Abstract: Background. Trocar Site Hernia (TSH) is defined as an incisional hernia which occurs after minimally invasive surgery on the trocar incision site.In 2004 Tonouchi classified trocar site hernias into 3 types: Early onset type; Late onset type; Special type. Case Report. We report the case of a 76-year old woman that underwent an emergency explorative laparotomy on the 10th p.o. day after a laparoscopic left hemicolectomy. Surgery showed a small bowel herniation through the 12 mm trocar incision site; the intestinal loop appeared necrotic and had to be resected, and the hernia orifice was repaired. We carried out a review of literature about this topic. Discussion. The clinical onset of a trocar site hernia is usually early, occurring within the 30th post operative day and it is caused by the omentum or small bowel entrapment into the trocar orifice. The clinical presentation is insidious, with progression to an acute abdomen, and an emergency surgical approach is often required. Conclusions. TSH is a severe complication of operative laparoscopy especially with large-bore trocar ports. The incidence of TSH resulting from our review ranges from 0.007% to 22% with an average of 1.85%. Prevention of TSH appears to be more effective when trocar insertion through the abdominal wall is tangential, the closure of both the fascia and the peritoneum is performed if the incision is greater than 7 mm, the suture of extra umbilical port site is performed under laparoscopic vision.
Abstract: The aim of this study was to describe and evaluate the feasibility and the eventual advantages of ghost ileostomy (GI) versus covering stoma (CS) in terms of complications, hospital stay and quality of life of patients and their caregivers after anterior resection for rectal cancer.
Abstract: In patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial. In fact, a covering stoma (ileostomy or colostomy) is worsened by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and poorer quality of life. The advantage of Ghost Ileostomy (GI) is that an ileostomy can be performed only when there is clinical evidence of anastomotic leakage, without performing further interventions with related complications when anastomotic leak is absent and therefore the procedure is not necessary. Moreover, in case of anastomotic dehiscence and necessity of delayed stoma opening, mortality and morbidity in patients with GI are comparable with the ones that occur in patients which had a classic covering stoma. On the other hand, is simple to think about the possible economic saving: avoiding an admission for performing the closure of the ileostomy, with all the costs connected (OR, hospitalization, post-operative period, treatment of possible complications) represents a huge saving for the hospital management and also raise the quality of life of the patients.
Abstract: In western countries intestinal obstruction caused by sigmoid volvulus is rare and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess what is the correct surgical timing and how the prognosis changes for the different clinical types.
Abstract: ABSTRACT: BACKGROUND: Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it 2 has performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. METHODS: We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage . CONCLUSIONS: The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.
Abstract: ABSTRACT: BACKGROUND: The emergency treatment of incisional hernias is infrequent but it can be complicated with strangulation or obstruction and in some cases the surgical approach may also include an intestinal resection with the possibility of peritoneal contamination. Our study aims at reporting our experience in the emergency treatment of complicated incisional hernias. METHODS: Since January 1999 till July 2008, 89 patients (55 males and 34 females) were treated for complicated incisional hernias in emergency. The patients were divided in two groups: Group I consisting of 33 patients that were treated with prosthesis apposition and Group II, consisting of 56 patients that were treated by performing a direct abdominal wall muscles suture. RESULTS: All the patients underwent a 6-month follow up; we noticed 9 recurrences (9/56, 16%) in the patients treated with direct abdominal wall muscles suture and 1 recurrence (1/33, 3%) in the group of patients treated with the prosthesis apposition. CONCLUSIONS: According to our experience, the emergency treatment of complicated incisional hernias through prosthesis apposition is always feasible and ensures less post-operative complications (16% vs 21,2%) and recurrences (3% vs 16%) compared to the patients treated with direct muscular suture.
Abstract: ABSTRACT: BACKGROUND: Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. METHODS: We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. RESULTS: The feasibility of diagnostic laparoscopy is high (60-100%), while that of therapeutic laparoscopy is low (40-88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies [less than or equal to] 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic meccanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. CONCLUSIONS: Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.
Abstract: Analyzing a complex case and referring to the literature, the authors describe abdominal compartmental syndrome as a complication of Fournier's gangrene, stressing out the importance of an early diagnosis to perform prompt and effective treatment. The characteristic of this case is not represented only by the Fournier's gangrene rarity, but also by the appearance of an abdominal compartmental syndrome due to the gangrene extension from the scrotum to the abdominal wall and cavity through the spermatic funiculus. The treatment of the abdominal compartmental syndrome was the surgical toilette of the necrotic regions (scrotum, abdominal wall and cavity) together with an orchiectomy.
Abstract: ABSTRACT: INTRODUCTION: Skin metastasis from internal carcinoma rarely occurs. It has an incidence of 0.7 to 9% and it may be the first sign of an unknown malignancy. However, it can also occur during follow-up. CASE PRESENTATION: A 90-year-old female patient was admitted to our surgical division with a diagnosis of anemia from a bleeding gastric adenocarcinoma. She underwent a gastric resection and Billroth II retrocolic Hofmeister/Finsterer reconstruction. She developed an enteric fistula, which needed a permanent abdominal drain until the 60th postoperative day. After 12 months she was readmitted to our division with subacute small bowel obstruction and an erythematous swelling on the right side of the abdomen. Biopsies characterized it as a cutaneous metastasis from the gastric adenocarcinoma. No surgical therapy was performed given her poor clinical condition. CONCLUSION: Skin metastasis from carcinomas of the upper gastrointestinal tract is very rare. Persisting erythematous nodules must be biopsied in order to diagnose cutaneous metastases and to recognize them early and start prompt therapy with anti-tumour agents before the occurrence of massive visceral metastases.
Abstract: Heparin-induced thrombocytopenia (HIT), is a severe side effect of heparin. It occurs both in patients treated with unfractionated heparin (UFH) and in patients treated with low molecular weight heparin (LMWH). It is associated with anti-heparin/platelet factor (PF4) antibodies. HIT is a rare pathology, with rates going from 8% to 10% in patients in ventricular assist device support. The authors present three clinical cases which occurred in the Department of Anesthesiology of the Civil Hospital of Strasbourg (France) in patients receiving biventricular assistance bridge-to- cardiac transplantation. All the three patients were hospitalized for myocardial infarction. In case 1 HIT was diagnosed on VI day postoperative after a ventricular assistance device (VAD) implant. The patient was treated with lepirudin and transplanted after 73 days. In case 2 HIT diagnosis was made after 9 days receiving VAD. Also this patient was treated with lepirudin and transplanted after 48 days. Both case 1 and 2 received intra-aortic balloon pump (IABP) assistance before receiving VAD. Case 3 received VAD on XXII day of hospitalization; the patient developed HIT after 5 days, which was treated with lepirudin. He was transplanted after 66 days, but he died in course of intervention. HIT in patients undergoing VAD bridge-to-transplantation is a rare and often misdiagnosed cause of thrombocytopenia. Correct diagnosis, management and therapy are mandatory in this kind of patients, but they are not easy and standardized.
Abstract: Background: Incomplete endoscopic examination of the colon occurs in 5–10% of patients. It is due to obstructing cancer,excessive length of the colon, anatomical anomalies or adhesions.Virtual colonoscopy can explore the colic lumen with high specificity and sensitivity.Materials and Method: From January 2005 to March 2008 we treated 31 patients with obstructing colorectal cancer not enabling a complete colonoscopy. All patients underwent a virtual colonoscopy, which revealed the presence of synchronous lesions (16%): pedunculated polyp ( 2 cases), sessile polyp (2 case), right colonic vegetating lesion (1 case).Results: In all 31 patients we performed a follow-up colonoscopy after three months from the surgical treatment. No other endoluminal lesions were found, confirming the results of virtual colonoscopy. In our experience virtual colonoscopy presented 100% of sensitivity and specificity. Conclusion: In a selected group of patients with insurmountable
obstructing colonic lesions, virtual colonoscopy is a safe and non invasive method to evaluate the whole colon, avoiding possible surgical reintervention due to the finding of synchronous neoplastic lesions at postoperative follow-up endoscopy.
Abstract: In 5-10% of patients it is not possible to achieve a complete endoscopic examination of the colon, because of obstructing cancer, excessive length of the colon, anatomical abnormalities or adhesions. Virtual colonoscopy is currently capable of investigating the colic lumen with a non-invasive technique, with high specificity and sensitivity. From January 2005 to July 2007 we treated 21 patients with obstructing neoplastic colorectal lesions, preventing a complete endoscopic examination. In all patients we performed a virtual colonoscopy, which revealed the presence of synchronous lesions (19%): a pedunculated polyp in two cases, a sessile polyp in one case and a right colonic vegetating lesion. In the 21 patients studied we performed a follow-up colonoscopy 3 months after the surgical treatment. No other endoluminal lesions were found, confirming the results of virtual colonoscopy. In our experience virtual colonoscopy presented 100% sensitivity and specificity. In this selected group of patients with obstructing lesions of the colon, virtual colonoscopy enables the surgeon to evaluate the entire colon, avoiding the execution of an intraoperative colonoscopy and possible surgical reintervention due to the finding of synchronous neoplastic lesions at postoperative follow-up endoscopy.
Abstract: AIM: The diagnosis-related group (DRG) system is a prospective hospital payment system used to categorize hospital patients expected to require similar hospital services. In Italy, hospital productivity is calculated from DRG-based data coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), which is a classification system for coding of diagnoses and operations for indexing medical records by diagnosis and operations. The aim of our survey was to determine the national incidence of appendectomies based on the coded summary of selected data in hospital discharge reports (HDR). METHODS: The Italian Ministry of Health online database was searched for data collected between 2001 and 2003. The search engine allows analysis by different regions but not by individual hospital. The national incidence of appendectomy was calculated using data collected from the ICD-9-CM and from the HDR. In a deeper analysis, regional data and data from individual hospitals were compared. RESULTS: The analysis revealed the incidence of appendectomy, rates of simple acute appendicitis vs complicated appendicitis, common laparotomic appendectomy vs laparoscopic appendectomy, as well as mean duration of hospitalization. CONCLUSION: The incidence of acute appendicitis has considerably decreased, whereas the rates of complicated appendicitis have increased because of longer diagnostic and therapeutic delay, inappropriate antibiotic therapy and upclassifying of diagnosis and procedures in the HDR (ICD-9-CM) in order to obtain a ''wider impact'' on DRG.
Abstract: ABSTRACT: INTRODUCTION: Gastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180 degrees . This rotation can occur on the longitudinal (organo-axial) or transverse (mesentero-axial) axis. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report the case of a patient with chronic intermittent gastric volvulus who underwent a successful laparoscopic treatment. CASE PRESENTATION: A 34-year-old woman presented with multiple episodes of recurrent upper abdominal pain associated with retching and vomiting, treated unsuccessfully with intramuscular metoclopramide. Endoscopic examination of the upper digestive tract showed a suspected rotation of the stomach, and a chronic recurrent gastric volvulus was revealed by barium meal. The patient was operated on successfully, with an anterior laparoscopic gastropexy performed as the first surgical approach. CONCLUSION: Experience with laparoscopic anterior gastropexy is limited only to a few described cases. Our patient was clinically and radiologically followed-up for 2 years with no evidence of recurrence, either radiological or symptomatic. Based on this result, laparoscopic gastropexy can be seen and considered as an initial 'gold standard' for the treatment of gastric volvulus.
Abstract: In patients with colorectal cancers synchronous neoplastic lesions are an increasingly frequent finding at preoperative staging; 3% of the cases are other cancers while 33-35% of the synchronous lesions are villous adenomas. The treatment of most colorectal adenomas can be performed by endoscopic poplypectomy. In 5% of cases there are synchronous colorectal lesions also requiring surgical treatment. From January 1995 to June 2007 we treated 5 patients with rectal lesions by transanal endoscopic microsurgery (TEM) together with a laparoscopic colectomy for the presence of synchronous lesions at the "Clinica Chirurgica Generale e d'Urgenza" of the University of Perugia,. Surgical timing involved performing a sequential exeresis characterised by a cancer resection, followed by resection of the voluminous adenoma: TEM for rectal cancer followed by a laparoscopic right hemicolectomy with an extracorporeal anastomosis for a voluminous villous adenoma (1 patient) and laparoscopic right hemicolectomy with an extracorporeal anastomosis for cancer followed by TEM for a voluminous villous adenoma (2 patients). One patient with left colon cancer associated with a voluminous villous rectal adenoma first underwent TEM for the rectal adenoma and then a left laparoscopic hemicolectomy with an extracorporeal anastomosis in order to ease the transit of the circular mechanical stapler. Another patient with rectal and right colon adenomas first underwent TEM for a voluminous rectal sessile adenoma and later a right hemicolectomy. The use of this minimally invasive approach allowed rectum preservation and less invasive surgery.
Abstract: The name ''carcinoid'' was invented by Ober-ndorfer in 1907, when the nature of those histological entities was little understood. Usually, they were found in various locations in the gastrointestinal (GI) apparatus (67%), most of them in the small intestine (25%), appendix (12%), and rectum (14%).The tecniques used for their removal are various. The authors present here a case of rectal carcinoid removed using the transanal endoscopic microsurgery tecnique, and referred to the diagnosis and treatment of this uncommon tumor. A 37-year-old male was admitted to the Santa Maria Hospital of Terni (Italy) with a chief complaint of intermittent pain in the lower right quadrant, that began three years ago. Complete blood count (CBC) and laboratory data as tumor markers and urinary 5-hydroxyindoleacetic acid (5-HIAA) showed no abnormalities, while urinary vanilmandelic acid level was elevate (18 mg/24 h). The patient was submitted to a colonoscopy with magnifying endoscopy and biopsy. The histologycal finding demonstrated a nodule characterized by cellular proliferation, with few microscopical abnormalities, arranged in small cords with a glandular pattern, separated by dense connective tissue. Histochemically the tumor cells were cytocheratins +/-, cromogranine positive, synaptophisine positive, CD56 positive and Growth Index MIB1-Ki67 which was almost zero. The patient also underwent an endoscopic ultrasonography and an Octreoscan. He was operated using a transanal endoscopic microsurgery technique. The use of Transanal Endoscopic Microsurgery (TEM) as a safe and feasible technique for exciding rectal tumors can be easily understood, for the excellent view and precise dissection. The use of new surgical devices as Harmonic Scalpel has improved the precision of this kind of approach, increasing the appropriateness of this approach compared to other kind of resection. A full diagnostic course and an immunohistochemistry are mandatory for precise diagnosis of rectal carcinoid. Careful attention must be paid to these tumors because of their unexpected behaviour.
Abstract: BACKGROUND: The aim of this study is to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to determine the optimal timing. PATIENTS AND METHODS: The study was performed in two groups of 70 consecutive patients (similar in age and ASA classification), retrospectively reviewed, who had been diagnosed with acute cholecystitis and were underwent early or delayed laparoscopic cholecystectomy. In early group surgery took place within 48 hours of admission in hospital. The interval for delayed laparoscopic cholecystectomy was 8-12 weeks after medical treatment. RESULTS: In delayed group 21,4% of patients required urgent surgery after failure of conservative treatment. The most important significant difference is the total hospital stay: the early group had a significant shorter hospital stay (7 days) vs delayed group (13 days). Other differences were the conversion rate (8,6% in early group vs 12,7% in delayed group) and median the operation time (84 min. in early group vs 106 min. in delayed group). Post-operative complications developed in 6,3% in early group vs 2,6% in delayed group. CONCLUSION: The optimal treatment of acute cholecystitis is urgent laparoscopic cholecystectomy but in our experience early laparoscopic cholecystectomy increased postoperative morbidity in hospital decreased conversion rate, median operation time and hospital stay.
Abstract: Sciannameo F., Coccetta M., Morelli U, Tocchio M., Locci E., Ronca P.
Aim. The aim of this study was to demonstrate the advantage of using antibiotic prophylaxis in prosthetic hernioplasty. The use of prosthesis in hernioplasty presents undoubtable advantages. It is possible to perform, also by local anesthesia, surgical operations with minimum discomfort for the patient and very short stay in hospital and convalescence. Late results are also excellent. On the other hand, the use of prosthetic materials is related to additional risks, first of all infection. Prosthetic infections represent a serious complication, absolutely to avoid. Rigorous asepsis and antibiotic prophylaxis are fundamental for infection prevention. A good antibiotic prophylaxis must be effective, cheap and without side effects.
Methods. The authors report their experience in over 3000 hernioplasties with prosthesis. In all these patients an antibiotic prophylaxis has been performed by only one infusion in the immediate preoperative period. The antibiotic used has been ampicillin-sulbactam and, in patients with allergy to penicilline, teicoplanin.
Results. Mortality was 0.1% (3 patients); these 3 patients were submitted to emergency surgery. In other 3 patients (0.1%), notwithstanding drainage and antibiotic therapy, a prosthesis infection occurred. Late complications observed were 0.3% for hernia recurrence and 0.1% for redo surgery due to persisting pain symptomatology.
Conclusion. The results obtained (prosthesis infections in 0.1% of cases) demonstrate the validity of this procedure.
language: Italian
Abstract: PURPOSE: Sacral neuromodulation is a novel treatment for selected urinary and bowel dysfunctions. A new method is described for electrode implantation, the "minimally invasive sacral neuromodulation implant technique." METHODS: After the percutaneous nerve evaluation test, a small longitudinal incision (3 cm) is made, and a catheter cannula segment is inserted through the sacral foramen beside an insulated needle. The electrode is introduced into the catheter cannula, which is then removed and fixed to the sacrum by means of small anchors. The proximal part of the lead is tunneled into the subcutaneous tissue, reaching the pocket made to accommodate the neurostimulator. RESULTS: This procedure was performed in ten patients (5 male; mean age, 50.4 years). In four patients a single electrode was implanted, and in six patients two electrodes were implanted. The minimally invasive technique was significantly faster, saving a mean time of 20 minutes for each electrode. The incision made directly on the sacral foramen was significantly reduced (3 vs. 12 cm), avoiding the wide, blunt dissection of subcutaneous fat tissue. Application of the catheter cannula allowed the electrode to be introduced easily and correctly. The electrode anchors never failed: no cases of lead displacement or suboptimal position of the electrode occurred. A unilateral, sterile subcutaneous seroma occurred in one of the ten patients. CONCLUSIONS: The minimally invasive sacral neuromodulation implant technique seems to be a safe procedure-making sacral neuromodulation implant easier, faster, and safer, in as much as complications could be potentially reduced.
Abstract: PURPOSE: Mesorectal involvement is a common feature in rectal tumors. Neoplastic foci can be identified at pathologic examination of the mesorectum, but their incidence and prognostic significance remain to be defined. METHODS: A series of 77 patients with extraperitoneal rectal cancer, resected with total mesorectal excision, entered the study. After fixation, the excised specimens were submitted to serial transverse sections and staining. Direct tumor infiltration, lymph node involvement, and neoplastic microfoci in the mesorectum were investigated. Patients with mesorectal foci were compared with those without deposits with regard to clinical and pathologic parameters; different patterns of foci (endovasal, endolymphatic, perineural, isolated) were also considered. Univariate and multivariate analyses were used to evaluate the impact on survival rate. RESULTS: Neoplastic mesorectal involvement was found in 64 patients (83.1 percent). Direct tumor infiltration was detected in 66.2 percent, node involvement in 28.6 percent, microscopic foci in 44.2 percent of cases (endovasal in 11.7 percent, endolymphatic in 15.7 percent, perineural in 26 percent, isolated in 14.3 percent). In 7 cases (10.9 percent) microfoci alone (without any kind of other mesorectal involvement) were detected. Deposits were found in 18.8 percent of TNM Stage I tumors, in 46.9 percent of Stage II and in 59.3 percent of Stage III cancers. Similar incidence was found in patients treated with integrated therapies and surgery alone (43.3 vs. 44.7 percent, P = not significant). Poorer median (44.5 vs. 57 months, P = 0.04) five-year overall survival rate (43.4 vs. 63.3 percent, P = 0.016) and disease-free survival rate (43.3 vs. 57.7 percent, P = 0.048) were observed in patients with microscopic foci compared with those without deposits. Tumor configuration was found to be a independent prognostic factor for both overall and disease-free survival rates; furthermore, endolymphatic, perineural, and isolated foci significantly affected overall survival rate, while TNM staging affected disease-free survival rate. CONCLUSIONS: The incidence of neoplastic foci in the mesorectum is high, even in early staged tumors and despite aggressive preoperative treatment. They seem to affect prognosis. Such features should, therefore, be considered when local excision of the tumor is planned. Presence of mesorectal foci should modify conventional staging of the rectal tumor.
Abstract: Introduction : Laparoscopic colorectal surgery has now established itself as the gold standard
for the treatment of both benign and malignant colorectal disease. We report on our experience
in instituting a new laparoscopic colorectal service in a Tertiary Referral Unit
Methods: A retrospective analysis was carried out on all patients undergoing laparoscopic
colorectal resections by a single laparoscopic colorectal surgeon from Sept 2007 to September
2010. Ninety-three cases were carried out in total including 12 of which were performed via
SILS technique. This includes 54 patients with CRC, 10 diverticular disease, 19 inflammatory
bowel disease (7 UC and 12 Crohns), 4 polyps, 5 rectal prolapse, 1 sigmoid volvulus.
Operations performed: small bowel resection (5), right hemicolectomies(30), extended right
hemicolectomy(8), left hemicolectomy(3), Hartmans(3 ), reversal of Hartmans(3), rectopexy(5),
restorative proctocolectomy(2), APER (3), anterior resections (21-including 5 synchronous
laparoscopic liver and rectal resections)
Results: There were no deaths and only two (2.1%) conversions. The first involving a locally
advanced caecal tumour and the other was a rectal cancer in a patient who had undergone
previous radical radiotherapy for prostate cancer. There were two anastomotic leaks(2.1%). The
first from a right hemicolectomy requiring a laparotomy and the other from an extended right
hemicolectomy requiring radiological drainage. 2 port site hernias: 1 large bowel obstruction
(due to adhesions): 1 tight ileostomy requiring revision and 2 pelvic collections requiring
radiological drainage
Conclusion: A laparoscopic colorectal service can be successfully developed in a tertiary
referral unit with a low conversion rate and low rates of mortality and morbidity
Key statement: A laparoscopic colorectal service can be successfully developed in a tertiary
referral unit with a low conversion rate and low rates of mortality and morbidity.
Abstract: Introduction: Newer technical advances, such as multi-channel ports and articulated
instruments, has allowed surgeons to carry out complex pr ocedures via a single umbilical
incision. Single incision laparoscopic surgery (SILS TM) has the potential of playing an important
role in the evolution of minimally invasive surgery and we present our experience of colorectal
surgery using the SILS (TM) port
Methods: We have performed twelve major colorectal surgical procedures between June 2009
and August 2010 including right, left colectomies, anterior resection, small bowel resection,
subtotal colectomy, and restorative proctocolectomy.
These patients were compared with twelve matched cases who underwent multiple incision
laparoscopic surgery (MILS) for colectomies du ring the same period. Short term data are
available between the two groups.
Results: Twelve patients underwent successful SILS (TM)colectomies with no conversions nor
major intra- or post-operative complications. Operating time ranged from 126 -346mins (MILS
105 – 320mins) and inpatient stay ranged from 3-12 days (MILS 3-11 days). 1 patient
developed a post-operative ileus and 1 encountered minor PR bleeding in the SILS(TM)
group. In the MILS group, one patient required post-operative blood transfusion, one developed a pelvic
collection and one developed a surgical site infection. The maximum incision length in the
SILS(TM) patients was 3.5cm and at outpatient fo llow-up all of them had no visible scar
Conclusion: SILS colectomies are safe surgical procedures and comparable to the standard
MILS approach. The outcomes are similar but there is an improvement in cosmesis and post-op
pain. SILS(TM) may become the standard surgical approach in patients with suitable colorectal
pathology Key statement: Single incision laparoscopic surgery (SILS)(TM) has the potential of playing an
important role in the evolution of minimally invasive surgery and we present our experience of
colorectal surgery using the SILS(TM) port. SILS(TM) may become the standard surgical approach in
patients with suitable colorectal pathology
