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Background The study aim is to evaluate if diverting drainage of bile and pancreatic secretions with an isolated Roux loop technique helps to decrease the rate of postoperative morbidity and mortality, in particular postoperative pancreatic fistula (POPF). Methods A prospectively-maintained database between 2006 and 2018 was reviewed. Patients who underwent primary elective pancreaticoduodenectomy were included. Two types of reconstruction methods were compared single loop (SJL) reconstruction (28 patients) and isolated Roux-en-Y (DJL) reconstruction (36 patients). Demographic characteristics and perioperative results were compared between the two groups. Results This study includes 64 patients. The average duration of surgery was 308 mins; it was longer for DJL (p less then 0,0001). Major postoperative complications were seen in 24 patients (9 in SJL; 15 in DJL) without statistically significant difference. The most frequent complication that occurred was PJ anastomosis failure (4 in SJL; 6 in DJL). The choice of postoperative complication management was not related to surgical reconstruction technique (p 0.389). Length of hospital stay in DJL was significantly longer than in SJL (p 0.04). Conclusions No significant advantage of one technique over the other was found. In our opinion, surgeons should choose the approach with which they have the most experience and ease.Background Hernia repair is one of the most frequent operation in general surgery. The aim of this is study is to present a new preperitoneal atraumatic dissection of peritoneal flap during laparoscopic transabdominal preperitoneal inguinal hernia repair. Methods From January 2019 to Dicember 2019, 30 patients (19 male, 11 female) attended and woman; bilateral inguinal hernia. Results The median age of patients was 46,46 (32-88). The median time of operation was 63,8 (45-100) minutes. All procedures were performed without complications and convertions. Conclusions Based on our experience the soft technique is a safe and feasible way to create a preperitoneal flap. Operating time is drastically reduced and the learning curve is reduced even for less experienced surgeons.Background The open abdomen or laparostomy is a great advance of surgery based on the concept of damage control surgery. Aim of the study is to review the laparostomy outcomes of non- trauma emergency surgery patients in a district general hospital and identify parameters affecting early definite primary fascial closure. Methods The records of all non-trauma emergency surgical patients who underwent laparostomy in a three-year period in a single institute were studied retrospectively. Outcomes included length of stay, morbidity, mortality, readmission rates, number of re-look operations, rate of definite primary fascial closure and time to closure. Results Thirty-two patients were included. Morbidity was 84.4% and mortality rates were 21.9% (in- Hospital), 18.8% (30-day) and 46.9% (overall). Median length of hospital stay was 22 days. Rate of primary fascial closure was 87.5% and median time to closure was two days. The number of relook operations was the only independent prognostic factor of definite early primary fascial closure, with higher rates of closure in patients with 1-2 relooks. Conclusions Although the open abdomen has been demonstrated to improve survival, the precise role in abdominal sepsis has not been elucidated. Current consensus does not support use of open abdomen routinely, however in selected situations it becomes unavoidable. Laparostomy is a valid option in non-trauma emergency surgery and can be managed safely in a district hospital. High closure rates can be achieved if one or two re-look operations are performed with an early attempt for closure.Background Non-palpable breast lesions are more frequent now than in the past due to the attention toward the mammary pathology and the screening diffusion; the marking of such lesions is very important for a successful surgery. The SentiMag system uses a magnetic marker that is inoculated transdermal in the breast through an 18-gauge needle. Methods Between April 1st and June 30th 2018, 16 patients with non-palpable breast lesions were selected and subjected to surgery using the Sentimag System in our Unit. selleck chemical They were women with a mean age of 52 years (range 30 - 84). Seven out of 16 (43.7%) had a borderline preoperative histological or cytological diagnosis (C3/B3), and 9 (56.3%) a diagnosis of carcinoma (C5/B5). Six (37.5%) were marked on ultrasound guidance and 10 (62.5%) on a mammography stereotaxic guide. Results The time for the marker positioning ranged from 2 to 10 minutes. The radiological control of the surgical specimen always showed the presence of both the lesion and the marker, both centered within the specimen and intact. The pathology revealed 7 benign lesions, one in situ and 8 infiltrating carcinomas. Discussion The SentiMag represents a fast and safe preoperative marking system of non-palpable breast lesions, cutting the radio exposure for personnel and patients. The marker is not displaced over time and it is rapid to place and easy to locate intraoperatively, allowing a clear dissection plane around the lesion. Thus, this reduces the amount of gland removed, improving the aesthetic result mostly in small breasts.Background Colorectal cancer (CRC) obstruction is frequent but doubts remain on the best treatment. The aim of this study is to analyze the different operative approach used for CRC treatment and evaluate the outcomes for the different cases. Materials and methods Patients were collected from January 2014 to December 2019 and divided in four groups (PH = Hartmann's procedure, PA = primary anastomosis - P groups - SD = deviating stoma, SS = SEMS - S groups). The main end-points were the quality of life and the oncologic safety. Results 108 patients were enrolled. The mean follow-up time was 39 months. The stomas were performed less frequently in SS but lasted more in that group. Only 45% underwent reversal surgery. Cumulative operating time was greater in S vs P. The rate of major complications was similar. PA had a greater overall survival and disease-free survival than PH. Conclusions The various options of treatment should have different indications primary anastomosis in stable patients, Hartmann in critical cases, SEMS for palliative intent and stoma when neo-adjuvant therapy is needed.