The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.

Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes.

Background: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent strategy to improve resectability of extensive hepatic malignancies. Recent surgical advances, such as the application of technical variants and use of a mini-invasive approach (MI-ALPPS), have been proposed to improve clinical outcomes in terms of morbidity and mortality.

Methods: A total of 119 MI-ALPPS cases from 6 series were identified and discussed to evaluate the feasibility of the procedure and short-term clinical outcomes.

Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?

Background: Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients.

Methods: The analysis included 403 LLR for HCC from seven European centres.

Laparoscopic surgical treatment of hepatic splenosis. A case report.

Aim: Isolated hepatic splenosis is a rare but possible condition in abdominal surgery. At radiological imaging liver splenosis mimics malignant or pathological condition of the liver; obtaining a certain diagnosis prior to surgery is difficult. For this reason, the patients undergo to unnecessary operation, with a laparotomy access.

Mils for HCC: the state of art.

After an initial skepticism, minimally invasive liver surgery (MILS) gained popularity and is nowadays a consolidated option in specialized centers for the surgical treatment of selected patients affected by both benign and malignant liver diseases. Nevertheless, the role of MILS in the surgical treatment of hepato-cellular carcinoma (HCC) developed on the background of chronic liver disease is still a matter of debate. The indications and the current evidences on MILS for HCC are discussed in this paper.

Laparoscopic Drainage as First Line Treatment for Complex Pyogenic Liver Abscesses.

Unlabelled: Background/aims: Pyogenic liver abscess (PLA) is a rare but potentially fatal condition if untreated. In available retrospective series successful rate of per- cutaneous drainage (PD) on large multiloculated PLA, that has been definited "complex". In this observation- al study, we report the experience of our Institution in performing laparoscopic drainage of complex liver ab- scess over a 5-years period as first line treatment for selected cases of PLA.

Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis.

Background: Previous studies comparing open distal pancreatectomy (ODP) and laparoscopic distal pancreatectomy (LDP) have found advantages related to minimal-access surgery. Few studies have compared direct and associated costs after LDP versus ODP. The purpose of the current study was to compare perioperative outcomes of patients undergoing LDP and ODP and to assess whether LDP was a cost-effective procedure compared with the traditional ODP.

Single port laparoscopic cholecystectomy: a new evolving technique.

Although multiple groups have reported initial success with single port laparoscopy, no consensus exists concerning the technical aspect of this surgery. In this report, we describe in detail our technique to perform single port laparoscopic cholecystectomy. Twelve cases of single port laparoscopic cholecystectomy for gallbladder stones were performed in our surgical unit.

Laparoendoscopic single site liver resection for recurrent hepatocellular carcinoma in cirrhosis: first technical note.

Introduction: Single port access laparoscopic redo liver resection for hepatocellular carcinoma on cirrhosis through a single transumbilical skin incision has not been reported in the literature so far.

Methods: A wedge resection of segment III lesion with a laparoendoscopic single site surgical incision is described in detail analyzing the technical aspects of the procedure.

Results: There were no intraoperative complications with no intraoperative or perioperative blood transfusions.

Revision surgery for incidentally detected early gallbladder cancer in laparoscopic era.

Background: Incidentally detected early gallbladder cancer (IDEGB) is an early carcinoma first diagnosed on microscopic examination after a cholecystectomy for symptomatic benign gallbladder disease. After diagnosis of IDEGB it is often necessary a completion of treatment by a second tailored revision procedure. Despite early reports contraindicating laparoscopic approach because of high risk of neoplastic seeding, recent data seem to demonstrate that this approach per se does not influence clinical outcomes.

Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes.

Background: Few data regarding survival or pattern of recurrence after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) on cirrhosis have been reported so far.

Methods: A retrospective analysis of a prospectively maintained database of 109 laparoscopic interventional procedures performed for HCC in cirrhotic liver between 2000 and 2008 was conducted.

Results: Sixty-five patients underwent an LLR.

Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience.

Background: Some series have suggested that laparoscopy is beneficial for resection of hepatocellular carcinoma. This has to be confirmed in larger series. The aim of this study was to analyze the results of 3 European surgical centers on laparoscopic liver resections for hepatocellular carcinoma.

Laparoscopic hand-assisted right hemihepatectomy by ultrasound-directed intrahepatic approach.

Background/purpose: Laparoscopic hepatectomy is a promising option for patients affected by a liver mass, and the procedure is gaining popularity. Minor laparoscopic resections have been widely reported. In contrast, major laparoscopic hepatectomy has been performed in only a limited number of cases.

Surgical treatment of giant liver hemangiomas by enucleation using an ultrasonically activated device (USAD).

Hemangioma is the most frequent focal liver lesion. It affects mainly women and may cause symptoms such as abdominal pain, mass, and early satiety, or complications such as heart failure or coagulopathy (Kasabach-Merrit syndrome). Although, surgical resection is the only curative treatment for symptomatic giant hemangiomas, the best surgical technique (formal liver resection or enucleation) is still debated.

Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results.

Background: Recurrence of cancer and the need for several surgical treatments are the Achilles' heel of the treatment for hepatocellular carcinoma (HCC) in cases of cirrhosis. The difficulty of reintervention is increased by the formation of adhesions after the previous hepatectomy that can make a new surgical procedure more difficult and less safe. With a minimally invasive approach, the formation of postoperative adhesions seems to be minimized, and the adhesiolysis procedure seems to be faster and safer in terms of blood loss and risk of visceral injuries.

Laparoscopic segment VI liver resection using a left lateral decubitus position: a personal modified technique.

Background: Laparoscopic technique for lesions located in the left liver is well described in the literature. On the contrary, the best laparoscopic approach for lesions located in the right liver, such as in segment VI, is still debated.

Aim: In this article, we provide a detailed description of a laparoscopic segment VI liver resection using a left lateral decubitus position with the right side up, facilitated by a personal technique.

Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients.

Background: The laparoscopic approach for liver resections is still limited and controversial. Nevertheless the advantages connected with a mini-invasive approach are significant, especially in cirrhotic patients. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made endoscopic hepatic surgery feasible and safe.

Hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy. A retrospective study on 51 cases.

Background/aims: Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003.

Methodology: The Authors report the data of a retrospective multicentric study of 51 patients -39 women (76.

Laparoscopic radiofrequency ablation combined with laparoscopic liver resection for more than one HCC on cirrhosis.

The management of patients affected by more than one hepatocellular carcinoma (HCC) is still controversial but nowadays a multimodal approach to this pathology seems to be the most effective and versatile therapeutic option. When orthotopic liver transplantation is not indicated, survival-time and quality of life improvement is the goal for patients who will have a long metabolic and oncologic disease history. Combined use of minimally invasive nonsurgical treatments [percutaneous ethanol injection, radiofrequency ablation, transcutaneous arterial chemioembolization (TACE)] allows to offer to the patients the advantages of each therapeutic procedure reducing their individual side effects and complications.

Laparoscopic incisional and umbilical hernia repair in cirrhotic patients.

Background: Traditional approach to incisional hernias (IHs) in cirrhotic patients is plagued by a significant recurrence rate and frequent wound infections. The laparoscopic repair of IHs was designed to offer a minimally invasive and tension-free technique that yields less morbidity and fewer recurrences than the standard open repair. In cirrhotic patients there are additional reasons for the benefits of laparoscopy.

Laparoscopic left lateral hepatic lobectomy: a safer and faster technique.

Background/purpose: Laparoscopy for liver resection is highly specialized field because laparoscopic liver surgery presents severe technical difficulties, such as control of bleeding and risk of gas embolism. At present, a limited number of laparoscopic anatomical left lobectomies have been reported in the literature, but we believe that the use of stapling devices has made this technique safer and faster.

Methods: From January 2000 to May 2005, eight patients (five men, three women; mean age, 60.

Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis.

Laparoscopic surgery is a relatively new option for the treatment of hepatocellular carcinoma (HCC) on cirrhosis. To date, there have been only a few reports of this option for this pathology in the literature, probably because of the intra operative difficulties related to the treatment of this pathology (even at laparotomy) and because of the problems related to the minimally invasive approach (technical difficulties, complicated management of the bleeding, lack of dedicate tools, and fear of gas embolism). In this article we report four patients from our whole series (23 laparoscopic liver resections for HCC) who underwent a laparoscopic resection for completely exophytic HCC on cirrhosis, located in segment IV in two patients, and in segment III and segment V respectively, in the other two.