Laparoscopic and robotic distal gastrectomy for gastrointestinal stromal tumour: case report.

Background: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the digestive tract. The most frequent site of occurrence is the stomach. Due to the high potential for malignancy of GIST, resection should be the first-line treatment.

Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis.

Background: We hypothesized that robotic assistance (RARS) could provide better intraoperative and short-term outcomes than a traditional laparoscopic approach (LARS) to rectal cancer surgery.

Methods: Systematic review of the literature, including electronic searches and communications to international robotic meetings.

Inclusion Criteria: studies involving rectal cancer patients and comparing outcomes of robotic surgery vs laparoscopic surgery.

[Current state of digestive system robotic surgery in the light of evidence based medicine].

The incorporation of robotics in minimally invasive surgery has had mixed reception in the different fields of digestive surgery. Nowadays we are exposed to a continuous stream of publications on robotic approach techniques and outcomes, which do not always provide objective criteria and whose value, through scientific evidence analysis, is sometimes arguable. With the aim of shedding light on current knowledge on digestive robotic surgery and giving an update of its possibilities, the authors analyse the abundant literature available on the different digestive robotic surgery procedures, and sum up their own experience.

Lessons learned from long-term university training in minimally invasive surgery in Spain.

Purpose: Starting from our prolonged experience in university minimally invasive surgery training (1993 to 2005), we aim to analyze the most important differences in participants' requirements from these courses along this time span.

Methods: Surveys' answers from the 6 first course editions (from 1993 to 1999, group 1) are compared with the last 6 ones (from 1999 to 2005, group 2), for a number of items including reasons to choose these courses, opinion about duration of training minimally invasive surgery (MIS) courses, responsibility of training MIS, and opinion about experimental training with animals.

Results: Total number (N) of participants was 341, with 177 in group 1 and 164 in group 2.

Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis.

Introduction: We report the final analysis of a prospective single-blinded randomized trial designed to investigate whether omission of preoperative mechanical bowel preparation increases the rate of surgical-site infection and anastomotic failure after elective colon surgery with intraperitoneal anastomosis by a single surgeon.

Patients And Methods: Patients scheduled to undergo an elective colon or proximal rectal resection with a primary anastomosis by a single surgeon were randomized to receive either oral polyethylene glycol (Group A) or no mechanical bowel preparation (Group B). Patients were followed by an independent surgeon.

Mechanical bowel preparation for elective colorectal surgery with primary intraperitoneal anastomosis by a single surgeon: interim analysis of a prospective single-blinded randomized trial.

We report an interim analysis of a prospective single-blinded randomized trial designed to investigate whether preoperative mechanical bowel preparation influences the rate of surgical-site infection and anastomotic failure after elective colorectal surgery with primary intraperitoneal anastomosis performed by a single surgeon. Patients scheduled to undergo an elective colorectal procedure with a primary intraperitoneal anastomosis were randomized to receive either oral polyethylene glycol lavage solution and enemas (group A) or no preparation (group B). Surgical-site infection and anastomotic failure were investigated.

Luminal oxidants selectively modulate electrogenic ion transport in rat colon.

Aim: To investigate the effects of luminal exposure to H2O(2) and two related thiol oxidizing agents on basal and stimulated chloride secretion in native colon using electrophysiological and pharmacological approaches.

Methods: Unstripped rat distal colon segments were mounted in Ussing chambers. Potential difference, calculated resistance and short-circuit current across unstripped colon segments were monitored with a dual voltage/current clamp.

Effects of luminal ATPase inhibitors on electrogenic ion transport in rat distal colon.

Background: The involvement of transport proteins, other than chloride channels, expressed in the luminal membrane of epithelial cells in regulated chloride secretion in native colon remains poorly understood. There are at least two distinct ATPases expressed in the apical membrane of rat colonocytes. They can be distinguished by their different sensitivity to the vanadium-derived compound orthovanadate.

Total mesorectal excision for rectal cancer: the truth lies underneath.

The surgical technique itself has emerged as a crucial factor for local recurrence since the popularization of total mesorectal excision for the treatment of rectal cancer. This procedure is associated with lower local recurrence rates after "curative" surgery compared to traditional dissection of the rectum. The aim is to remove an intact mesorectal envelope from the promontorium down to the pelvic floor by sharp dissection with tumor-free margins and without causing injury to the pelvic nerves.

Electrogenic ion transport in mammalian colon involves an ammonia-sensitive apical membrane K+ conductance.

It is remarkable that high ammonia concentrations can be present within the colonic lumen without compromising normal epithelial function. We investigated the impact of luminal ammonia on Cl- secretion in native tissue. Stripped human colonic mucosa and unstripped rat distal colon were used.

Peptide YY secretion in morbidly obese patients before and after vertical banded gastroplasty.

Background: The Peptide YY (PYY) secretion pattern was assessed in morbidly obese (MO) patients before and after vertical banded gastroplasty (VBG).

Methods: 12 MO patients (10 women, 2 men) age 29-62 years, BMI 50.7 +/- 9.

Progesterone inhibits chloride transport in human intestinal epithelial cells.

Several pieces of evidence suggest that female sex hormones may play a role in the regulation of electrolyte transport. We therefore hypothesized that female sex hormones might impair regulated transcellular chloride transport in human intestinal epithelial cells. The T84 cell line was used for electrophysiological studies.

[The phospholipase A2 inhibitor, aristolochic acid, inhibits chloride secretion without altering barrier function].

Aim: To study the effect of aristolochic acid (AA) and the effect of phospholipase A2 (PLA2) on barrier function and electrogenic chloride secretion in intestinal epithelium.

Material And Methods: Electrophysiological studies were performed in the T84 cell line and rat distal colon. Ionic secretion and transepithelial resistance were determined.

Open biliary tract surgery: multivariate analysis of factors affecting mortality.

Background/aim: The overall mortality rate in patients undergoing supraduodenal choledochotomy for benign biliary tract disease is around 3%. The aim of this study is to identify and quantify factors affecting the mortality in a group of patients undergoing open common bile duct exploration for benign biliary disease.

Methods: Patients (n = 158) who underwent common bile duct exploration during a 5-year period in a teaching hospital were retrospectively reviewed.

[Intestinal pneumatosis].

Intestinal pneumatosis is an infrequent disease of difficult clinical and radiologic diagnosis. It may be accompanied by pneumoperitoneum in up to 30% of the cases leading to differential diagnosis with pictures of visceral perforation. We herein present 4 cases of intestinal pneumatosis in whom pneumoperitoneum was associated in 3 patients.

[Chloride secretion in the intestinal epithelium: channels, ions, and intracellular signaling].

Salt and water secretion by epithelial cells is required to hydrate the mucosal surface of both gastrointestinal and respiratory tracts. Intestinal secretion is the result of active transcellular chloride transport by epithelial cells lining the crypts. Defective chloride secretion is responsible for many common disorders such as secretory diarrhea and cystic fibrosis.

[Necrotizing gastroenteritis associated with inflammatory bowel disease].

Gangrene of the stomach is a rare and catastrophic event, usually attributed to local pathologic conditions. Although there are no cases documented in the literature, non-occlusive arterial ischemia is sometimes listed among the causes of necrotizing gastritis. We report a case of necrotizing gastroenteritis associated with a low flow state secondary to an episode of fulminant colitis, fecal peritonitis and septic shock.

Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion.

The objective of this study was to determine the morbidity associated with trocar and needle insertion for laparoscopic surgery and to identify risk factors for complications. Data from a prospectively collected database of all laparoscopic operations performed at a major teaching hospital over a 4-year period were analyzed. In 203 patients closed laparoscopy (Veress needle plus blind trocar insertion) was used to establish the pneumoperitoneum.

Complications of laparoscopic cholecystectomy in the ageing patient.

Aim: to determine the safety of simple laparoscopic cholecystectomy in ageing patients.

Method: the outcome of patients between 60 and 70 years of age and patients over 70 who underwent laparoscopic cholecystectomy for symptomatic non-malignant gallbladder disease was comparatively analysed. All patients over 60 years of age with symptomatic gallbladder disease and without cholecholithiasis, septic shock, diffuse peritonitis, gallbladder malignancy, portal hypertension or contraindication for general anaesthesia were selected for simple laparoscopic cholecystectomy (n = 158).

Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative thromboembolic disease. We report two cases of pulmonary embolism following laparoscopic cholecystectomy, review the incidence of deep venous thrombosis and pulmonary embolism in laparoscopic cholecystectomy, and suggest a specific prophylactic scheme for patients undergoing laparoscopic cholecystectomy. In spite of the low incidence of postoperative thromboembolic disease following minimally invasive procedures, the risk of pulmonary embolism must not be underestimated and its symptoms must not be underdiagnosed.