protocol for conservative treatment in this specific condition is not available. Annual follow-up of these patients is essential., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Diverticular disease is a common disorder of the colon with an extremely rare presentation: giant colonic diverticulum (GCD). GCD is defined as a diverticulum measuring 4 cm or larger and affects the sigmoid colon in 90% of the cases., Patients: We report on a case of a 74-year-old woman with a GCD., Methods: We present a case report of a 74-year-old woman with a GCD. A brief review of the literature concerning clinical presentation, diagnosis, differential diagnosis, pathogenesis, histological classification and treatment of GCD will be discussed., Results: Our patient was treated according to the available information in the literature. The outcome was uneventful., Conclusions: GCD is a rare presentation of diverticular disease. Because of the risk of serious complications, a correct diagnosis and treatment is essential. The investigations of choice include a plain abdominal X-ray and an abdominal CT scan. Surgical treatment is the treatment of choice with preferably a colectomy with en-bloc resection of the diverticulum.

Purpose: A rectovaginal fistula (RVF) is a rare disease. It's an epithelium-lined abnormal communication between rectum and vagina. It represents approximately 5% of all anorectal fistulas. RVF may have different causes., Methods: We present a case of a 58-year-old woman with a rectovaginal fistula after stapled hemorrhoidopexy (Longo operation)., Results: A 58-year-old woman presented herself in our department with vaginal fecal discharge and vaginitis almost one month after a stapled hemorrhoidopexy was performed in another hospital. On vaginal examination, a large dorsal defect was palpated at four cm. On rectal examination, the stapler line was palpable at four cm and just distal to this stapler line, a large defect could be palpated. A lower gastrointestinal tract radiography was performed and identified a RVF. The patient was put on antibiotics and two operations were planned. First, a temporary ileostomy was created. After healing of the vaginitis, reconstructive surgery with anatomic fistula repair in combination with the interposition of healthy, vascularised tissue was performed. In this case, we chose the Martius flap. The operation as well as the postoperative course was uneventful., Conclusions: Cases of postoperative RVF have been increasingly reported since the introduction of stapled hemorrhoidopexy. Patients with RVF can have a varying degree of symptoms. Diagnosis is primarily based on the patient's medical history together with a clinical examination. There are many surgical approaches for RVF. Anatomic fistula repair alone is associated with lower success rates compared with combined procedures with the adjunctive interposition of healthy, vascularised tissue.

We report a case of spontaneous retroperitoneal haemorrhage by bleeding of an adrenal adenoma. Retroperitoneal haemorrhages are rarely encountered in practice, but must be rapidly diagnosed due to the life threatening risk. The etiologies, clinical assessment, management and differential diagnosis of spontaneous retroperitoneal haemorrhages are discussed.