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The aim of this prospective cohort study was to identify the patient factors that predict postoperative deviation from each item of a fast-track colorectal surgery protocol (FT) and these factors’ influences on postoperative outcomes. A total of 606 patients with colorectal pathology from 2005 to 2011 were analyzed to assess the relationships between patient factors, the outcome variables, and the items of the FT program. The median length of stay was 5 days, and readmission rate was 2.3. The morbidity rate was 26.7. Independent predictors of prolonged length of stay were older than 75 years of age, ASA grade 3 and 4, and the presence of an ileostomy. Independent predictors of morbidity were age above 75 years old and ASA grade, whereas age was confirmed as an independent predictor of mortality. Male sex, age above 75 years old, and ASA 3 and 4 were identified as independent predictors of negative compliance to most of the postoperative FT items.

Patients with significant comorbidities often are denied laparoscopic colorectal resections, because they are thought to be too “high-risk.” This study was designed to examine the feasibility and safety of laparoscopic colorectal resections in high-risk colorectal cancer patients and to compare them with a similar cohort of patients undergoing open resections in the same time period.This was a single-center, prospective, cohort study conducted at a high-volume, nonuniversity, tertiary care hospital. From a database of 616 patients submitted to elective colorectal surgery for cancer within a fast-track protocol (January 2005 to November 2011), 188 patients who met at least one minor (age >80 years and body mass index (BMI) >30 m/kg2) and one major (cardiac, pulmonary, renal or liver disease, diabetes mellitus) criterion were classified as high-risk. Differences in baseline characteristics, intraoperative outcomes, and short-term (30-day) postoperative outcomes, as well as the pathology findings and the readmission and reoperation rates, were compared between the open and laparoscopic cohorts in both high- and low-risk groups and between high- and low-risk groups.During the study period, 68 high-risk patients underwent laparoscopic resections and 120 had open surgeries. A shorter length of postoperative stay (6 vs. 9 days, p< 0.0001) and fewer postoperative nonsurgical complications (4 % vs. 19 %, p= 0.003) were observed among the laparoscopic group. Postoperative major (p= 0.774) and minor complications (p= 0.3) and reoperations (p= 0.196) were similar between the two groups, and a significantly lower rate of mortality (1.5 vs. 7.5 %, p= 0.038) was observed in the laparoscopic group than in the open group.Laparoscopic colorectal resection can be safely performed on “high-risk” surgical patients with better results than a similar group of high-risk patients undergoing open colon resections.

The present report summarizes 12 cases with achalasia treated with laparoscopic Heller myotomy and anterior fundoplication according to the method of Thal and Dor.

The present report summarizes 12 cases with achalasia treated with laparoscopic Heller myotomy and anterior fundoplication according to the method of Thal and Dor. From 1997 to 2005 at 2 institutions in Europe, 12 patients (7 male and 5 female, ages ranging from 3.5 to 7 years) were treated for esophageal achalasia (EA) with laparoscopic Heller myotomy and anterior fundoplication according to Thal and Dor. In 1 case a perforation of the esophageal mucosa occurred, which was promptly treated during surgery. Follow-up ranged from 18 to 60 months and included clinical examination and barium radiography of the upper digestive tract. Postoperatively, 10 patients showed a normal weight curve and complete resolution of symptoms. All patients showed complete regression of digestive and respiratory symptoms from the first examination, with a normal oral meal intake and an improvement of weight and height parameters. One case required repeat intervention after 2 years because of persisting pain; in this case surgery revealed an insufficient myotomy. Modified extramucosal Heller cardiomyotomy associated with 180° anterior antireflux plastic surgery (according to Thal and Dor's procedures) is a useful and safe procedure in the treatment of EA in pediatric patients. Our data, which are supported by long-term follow-up, also stress the relevance of anterior fundoplication in preventing postoperative gastroesophageal reflux.

Background: Some technical aspects of laparoscopic spleen surgery still are debated, although efforts have been made to standardize them. The position of the patient, the approach to the spleen, vessel identification and division, and spleen extraction can vary from center to center. Methods: This retrospective muticentric study led by the Società Italiana di Videochirurgia Infantile (SIVI) examined indications, surgical details, and complications of laparoscopic spleen surgery in the pediatric population during a 5-year period. Results: The study period from January 1999 to December 2003 (5 years) involved nine centers and included 85 patients with a mean age of 10 years (range, 2–17 years). Hypersplenism or severe hemolysis in cases of hematologic disorders represented the most important indications. More than 90% of the patients underwent total laparoscopic splenectomy. Specific technical details from each center were collected. Intraoperative complications occurred in 19% of the patients (hemorrhage in 8% and technical problems in 14%), and 6% of the patients required conversion to the open approach. No deaths occurred, and no reoperations were required. Postoperative complications were experienced by 2% of the patients. Conclusion: Laparoscopic spleen surgery is safe, reliable, and effective in the pediatric population. On the basis of the results, some technical details for laparoscopic spleen surgery can be suggested. The patient is preferably kept supine or lateral, approaching the spleen anteriorly. Moreover, the ilar vessels should be identified selectively and individually, with initial artery division performed to achieve spleen shrinking. Any hemostatic device proved to be effective in experienced hands. Once freed, the spleen is preferably extracted via a suprapubic cosmetic transverse incision (faster, easier, and safer), although a bag can be used. Finally, the size of the spleen does not represent a contraindication for a trained and experienced surgeon. Nevertheless, this parameter must be considered when laparoscopic spleen surgery is planned.

Since 1988, when Rogers first described a boy with anophthalmia associated with esophageal atresia, eight similar cases have been reported. These patients lend support to the hypothesis that this association of congenital anomalies constitutes a discrete entity, although the etiology is still unknown.We report a patient with this combination of malformations as well as a marked hypoplasia of the entire left half of the body. © 2003 Wiley-Liss, Inc.

The aim of this research is the application of the Method of Organizational Congruencies before and after the substitution of organic solvents with vegetable agents for the cleaning of an offset printing machine in order to assess the organizational changes. A solvent-free process is the goal of the Subsprint Project (Technology Transfer Program of the European Community). This, study shows how human and environmental health is improved by using vegetable agents, though this change may lead to some other organizational constraints such as an increase of tbe time needed, monotony, and repetitiveness of the technical actions involved. The authors underline that the knowledge of the impact of the new technology on health helps a better understanding of the resistance to the change and its further amelioration.

A rapidly expanding pandemic of the new coronavirus has become the focus of global scientific attention. Data are lacking on the impact of the pandemic caused by the severe acute respiratory syndrome coronavirus 2 on health-related quality of life among patients affected by primary antibody deficiencies (PADs).

We evaluate the results and complications of laparoscopic urological procedures in children.

: Background: Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux (GER) in children. We present the prospective experience and short-term results of eight Italian pediatric surgical units. Methods: We included all the children with complicated GER, operated after January 1998 by single surgeons from eight different centers. Diagnostic aspects, type of fundoplication, and complications were considered. All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences. Results: 288 children were prospectively included. Mean age was 4.8 years (3 m–14 y). Nissen fundoplication was done in 25%, floppy Nissen in 63%, Toupet in 1.7%, and anterior procedures (Lortat Jacob, Thal) in 10%. Gastrostomy was associated, if neurological impairment or feeding disorders were present. Mean follow-up was 15 months and reoperation was necessary in 3.8% of cases. Conclusions: This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden standard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach.

Background: Esophageal atresia (EA) with distal fistula, also called III type, represents the most common form of EA, with a frequency of 1 case in 4000, often associated with other congenital anomalies. VATER syndrome represents a non-random etiologically diverse association of vertebral defects, anal atresia, tracheo-esophageal fistula and radial or renal defects. We describe a novel multiple malformation pattern, characterized by tracheal stenosis, type II laryngeal web, esophageal atresia (EA) with distal fistula, vestibular fistula (VF), atrial septal defect (ASD) and patency of the ductus arteriosus (PDA), never reported in literatureCase report: Newborn with normal delivery at the end of pregnancy with polydramnios seen by an ultrasonographic examination, birth weight 2.80 Kg and length 45.6 cm. At birth Apgar score was 7 and 8 at 1' and 5' min, respectively. Insertion of a nasal-gastric probe was immediately tried, with an obstacle to progression. An immediate X-ray thorax-abdomen showed 'a stop of the radiopacal nose-gastric probe at level of D4, with a back-banding, arousing suspection of EA'. Moreover, the presence of air in the digestive tube induced to suppose the presence of a tracheo-esophageal fistula. The examination of the perineal region showed an anorectal malformation (VF) with regular canalization and immediate emission of meconio. An ultrasonographic exam of the hearth showed the presence of ASD and PDA. An optic fibers laryngscope, used for repeated episodes of crisis of apnea with cyanosis and bradycardia, showed the presence of an anterior II type laryngeal web. A nuclear magnetic resonance (MRI) pointed out the presence of a tracheal stenosis involving a wide feature of tracheal lume. Cariotype asset was examined without finding any chromosomic alteration.Treatment: On the second day of life, the patient underwent surgery in order to correct the EA through a right posterolateral toracotomy on the fourth intercostal space. An extrapleuric surgical approach was performed and a distal tracheoesophagel fistula was isolated during the surgical exploration. A resection of the laryngeal web was performed by means of laser CO2. Unfortunately, this procedure did not give appreciable improvements of the respiratory dynamics and the patient died in sixtyfourth day of life, during a serious respiratory crisis.Discussion: It could be considered an original syndrome like an expansion of VATER association. In fact, the concomitant presence of tracheal stenosis and EA takes place rarely, and the correlation between these two defects is little studied. If it is taken into account the concomitant presence of a laryngeal web of II type, such an association appears unique. More observations will be necessary, along with in-depth genetic studies, to determine the cause and the genetic transmission of this multiple malformation syndrome.