Introduction: Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is a spreading technique for the treatment of peritoneal carcinomatosis, a technique that is associated with high morbidity and mortality rates. We report retrospectively the experience of St Constantin Hospital Brasov, underlining the good results obtained in terms of both reduction of complications and oncologic outcome. Methods: Between Juin 2013 and October 2015, 32 patients with a median age of 55.6 years, underwent 34 CRS-HIPEC combined procedures. Results: CCR-0 resection was achieved in 19/34 of patients, CCR-1 in 8/34 of patients and CCR-2 in 7/34 of patients, with a median operative time of 560 minutes (range 400-620 minutes). Median hospital stay was 9 days(4 days in laparoscopic HIPEC-20 days). Total morbidity rate was 40%, with WHO grade 3 and 4 morbidity rate 0 and the 30 days mortality was 0. With a median follow up of 11.8 months, the overall survival (OS) rate was 62%. Gastrointestinal (GI) origin in contrast with ovarian origin and peritoneal cancer index (PCI) higher than 19 showed a worst prognosis in terms of both OS and Progression Free Survival (PFS). Conclusions. In a referral surgical oncology centre, CRS-HIPEC related perioperative mortality and morbidity can be reduced with a multidisciplinary patient management and a correct patient selection for this procedure. Our single centre retrospective series confirm the advantage in PFS and OS of the combined treatment CRS-HIPEC in the management of peritoneal carcinomatosis.

Introduction Gastroesophageal reflux disease (GERD) is a major public health problem. The "gold standard" in the surgical treatment of this condition is the laparoscopic technique called Nissen fundoplication. Aim This paper presents a safer alternative of the laparoscopic Nissen fundoplication, with special focus on the most difficult moment of the intervention, the creation of a retroesophageal passage. Material and method (presentation of the surgical technique) The conventional Nissen technique consists of the dissection of the esogastric junction in a clockwise direction, right to left: right pillar, hiatus, left pillar, retroesophageal passage, skeletonization of the fornix and reconstruction of the valve. We decided to perform a technique inspired from laparoscopic sleeve gastrectomy, which starts in anticlockwise direction, with the skeletonization of the upper third of the greater curvature of the stomach, then continues with the complete dissection of the left diaphragmatic pillar ("left side first") and finally with the dissection of the right pillar and the creation of the retroesophageal passage, thus, the procedure becoming less complicated. A complete decollement of the area nuda is performed, this way avoiding possible complications at this stage, like: bleeding from the area nuda or short vessels, ruptures of the stomach, esophagus, spleen, penetrating the thoracic cavity with a retroesophageal clamp, etc. Results Introduced in 2011, this technique was applied with success in all 20 consecutive cases of hiatus hernia operated in our clinic. There were neither intraoperative accidents and conversions nor early or late postoperative complications. 19 cases were primary Nissen while one case was a recurrent hiatal hernia after an insufficient cruroplasty made in another center. There were three cases in which we had to use Parietene Composite type mesh to strengthen the cruroplasty. Conclusion The applied modification has improved the original laparoscopic Nissen fundoplication technique, thus this has become a less complicated procedure at the same time providing more security to the patient.