AimsIatrogenic colonoscopy perforations (ICP) are a rare but severe complication of diagnostic and therapeutic colonoscopies. The present systematic review and meta-analysis aims to investigate the operative and post-operative outcomes of laparoscopy vs. open surgery performed for the management of ICP.MethodsA literature search was carried out on Medline, EMBASE, and Scopus databases from January 1990 to June 2016. Clinical studies comparing the outcomes of laparoscopic and open surgical procedures for the treatment for ICP were retrieved and analyzed.ResultsA total of 6 retrospective studies were selected, including 161 patients with ICP who underwent surgery. Laparoscopy was used in 55% of the patients, with a conversion rate of 10%. The meta-analysis shows that the laparoscopic approach was associated with significantly fewer post-operative complications compared to open surgery (18.2% vs. 53.5% respectively; Relative risk, RR: 0.32 [95%CI: 0.19–0.54; p < 0.0001; I2 = 0%]) and shorter hospital stay (mean difference −5.35 days [95%CI: −6.94 to −3.76; p < 0.00001; I2 = 0%]). No differences between the two surgical approaches were observed for postoperative mortality, need of re-intervention, and operative time.ConclusionThe present study highlights the outcomes of the surgical management of an endoscopic complication that is not yet considered in clinical guidelines. Based on the current available literature, the laparoscopic approach appears to provide better outcomes in terms of postoperative complications and length of hospital stay than open surgery in the case of ICP surgical repair. However, the creation of large prospective registries of patients with ICP would be a step forward in addressing the lack of evidence concerning the surgical treatment of this endoscopic complication.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-017-0121-x) contains supplementary material, which is available to authorized users.

Age-adjusted charlson comorbidity index (a-cci) score has been used to weight comorbid conditions in predicting adverse outcomes. A retrospective cohort study on adult patients diagnosed with complicated intra-abdominal infections (ciAi) requiring emergency surgery was conducted in order to elucidate the role of age and comorbidity in this scenario. two main outcomes were evaluated: 90-day severe postoperative complications (grade ≥ 3 of Dindo-Clavien Classification), and 90-day all-cause mortality. 358 patients were analyzed. a-CCI score for each patient was calculated and then divided in two comorbid categories whether they were ≤ or > to percentile 75 (= 4): Grade-A (0-4) and Grade-B (≥ 5). Univariate and multivariate regression analyses were performed, and the predictive validity of the models was evaluated by the area under the receiver operating characteristics (AUROC) curve. Independent predictors of 90-day severe postoperative complications were Charlson Grade-B (Odds Ratio [OR] = 3.49, 95% confidence interval [95%CI]: 1.86-6.52; p < 0.0001), healthcarerelated infections (oR = 7.84, 95%CI: 3.99-15.39; p < 0.0001), diffuse peritonitis (OR = 2.64, 95%CI: 1.45-4.80; p < 0.01), and delay of surgery > 24 hours (OR = 2.28, 95%CI: 1.18-4.68; p < 0.02). The AUROC was 0.815 (95%CI: 0.758-0.872). Independent predictors of 90-day mortality were Charlson Grade-B (OR = 8.30, 95%CI: 3.58-19.21; p < 0.0001), healthcare-related infections (OR = 6.38, 95%CI: 2.72-14.95; p < 0.0001), sepsis status (OR = 3.98, 95%CI: 1.04-15.21; p < 0.04) and diffuse peritonitis (oR = 3.06, 95%CI: 1.29-7.27; p < 0.01). The AUROC for mortality was 0.887 (95%CI: 0.83-0.93). Posthoc sensitivity analyses confirmed that the degree of comorbidity, estimated by using an age-adjusted score, has a critical impact on the postoperative course following emergency surgery for ciAi. early assessment and management of patient's comorbidity is mandatory at emergency setting. Complicated intra-abdominal infections (cIAI) are the second most common site of invasive infections in critically ill patients 1. They are associated with poor outcomes in high risk patients, with an estimated overall mortality ranging from 10% to 35% 2-4. cIAI implies the extension of the process beyond the organ to the peritoneal cavity and is then associated with localized or diffuse peritonitis. A landmark multi-centric international prospective cohort study, evaluated adult patients presenting with cIAI undergoing surgery or interventional drainage and identified the independent risk factors of mortality 3. They were namely patient's age, immunosuppression, small bowel perforations, a delay of initial intervention over 24 hours, and intensive care unit (ICU) admission. Previous studies on IAI also showed other factors that potentially influence patient's prognosis, such as an extended peritonitis, sepsis development, or healthcare-related infections 4. An emergency surgical procedure is often needed in the management of cIAI, leading to a non-despicable cost burden to healthcare ...

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A 54-year-old woman was admitted to the emergency department with a 2-week history of alimentary vomiting. She had undergone laparoscopic adjustable gastric banding 6 years earlier. CT revealed a mesenteroaxial gastric volvulus and ischemia on the gastric wall. Emergent diagnostic laparoscopy was performed, and severe peritonitis and gastric necrosis caused by volvulation was found. After band removal, a fundal perforation was noted, but a viable lesser curvature enabled laparoscopic sleeve gastrectomy to be performed. The postoperative course was uneventful. Laparoscopic adjustable gastric banding is considered a safe and effective method for the surgical treatment of obesity, but it is associated with a number of complications, such as pouch dilatation and band slippage. Although infrequent, ischemic complications are life-threatening conditions that require urgent surgery. This is the first report of this unusual complication managed laparoscopically.