Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair

The inguinal hernia repair is one of the most frequent surgical procedures: in the world, even year, at least 20.000.000 inguinal hernia repair procedures are performed. Although the laparoscopic approach is widely recognized as a valid treatment for many diseases and some laparoscopic surgical procedures have become gold standard techniques (e. g. cholecystectomy, appendectomy, gastro-esophageal junction surgery), the minimally invasive approach for groin hernia treatment is still very controversial today, but in the last few years, it tends to become the standard practice for 1 day surgery. We present here the technique of laparoscopic Transabdominal Preperitoneal approach (TAPP). The surgical technique is described step-by-step, including surgical details and the new concept of “inverted Y” to achieve the “critical view of safety” for laparoscopic inguinal hernia repair.

Gastrointestinal surgery

This chapter discusses the anaesthetic management of gastrointestinal surgery. It begins with a description of management principles for major gastrointestinal (GI) surgery, both open and laparoscopic. Surgical procedures covered include colorectal surgery; laparoscopic surgery (including laparoscopic cholecystectomy and laparoscopic colonic surgery); appendicectomy; inguinal hernia repair, and anal/perianal procedures

Pneumoperitoneum effect on testicular oxidative stress and histopathology – Systematic review

Pneumoperitoneum is characterized by the presence of abdominal cavity gas. Thus, this is used as a tool to create a space in the abdominal cavity for video laparoscopic surgical procedures. However, insufflation of abdominal cavity is capable of causing damage induced by tissue ischemia and reperfusion, which is caused by hypoxia and an imbalance between free radical production and antioxidant defense system capacity. The objective of this study was to bibliographic review the negative effects of exposing healthy animals to different pneumoperitoneum settings by assessing oxidative stress and testicular histopathology, identifying intra-abdominal pressures that did not result in testicular alteration. A systematic search was carried out in three databases using the following terms: pneumoperitoneum AND testi* or gonad. The survey conducted in the databases yielded 2209 scientific articles. After applying inclusion and exclusion criteria, six papers were selected. All the articles selected addressed the effects of pneumoperitoneum on testicular structure and used at least one scoring system to perform histopathological evaluation of the testis. Three studies verified the occurrence of changes in oxidative stress. According to this literature review, pneumoperitoneum used at intra-abdominal pressures equal to, or greater than, 9 mmHg caused testicular histological damage. According to the biomarkers used in studies, pressures greater than 10 mmHg were sufficient to cause testicular oxidative stress.

Surgery Safety Protocol for Patients and Staff During the COVID-19 Global Pandemic – A Prospective Study of 78 Consecutive, Open and Laparoscopic Surgical Procedures

Background: To evaluate safety, for patients and staff, and efficacy of a protocol for the surgical treatment of patients during COVID-19 pandemic (50 days period) in a hospital located in the northern Italy. Methods: Two different pathways were adopted (non-COVID-19 and COVID-19), with dedicated OR and ICU, and PPE for personnel. A monitoring of patients and staff for COVID-19 was carried out. Results: 78 patients were included. Laparoscopy was used in 33.4% without gas filtration. COVID-19- positive patients (11.5%) were older men (0.04%), with elevated ASA score (0.002), and two or more comorbidities (0.02). They experienced longer hospitalization (0.003), more complications and more deaths (0.0001). All COVID-19 related deaths were due to severe acute respiratory syndrome. None of the patients included resulted infected, but one out of 47 staff personnel (<2%). Conclusion: COVID-19 is largely unknown, but a safe and effective surgical pathway is feasible.

Intraoperative pancreatic injury gives rise to severe postoperative pancreatic fistula: Results of a review of unedited videos of the laparoscopic surgical procedures

Objective To examine risk factors for and causes of severe postoperative pancreatic fistula (sPOPF) after laparoscopic gastrectomy (LG) Summary of Background Data There are few reports on POPF after LG. Methods Between February 2012 and March 2014, we examined 86 patients who underwent LG comparing them with 33 patients who underwent open gastrectomy (OG) for gastric cancer. Risk factors for severe POPF (sPOPF) of Clavien-Dindo grade IIIa or higher were examined. To investigate causes of sPOPF, we reviewed unedited video recordings of laparoscopic surgical procedures. Results sPOPF occurred to 3 patients (3.5%) after LG and 1 patient (3.0%) after OG, indicating no significant difference (p=0.901). Univariate analysis showed no significant risk factors for sPOPF after LG. By reviewing video recordings, all 3 patients with sPOPF after LG had direct pancreatic injury by ultrasonically activated device (USAD) during peripancreatic lymphadenectomy. In 2 of them, pancreas was injured while the contour of pancreas was obscured by bleeding. Durations of drain placement and postoperative hospitalization were longer for patients with sPOPF than for those without POPF or grades I and II POPF (p = 0.003, 0.018; respectively). Conclusions No risk factors for sPOPF after LG could be identified. USAD-induced direct pancreatic injury resulted in sPOPF, which significantly complicated the postoperative clinical course. Direct pancreatic injury can occur whether patient has previously reported risk factors (i.e. male, high BMI, distal pancreatectomy) or not. To prevent pancreatic injury, surgeons should manage hemostasis and keep good surgical field to recognize the contour of pancreas accurately.