Background Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. Methods All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. Results A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age( p = 0.344), gender( p = 0.318), ASA classification( p = 0.963), Gharbi classification( p = 0.649) whereas there were significant differences related to cyst location( p = 0.040) and size( p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. Conclusion Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.

BackgroundEpidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow. Comparing laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD) under spinal anesthesia (SA) and general anesthesia (GA).MethodsWe prospectively evaluated COPD patients who underwent laparoscopic cholecystectomy under general anesthesia (Group 1, n = 30) or spinal anesthesia (Group 2, n = 30) in our clinic between January 2016 and January 2018. Patients with COPD were further divided into groups according to their preoperative stages (Stage 1–4). Intraoperative vital findings, postoperative pain, complications, and length of hospitalization were compared between the general (GA) and spinal anesthesia (SA) groups.ResultsThe mean age of the patients in the GA group was 61.0 ± 6.7 years and was 61.0 ± 7.7 years in the SA group. In the GA and SA groups, the mean ASA score was 2.8 ± 0.6 and 2.9 ± 0.6, respectively, the mean operation duration was 31.7 ± 5.1 and 30.6 ± 5.1 min, respectively, and the length of hospitalization was 3.2 ± 1.7 and 1.5 ± 0.5 days, respectively. The partial carbon dioxide rates (PaCO2) at the postoperative 5th and 20th minutes were lower in the SA group than in the GA group. Further, the requirement for postoperative analgesia was lower in the SA group, and the length of hospitalization was significantly shorter in the SA group. There was no significant difference between the two groups in terms of operation duration.ConclusionLaparoscopic cholecystectomy is a rather safe procedure for COPD patients under general and spinal anesthesia. However, spinal anesthesia is preferred over general anesthesia as it has better postoperative analgesia and causes no impairment of pulmonary functions.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0396-1) contains supplementary material, which is available to authorized users.

In this study, we show that treatment of patients with an anal fistula by injection of Permacol™ is a safe and successful method that does not compromise continence.

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Colorectal carcinoma (CRC) is one of the most widespread malignant tumors worldwide. Patients who had disease at the same stage might have diverse clinical consequences due to the heterogeneity of the molecular changes. 1,2 Therefore, there is a great need to understand the molecular pathology underlying CRC and to identify new biomarkers.Caudal-type homeodomain transcription factors2 (CDX2) is a caudal-type homeobox gene, encoding a transcription factor that plays an important role in proliferation and differentiation of intestinal epithelial cells. 3 Low expression of CDX2 increases susceptibility for tumors, while overexpression of CDX2 inhibits growth and promotes differentiation of colorectal cancer cells. 4,5 Villin is a protein belonging to the gelsolin family of calcium regulated actin-binding proteins. 6 Villin is a particularly specified protein and is revealed in intestinal and renal proximal tubular epithelium. Villin had been detected in CRC and has been used to differentiate neoplasms of intestinal origin from nonintestinal neoplasms. 7,8 The rationale of this research was to clarify the importance of CDX2 and Villin expression in colorectal condition.The objective of the study was to clarify immuno-histochemical expression of CDX2 and Villin in a subsection of advanced stage primary colorectal cancer, detect its association with tumour invasion, differentiation, survival and lymph node metastasis. METHODOLOGYFormalin-fixed, paraffin-embedded tissue specimens were obtained from 70 patients who underwent surgery

According to the American Joint Committee on Cancer (AJCC) Staging Manual, the most predominant areas for GISTs are the stomach (60%), small intestine (30%), rectum (3%), colon (1-2%), esophagus (< 1%), and omentum/mesentery (rare) [6]. Patients suspected of GISTs may have multiple symptoms such as early satiety, fatigue, anemia, intraperitoneal hemorrhage, GI bleeding, or abdominal pain. Some have acute abdominal pain that may require emergency medical attention [2,4,5,7]. GISTs are histologically categorized into 1 of 3 groups: 1) Spindle cell type (70%), 2) Epithelioid cell type (20%), or 3) A combination of both [8]. GISTs are typically positioned on the bowel wall; however, these may form masses that are serosal-or mucosal-based. Most GISTs present singularly as a well-circumscribed nodule [2]. Diagnostic approaches that have been routinely used are computed tomography (CT), MRI, endoscopy, and endoscopic ultrasound [9]. For histochemical detection and diagnoses of GISTs, CD-117 antigen, with a positivity rate of approximately 95%, has been used [10,11]. Other markers for GISTs may be used and include the CD-34 antigen, smooth muscle actin, desmin, and S100 protein [12].

Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract