Background Total mesorectal excision (TME) represents the “gold standard” of rectal cancer surgery. In locally advanced lesions neoadjuvant treatments (e.g. radiotherapy-nRT, radio chemotherapy-cnRT) have been shown to improve TME oncological results, reducing local recurrences rate. Nevertheless, these treatments have significant functional consequences impacting patients’ quality of life (QoL). The resulting syndrome is known as Low Anterior Resection Syndrome (LARS). The purpose of this work was to evaluate the association between risk factors and the development of LARS in a prospective series of laparoscopic sphincter-saving TME. Methods The study was conducted as a retrospective observational epidemiological study of a prospective database, including all patients undergoing laparoscopic anterior resection surgery for rectal cancer at our Unit from 1st January 2013 to 31st May 2018. The diagnosis of LARS was performed using the LARS Score. We classified risk factors in patient-related, pre-, intra- and post-operative factors. Results The sample included 153 consecutive patients. Forty-one were affected by “low” rectal cancer, 74 by “middle” rectal cancer, 38 by “high” rectal cancer. The prevalence of overall LARS (major LARS + minor LARS) in our series was 35.9% (55/153 cases). Association between nRT and overall/major LARS was significant (respectively p = 0.03 and 0.02). Distal localization of tumor was also significantly associated with LARS [overall LARS (p = 0.03), major LARS (p = 0.014)]. Conclusions In our study, neoadjuvant radiotherapy and tumor localization resulted independent risk factors for LARS after laparoscopic sphincter-saving TME. Tumor localization in the “middle” and “high” rectum resulted a protective factor compared to the localization in “low” rectum.

Appendicular diverticulosis is a rare condition observed in about 0.004–2% of all appendectomy specimens. Risk of perforation/bleeding is high and a relevant association with mucinous neoplasms is known. Appendectomy is indicated even in case of occasional finding. We present the case of a 22-year-old man who entered the Emergency Room for pain in right iliac fossa. Blood tests showed only a slight increase in C-reactive protein. Abdominal ultrasound (US) evidenced an appendix with thickened walls and a rounded fluid-filled hypoechoic lesion at its distal tip. Laparoscopic appendectomy confirmed the presence of mucocele. Postoperative course was uneventful and the patients discharged on postoperative day 3. Histological examination indicated diverticulitis/peridiverticulitis of the appendix and acute suppurative appendicitis. No perforation of the diverticula was detected. No neoplastic epithelium/mucous material was observed. In our case, preoperative US proved to be a useful alternative to computed tomography for the diagnosis.

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Low anterior resection syndrome (LARS) represents a long-term complication of sphincter-saving rectal resection and includes a variety of symptoms of bowel dysfunction, such as urgency, gas and stool incontinence, stool fragmentation, and obstructed defecation. In 2012, Briant proposed a universally accepted definition of LARS: "disordered bowel function after rectal resection, leading to a detriment in quality of life" [1]. Restoration of intestinal function generally occurs within approximately 18 months after surgery, after which further improvement over time is unlikely. This means that a percentage of patients will have permanent changes in bowel function [2]. There are several risk factors for LARS, as the genesis is multifactorial. The main are listed below [3]. Anal Sphincter InjuryThe anal sphincter consists of:• a component of involuntary (visceral) smooth muscle, innervated by the parasympathetic system through the pelvic splanchnic plexus, or internal anal sphincter, responsible for contraction of the anus; • a component of voluntary (somatic) striated muscle, innervated by the first branch of the pudendal nerve and the inferior rectal nerve, i.e., the external anal sphincter.