Karen Chang • Mathew Fakhoury •
Moshe Barnajian • Cristi Tarta • Roberto Bergamaschi

Background This study was performed to evaluate shortterm clinical outcomes of laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon.
Methods This was a retrospective study of selected patients who underwent laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon for tumors or Crohn’s disease by a single surgeon from July 2002 through June 2012. Data were retrieved from an Institutional Review Board-approved database. Study end point was postoperative adverse events, including mortality, complications, reoperations, and readmissions at 30 days. Antiperistaltic side-to-side anastomoses were fashioned laparoscopically with a 60-mm-long stapler cartridge and enterocolotomy was hand-sewn intracorporeally in two layers. Values were expressed as medians (ranges) for continuous variables.
Results There were 243 patients (143 females) aged 61 (range = 19–96) years, with body mass index of 29 (18–43) kg/m2 and ASA 1:2:3:4 of 52:110:77:4; 30 % had previous abdominal surgery and 38 % had a preexisting comorbidity. There were 84 ileocolic resections with ileo ascending anastomosis and 159 right colectomies with ileotransverse anastomosis. Operating time was 135 (60–220) min. Estimated blood loss was 50 (10–600) ml. Specimen extraction site incision length was 4.1 (3–4.4) cm. Conversion rate was 3 % and there was no mortality at 30 days, 15 complications (6.2 %), and 8 reoperations (3.3 %). Readmission rate was 8.7 %. Length of stay was 4 (2–32) days. Pathology confirmed Crohn’s disease in 84 patients, adenocarcinoma in 152, and other tumors in 7 patients.
Conclusion Laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon resulted in a favorable outcome in selected patients with Crohn’s disease or tumors of the right colon.
Keywords Laparoscopy  Right colon resection  Intracorporeal ileocolic anastomosis  Crohn’s disease  Tumor


Full paper: Laparoscopic right colon resection with intracorporeal anastomosis

June 8th, 2018

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C. Tarta • M. Bishawi • R. Bergamaschi

This study is a narrative review of the current literature regarding intracorporeal ileocolic anastomosis in laparoscopic right colon resection for benign or malignant diseases of the right colon and terminal ileum.
The search strategy included Medline, Embase, CINAHL, ACP Journal Club, and Cochrane databases with laparoscopic right colectomy and intracorporeal anastomosis as keywords. All retrieved references were screened by two independent blinded reviewers. Thirteen papers including 611 patients undergoing laparoscopic right colon resection with intracorporeal ileocolic anastomosis
for benign or malignant diseases of the right colon and terminal ileum were identified. There were eight case series and five case control studies. Anastomoses were fashioned as antiperistaltic or isoperistaltic, totally stapled or stapled/handsewn. The mesenteric defect was mostly left open. Overall operating time ranged from 53 to 360 min. The most common specimen extraction site locations were periumbilical, suprapubic, or transvaginal with a median incision length ranging from 3 to 6 cm. The overall rate of surgical site infection was 2.7 %. The anastomotic leak rates varied from 0 to 8.5 %. Postoperative mortality was 0.12 %. Intracorporeal ileocolic anastomosis following laparoscopic resection of the right colon is not commonly performed, but offers potential benefits if carried out by experienced surgeons in selected patients.
Keywords Review  Laparoscopic intracorporeal anastomosis  Laparoscopic right colon resection  Benign disease  Malignant disease  Right colon  Terminal ileum

Full paper: Intracorporeal ileocolic anastomosis_ a review

May 7th, 2018

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C. Foppa • P. I. Denoya • C. Tarta •
R. Bergamaschi


Assessing the blood supply of the bowel is a difficult task even for experienced surgeons. Laser-assisted indocyanine green (ICG) fluorescent dye angiography provides intraoperative visual assessment of blood flow to the bowel wall and surrounding tissues, allowing for modification to the surgical plan, which can reduce the risk of postoperative complications. ICG angiography was
prospectively performed in a single center during a 1-year period for small bowel ischemia and left colorectal resections.
ICG angiography played a major role in the intraoperative decision making in 4 of 160 patients, whose clinical and operative details are here reported. In case of acute small intestine ischemia, resection is not warranted unless absolute perfusion units are below 19 (relative 21 %). When evaluating blood supply to the left colon prior to anastomosing, resection is recommended with
absolute units lower than 18 (relative 31 %) even if the bowel appears macroscopically perfused.

Keywords: Laser-assisted ICG angiography  SPY  Small bowel ischemia  Left colorectal resection  Blood supply


Full paper: Indocyanine green fluorescent dye during bowel surgery: Are the blood supply ‘‘guessing days’’ over?

March 28th, 2018

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1)Department of Anatomy, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania
2)Department of Radiology, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania
3)Department of Surgery, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania
4)Department of Surgery, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania

Endothelial cells are highlighted using a variety of endothelial markers. One of the best known markers is CD34, a surface antigen. The most used immunohistochemical marker for identification of activated endothelial cells is CD105. We chose to compare these two markers in order to evaluate angiogenesis of the rectal cancers by determining the microvessel density (MVD). Our study included 31 patients with rectal cancer between 2010–2014, who underwent rectal resection at Arad and Timisoara Counties Hospitals, Romania. We used MVD quantification by highlighting the tumor blood vessels with two different endothelial markers using the immunohistochemical protocols. The CD34 evaluation of MVD was 37 vessels/field/×200 peritumoral (PT), compared with normal rectal mucosa with 17 vessels/field/×200. Intratumoral (IT) MVD for CD34 positive vessels was between 7 and 120 vessels/field/×200. Average IT MVD CD105+ was 13.7 vessels/field/×200, the PT MVD CD105+ was 10 vessels/field/×200. Usually, IT MVD CD105 is smaller than PT MVD CD105, a pattern that was not respected in our study. There was a statistical significant correlation between IT MVD CD34 and PT MVD CD34 with p=0.008, also IT MVD CD34 and IT MVD CD105 with p=0.009, PT MVD CD34 with PT MVD CD105, p=0.001. PT MVD CD34 had a statistical significant correlation with T, p=0.004. IT MVD CD105 associated with T, p=0.004, and with N, p=0.004. The evaluation of both CD34–CD105 showed the role of angiogenesis in the cancer proliferation and local spread, the angiogenesis level being maintained high even in the advanced stages of the disease. There was observed a difference between the intratumoral and peritumoral MVD, the study of this difference possibly leading to a better assessment of prognosis and adjusted therapies in the future.

Keywords: CD34, CD105, rectal cancer, endoglin, angiogenesis.


Full paper: Comparative analysis of microvessel density quantifiedthrough the immunohistochemistry expression of CD34 and CD105 in rectal cancer

March 28th, 2018

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