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Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.

Laparoscopic cholecystectomy (LC) has now become the “gold standard” treatment for symptomatic gallstone disease. Thanks to its advantages (i.e., smaller scars, reduced postoperative pain), patients enjoyed a shorter hospital stay and consequently, many healthcare providers have started to explore the feasibility of offering LC as a day-case procedure, and in 1990 some authors had already reported the first experiences of ambulatory surgery. Nowadays day-case LC (DLC) has been adopted with different rates and it is not fully accepted by all surgeons. The main question concerns whether the DLC might be feasible for all or just for selected cases. It is common opinion that DLC is indicated for selected cases and the selection may concern medical and logistic criteria. Some exclusion criteria may be considered advisable: common bile duct stones, acute cholecystitis, pancreatitis, patient’s age, and intraoperative complications. Some authors pointed out the importance of anesthesia and postoperative control of pain, nausea, and vomiting as strongly needed elements to allow patients’ early discharge. In conclusion DLC seems to be a safe and effective intervention in selected patients (with no or minimal systemic disease and within easy reach of the hospital) with symptomatic gallstones.

Classical outcome measures (mortality and complications) have to be considered to compare surgical treatments. As no significant differences between laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) were found in classical outcome measures, it is justified to consider health-related quality of life (HRQoL) an important secondary outcome measure. Indeed quality of life (QoL), symptoms resolution, duration of convalescence, and patient satisfaction and well-being are at least as important as the classical outcomes from a patient’s point of view. Instruments for measuring HRQoL may be disease specific or generic. We pointed out our attention to QoL considering these main topics: effectiveness of LC, comparison to OC, comparison to small-incision laparotomic cholecystectomy (SC), and impact of iatrogenic bile duct injury (BDI). In conclusion LC is an effective operation for the treatment of biliary disease-related symptoms in patients with cholelithiasis. LC improves QoL faster than OC, while long-term results are quite similar. When comparing QoL after LC and SC, the perception of health immediately after surgery is slightly better for patients treated with laparoscopic procedure, but the gain in QoL is small and of a very limited duration.

The recent introduction of new chemotherapeutic and radiotherapeutic schemes into clinical practice has led to the improvement in the overall survival of cancer patients. Hodgkin’s disease, testicular cancer, and pediatric malignancies are the pathologies with the highest survival rate; improved cure rates have also been achieved for breast cancer, ovarian cancer, and non-Hodgkin’s lymphoma. However, the long-term survival and/or recovery conferred by these treatments paradoxically expose cancer patients to a higher risk of important longterm complications, the most serious of which is the development of a second tumor.

Gastric carcinoma is the second most common cause of digestive tumour-related death in Europe, North America and Asia. Today, the gold standard of treatment is still surgery, but outcomes to date are unsatisfactory. The Japanese Society for Research in Gastric Cancer (JSRGC) recommends the routine execution of splenectomy during gastrectomy. This recommendation is contested by western Authors because of increased morbidity and mortality without any real advantage in terms of survival. Patients treated for gastric cancer in our department between 1993 and 2002 were selected for this study. The 132 patients recruited were divided into two groups: a) those treated for gastric cancer without splenectomy; and b) those in whom splenectomy was performed in conjunction with gastrectomy. We analysed: the extent of lymph node dissection, the execution of the splenectomy, and the prognostic importance of factors relating to the patient, tumour and surgeon. Splenectomy was not associated with any increase in morbidity. Complications, especially of the septic type, and perioperative mortality were similar in both groups, and the same was true of survival at both 3 and 5 years. In our opinion, splenectomy should not be routinely combined with surgery for gastric cancer but could be considered for T3-T4 neoplasms or those localized in the upper two thirds of the stomach.