Background: Wire-guided localization is the gold-standard for the detection of non-palpable breast lesions, although with acknowledged limitations. The aim of this study was to evaluate the combined use of LOCalizerr™ (Hologic, Santa Carla, CA, USA), and intraoperative ultrasound (IOUS) for localization and surgery of nonpalpable breast cancer. Patients and Methods: Patients with non-palpable breast lesions underwent localization procedure with LOCalizer™ and IOUS. After the placement of the marker, eight measures were made to guide the excision. LOCalizerr™ Pencil and IOUS were performed to obtain the distance between the dissection plane and the margins of lesions. Results: The procedure was feasible in the five enrolled patients and associated with clear oncological margins in all cases. Moreover, a high satisfaction according to Likert scale for surgeons, radiologists and patients, performing limited and tailored resections, was reported. Conclusion: Combining LOCalizerr™ and IOUS is an effective method for locating non-palpable breast cancer, guarantying excellent oncological and cosmetic results.Worldwide screening mammography campaigns and the improvement of 3D-tomosynthesis detection has led to an increase in the diagnosis of non-palpable breast lesions (1). It is acknowledged that one-third of breast cancers are occult at first clinical evaluation. The number of patients with nonpalpable breast cancer (NPBC) who are candidates for surgery might rise substantially considering the increasing use of neoadjuvant treatments and downstaging of palpable lesions (2). Therefore, accurate preoperative localization of non-palpable lesions is mandatory for correct surgical excision. In patients with early-stage NPBC, wire-guided localization (WGL) is widely adopted as the method of localization (3), despite being associated with several disadvantages, such as migration, trauma, breakage, patient discomfort, and risk of pneumothorax. Moreover, the placement of wires should be carried out during hospitalization, on the same day of surgery (4).Since the turn of the century, different innovative localizing wireless techniques have been tested and adopted in the search for the ideal system. Radioactive seed localization (RSL) consists of a system using an intraoperative gamma probe capable of identifying a 5-mm I 125 pellet with a titanium shell, the radioactive seed. Similar surgical outcomes after its application are reported, including oncological safety, reoperation rates, minimal invasiveness and cosmesis. The main limit of this technique is patient exposure to radioactivity (5-8).The SCOUT Radar Device (Merit Medical, San Josè, CA, USA) is a non-radioactive, non-wire localization device using infrared light and radar technology, and was approved by the U.S. Food and Drug Administration (FDA) in 2014 for localization of breast lesions. Despite positive results, its main limit is related to the significant cost of the intraoperative probe compared to WGL and RSL (9).The most recently introduced system is the MAGSEED ...

Highlights Gastric perforation caused by intragastric balloon represents a rare but life-threatening complication. There is a lack of information about perforation in the same day of surgery. An endoscopic and laparoscopic approach with a gastric wedge resection was performed.

After the initial widespread diffusion, laparoscopic adjustable gastric banding (LAGB) has been progressively abandoned and laparoscopic sleeve gastrectomy (LSG) has become the worldwide most adopted procedure. Nevertheless, recent reports raised concerns about the long-term weight regain after different bariatric techniques. Considering the large LAGB series recorded in our multicentric bariatric database, we analysed the anthropometric and surgical outcomes of obese patients underwent LAGB at a long-term follow-up, focusing on LAGB management. Between January 2008 to January 2018, demographics, anthropometric and post-operative data of obese patients undergone LAGB were retrospectively evaluated. To compare the postoperative outcomes, the cohort was divided in two groups according to the quantity of band filling (QBF): low band filling group (Group 1) with at most 3 ml of QBF, and patients in the high band filling group (Group 2) with at least 4 ml. 699 obese patients were considered in the analysis (351 in Group 1 and 348 in Group 2). Patients in Group 1 resulted significantly associated (p < 0.05) to higher % EWL and quality of life score (BAROS Score), 49.1 ± 11.3 vs 38.2 ± 14.2 and 5.9 ± 1.8 vs 3.8 ± 2.5, respectively. Moreover, patients with lower band filling (Group 1) complained less episodes of vomiting, epigastric pain and post-prandial reflux and significantly decreased slippage and migration rate (p < 0.001 for all parameters). LAGB is a safe and reversible procedure, whose efficacy is primarily related to correct postoperative handling. Low band filling and strict follow-up seem the success’ key of this technique, which deserves full consideration among bariatric procedures.

Background: Local wound complications are among the most relevant sequelae after an abdominoperineal resection (APR) for low rectal cancer. One of the proposed techniques to improve the postoperative recovery and to accelerate the initiation of adjuvant chemotherapy is the mesh reinforcement of the perineal wound. The aim of the current study is to compare the surgical and oncological outcomes after APR performed with a biosynthetic mesh reconstruction versus the conventional procedure. Methods: From 2015 to 2020, in two tertiary centres, the surgical outcomes, the wound events (i.e., surgical site infections, wound dehiscence and the complete healing time) and the oncological outcomes (i.e., time length to start adjuvant chemo-radiotherapy, an over 8-week delay in chemotherapy and the recurrence rate) were retrospectively analysed in patients undergoing APR reinforced with biosynthetic mesh (Group A) and conventional APR (Group B). Results Sixty-one patients were treated with APR (25 in Group A and 36 in Group B). Patients in Group A presented lower time for: healing (16 versus 24 days, p = 0.015), inferior perineal wound dehiscence rates (one versus nine cases, p = 0.033), an earlier adjuvant therapy start (26 versus 70 days, p = 0.003) and a lower recurrence rate (16.6% vs. 33.3%, p = 0.152). Conclusions: In our series, the use of a biosynthetic mesh for the neo-perineum reconstruction after a Miles’ procedure has resulted in safe, reproducible results affected by limited complications, guarantying a rapid start of the adjuvant therapy with clear benefits in oncological outcomes. Further randomized clinical trials with long-term follow-up are needed to validate these results.

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