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Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon's decision, experience, and availability of laparoscopic instruments.

BackgroundRetained surgical instrument or sponge following an intra-abdominal surgery is a potentially dangerous medico-legal problem. The condition may manifest either as asymptomatic or severe gastrointestinal complications. Transmural migration of gossypiboma is a rare entity that may lead to bowel or visceral perforation, obstruction and/or fistula formation. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in stomach, ileum, colon, bladder, vagina and diaphragm. To our knowledge, this is the fifth case reported in the medical literature. However, we report the first case of the largest gossypiboma to date: a surgical gas compress measuring 20 × 20 cm which was successfully treated endoscopically.Case presentationA 52-year-old woman with obstructive jaundice was referred to our clinic. She had a medical history of cholecystectomy and T-tube drainage for choledocholithiasis a year previously. Abdominal ultrasonography and computed tomography revealed a mass located into the stomach which was compatible with gastric carcinoma. On the gastroscopy, a surgical gas compress that had totally migrated into the stomach was observed. The compress was successfully removed by gastroscopy through the esophagus. The recovery of the patient was uneventful.ConclusionTransmural migration of gossypiboma into the stomach should be considered in the differential diagnosis of any postoperative patient with obstructive jaundice symptoms. Endoscopy may be feasible for both diagnosis and treatment even though the size of gossypiboma is large. However, surgery should be considered in case of fixed reaction or incomplete migration of gossypiboma located into the stomach.

Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intraabdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosisprior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.

Background The coronavirus disease 2019 (COVID‐19) pandemic has interfered with the treatment algorithm for patients with gastrointestinal (GIS) cancer, resulting in deferral of surgery. We presented the outcomes of our patients to evaluate whether surgery could be safely performed and followed‐up without delaying any stage of GIS cancer during the pandemic. Methods This was an observational study of 177 consecutive patients who underwent elective GIS cancer surgery between March 11 and November 1, 2020. They were assessed regarding their perioperative and 60 days follow‐up results for either surgical or COVID‐19 status. Morbidity was determined according to the Clavien‐Dindo classification (CDC). Continuous and categorical data were presented as median ± SD and number with percentage (%), respectively. Results The study included 44 gastric, 33 pancreatic, 40 colon, and 59 rectal cancer patients. All patients underwent surgery and received neo/adjuvant treatments without delay. The overall morbidity (CDC grade II–IV) and mortality rates were 10.1% and 3.9%, respectively. None of the patients or medical staff were infected with COVID‐19 during the study period. Conclusion GIS cancer surgery can be safely performed even within a pandemic hospital if proper isolation measures can be achieved for both patients and health workers. Regardless of the tumor stage, surgery should not be deferred, depending on unstandardized algorithms.

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PRP application to colonic anastomosis promotes the healing process in rats with intra-abdominal sepsis.

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