Search

OBJECTIVE: Pancreatic laparoscopic surgery represents one of the most discussed and demanding fields in surgery. Total pancreatectomy is considered to a viable option for treating both benign and malignant pathologies of the pancreas and, thanks to the introduction of laparoscopic techniques for pancreatic resections into clinical practice, it can be performed nowadays with a less invasive approach. CASE REPORT: We report the case of a combined total pancreatectomy, consisting of a totally laparoscopic body-tail mobilization followed by the opening of a right subcostal mini-laparotomy in order to perform a pancreaticoduodenectomy and a reconstructive phase. DISCUSSION: This technique represents the result of experience acquired in the last decade in the field of advanced laparoscopic pancreatic surgery. It consists of a widely accepted laparoscopic splenopancreatectomy and of a traditional pancreaticoduodenectomy which nowadays is considered safer and less time-consuming than the experimental laparoscopic one

Mesenteric fibromatosis is a rare benign mesenteric tumour, characterised by infiltrative growth and high rates of recurrence. Histological examination is the only diagnostic procedure capable of ruling out a malignant mesenteric neoplasm. It is not always possible to perform a radical removal of the tumour mass because it may have infiltrated important anatomical structures. In the present study the Authors report two cases of mesenteric fibromatosis and analyse the main clinical-diagnostic, therapeutic and prognostic problems posed by these tumours.

Meckel's diverticulum is the most common congenital abnormality of the intestinal tract, occurring in 2% of autoptic studies. The case of an 85-year-old man referred to the Emergency Surgery Unit for intestinal obstruction and lower gastrointestinal tract bleeding is reported. Surgical exploration revealed a complicated Meckel's diverticulum full of coproliths, immersed in pus and blood. Examination of the resected diverticulum showed necrotic diverticulitis in the absence of ectopic gastric or pancreatic tissues.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of malignancies derived from neuroendocrine cells that can occur anywhere along the gastrointestinal tract. GEP-NETs incidence has been steadily increasing over the past decades, in parallel with the increasing incidence of the metabolic syndrome (MetS). It is not yet fully known whether the MetS components (such as obesity, dyslipidemia and type 2 diabetes) could be involved in the etiology of GEP-NETs or could influence their outcomes. In this review, a panel of experts of the Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Endocrinology (SIE), and Italian Society of Pharmacology (SIF) provides a critical view of the experimental and clinical evidence about the association of GEP-NETs risk, outcomes, and therapies with the metabolic disorders typical of MetS. The potential therapeutic strategies for an optimal management of patients with both GEP-NETs and MetS are also discussed.

A 70-year-old woman was referred to the authors’ unit following hospitalization for cardiac failure, high urinary free cortisol concentrations and severe hypokaliemia. A computed tomography scan of the abdomen showed an adrenal adenoma. The 24-hour urinary free cortisol values were high and plasma cortisol levels failed to suppress following 1 mg dexamethasone test. Aldosterone to plasma renin activity ratio was also pathologic, confirmed by saline load. She showed no symptoms of glucocorticoid excess. She was diagnosed with combined primary hyperaldosteronism and Cushing’s syndrome. Cases of adrenal incidentalomas co-secreting cortisol and aldosterone are rare; they should be addressed in patients undergoing adrenal surgery for Conn’s syndrome to avoid adrenal insufficiency after removal of the tumor.

Background: The aim of the study is to analyze pancreatic metastases and their clinical, radiological, therapeutic and prognostic features. Methods: Three cases of pancreatic metastases observed and a world literature review of 333 cases were recorded. Results: Pancreatic metastases are due more frequently to renal cell carcinoma; they are usually metachronous and characterized by a long period of time between the resection of the primary tumor and their detection. The differential diagnosis with other pancreatic masses is difficult, but an accurate anamnesis, some peculiar findings of imaging techniques and percutaneous fine needle aspiration could allow preoperative diagnosis. Pancreatic resections are the treatment of choice allowing the better palliation and improving survival. 150/234 pancreatic metastases underwent pancreatic resections (resectability index = 64.1%); 88/132 patients are alive with a mean follow-up of 27.1 months; of the 44 dead patients the mean survival time was 21.3 months. Among pancreatic metastases the primary tumor with better prognosis is renal cell carcinoma. Conclusion: Pancreatic metastases are rare; their preoperative diagnosis is difficult but useful and possible. Surgical resection is suggested because the patient still may have a prolonged survival.

Context Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency. To our knowledge do not exist studies which defines learning curve (LC). Objectives To define a number of procedures needed to achieve LC in LLP. Methods From January 2008 to June 2012 data regarding 25 patients, undergoing LLP for pancreatic lesions, were collected in a prospective database. All procedures were performed by a single high volume surgeon in advanced laparoscopic and open pancreatic surgery. Decrease of the operative time (OT) was used as parameter to establish the achievement of LC. A preliminary multivariate analysis was carried out to establish which factors influenced OT. Correlation between OT and cumulative sum of procedure (CUSUM) was evaluated to calculate the LC cut-off. Finally multivariate analysis was repeated including LC cut-off. ANOVA test was used to estimate correlation and to calculate multivariate model. Results There were 18 (72%) females and 7 (28%) males with mean age of 55±16 years and mean BMI of 27±5 kg/m2. Patients were more frequently ASA II (64%). Thirteen patients (52%) presented one or more co-morbidity and had a previous surgical abdominal procedure. Splenectomy was carried out in 18 (72% ) cases. An extended resection was conducted in 5 cases (20%). Mean operative time was 219±52 min. Rate of conversion was 16%. Pathological examination showed only in 11 (44%) cases a malignant disease and none ductal adenocarcinoma. Preliminary multivariate analysis showed that splenectomy significantly decreased OT while size of lesion increased OT (P=0.033 and P=0.041, respectively). A significant inverse correlation was found between OT and CUSUM (P=0.050) and the LC cut-off was 14 procedures. Final analysis including LC cut-off showed that the achievement of LC cut-off reduced significantly OT (P=0.047). Instead BMI and extended resection independently increased OT (P=0.030 and P=0.022, respectively) Conclusion In our experience the number of procedure needed to achieve LC was 14 LLP. BMI and extended resection influenced OT even after the achievement of LC., JOP. Journal of the Pancreas, Vol 13, N° 5S (2012): September (Suppl.) - p. 548-650

Si descrivono le metodiche diagnostiche e la tecnica chirurgica per il trattamento di un linfangioma cistico del surrene.

L'opera si propone come testo di chirurgia per gli studenti del Corso di Laurea in Scienze Infermieristiche offrendo una visione immediata, completa e di estrema attualità della patologia chirurgica, della clinica chirurgica e degli aspetti terapeutico-assistenziali al paziente chirurgco con ampi riferimenti all'anatomia, alla fisiologia e alla patologia clinica. Vengono trattate la principali malattie di interesse chirugico con particolare attenzione alle innovazioni tecnologiche la chirurgia laparoscopica ed endoscopica. Vengono inoltre presentati i più importanti argomenti di chirurgia d'urgenza. Il manuale si completa e si rende estremamente adatto allo studio grazie ad un'ampia e chiara documentazione iconografica.

Si descrive il percorso diagnostico-terapeutico attuato presso il Policlinico S. Orsola-Malpighi per tutte le neoplasie del pancreas distinguendo quelle esocrine da quelle endocrine.

Vengono descritti 123 tumori stromali intestinali: le loro caratteristiche morfologiche, diagnostiche e terapeutiche.

Vengono descritti 11 casi di pazienti affetti da MEN I, raccolti retrospettivamente. Si evidenziano alcune caratteristiche diagnostiche terapeutiche e prognostiche della malattia.

Vengono descritti tre casi di fistole pancreatiche resistenti alla terapia medica convenzionale trattate con iniezione per via radiologiche di una sostanza sclerosante. I risultati sono stati ottimi

Le neoplasie gastriche e pancreatiche possono avvalersi dell'uso routinario della laparoscopia soprattutto in quelle forme considerate sospette per diffusione metastatiche peritoneale. Vengono presi in considerazione alcuni parametri in grado di stabilire se eseguire o meno una laparoscopia diagnostica.