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Splenectomy is a well-established second-line treatment for immune thrombocytopenia but novel medical therapies have changed the management of this disease. The objective of this study is to analyze the current results of splenectomy as a second-line treatment. Retrospective analysis of 53 consecutive patients with chronic immune thrombocytopenia submitted to splenectomy from January 2007 through December 2014. Several parameters were analyzed including postoperative morbidity and outcomes after surgery. Fifty-two (98%) patients underwent successful laparoscopic splenectomy without conversion to open procedure, with a mean operative time of 103.6 ± 38.1 minutes. The median postoperative length of stay was 3 days (range 1–36 days). There were 3 (5.7%) major postoperative complications resulting in 2 (3.8%) reoperations. No splenectomy-related mortalities occurred. Fifty (94.3%) patients presented a response 1 month after surgery (45 complete responses and 5 responses). In the follow-up (mean 24.8 ± 16.9 months) 37 (75.5%) patients had a complete and sustained response after laparoscopic splenectomy and an additional 11 (22.4%) presented platelet counts above 30×109/L (the majority of these patients eventually reaching normal platelet counts). No additional therapies were needed in 39 (79.6%) patients after surgery. In our experience, laparoscopic splenectomy is an effective second-line treatment for Immune Thrombocytopenia with short and long-term response rates of 94% and 91%, respectively. Major postoperative complications occurred in 6%. Future research should aim to discover new methods to properly select patients to different second-line treatments.

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

Contains fulltext : 110654.pdf (Publisher’s version ) (Open Access) ABSTRACT: The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38 degrees C or less than 36 degrees C by the third post-operative day were statistically significant indicators of patient mortality.