Background: Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal IPAA (Ta-IPAA), considering postoperative complications and medium-term functional outcomes. Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since October 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Results: Until March 2019, 8 patients underwent Ta-IPAA. In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively by a validated questionnaire (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, restriction in work and social genitourinary and sexual functions were also investigated. Conclusions: In our experience, Ta-IPAA provided good short and medium-term functional results in UC. Background Restorative proctocolectomy is widely adopted in the treatment of ulcerative colitis ,, , as well as in other inflammatory and neoplastic conditions, requiring an ileal pouch-anal anastomosis (IPAA) to reconstruct gastrointestinal continuity to the anus. Conventionally, either the laparoscopic or the open approach can be employed to gain rectal dissection and creation of ileal pouch-anal anastomosis. Pouch-anal anastomosis is usually made using a stapler, leaving a 2 cm rectal cuff in order to preserve continence and to reduce the risk of inflammatory recurrence or dysplasia. The dissection of the last centimeters of the rectum, rectum resection and ileal pouch-anal anastomosis could be demanding from a technical point of view due to narrow pelvic space and cross stapling of the distal part of the rectum is often challenging for surgeons. Transanal total mesorectal excision (TaTME) has been recently described in rectal cancer treatment, with potential technical and oncologic advantages compared to transabdominal approach. The transanal approach for the proctectomy has been described also in IPAA since 2015, showing feasibility and potential technical advantages; some series ,,, and initial comparative studies have been published , , showing a not increased rate of postoperative morbidity, equivalent quality of life and functional results. The aim of our study is to analyze a single centre experience of transanal IPAA (Ta-IPAA), examining e...

The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorises patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. Further haemorrhage has been consistently described as the most important risk factor for mortality. It is generally accepted that the risk of rebleeding and death is related to many factors, which are not entirely independent of each other.While previous studies have served to indicate which variables are important in determining the risk of rebleeding and death, few attempts have been made to devise a simple and therefore clinically useful risk scoring system that makes use of readily available clinical information to categorise patients by risk. We have used a large uniform database to analyse the risk factors for mortality and we have used the analysis to construct a simple numerical risk scoring system. The primary purpose of this score is to allow case mix assessment for comparative audit. An understanding of the risk associated with any particular patient is an important initial step in the management process. MethodsThe data presented were collected as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. Four health regions in England (North

BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

The presence of wristed instrumentation, tremor abolition, and motion scaling enhance dexterity by nearly 50% as compared to laparoscopic surgery. 3-D vision enhances dexterity by a further 10-15%. In addition, the presence of 3-D vision results in a 93% reduction in skills-based errors.