Introduction Trocar site hernia (TSH) is a complication of minimally invasive surgery that is often underestimated. These lesions cause patient discomfort and require surgery for their correction. Although there are some case reports for laparoscopic repair of TSH, there is data missing in the literature about this specific topic. The aim of this study is to evaluate safety and efficacy of the laparoscopic repair of TSH. Methods We collected data regarding 213 patients submitted to incisional hernia repair in the Department of General Surgery at Humanitas Mater Domini Clinical Institute in Italy since 2011 and 2019. We selected the patients submitted to laparoscopic repair of a TSH with an intraperitoenal mesh. We evaluated the clinical and surgical characteristics of the patients and the following outcomes: post-operative hospitalization, complications and long-term recurrences. Discussion Forty-two out of 213 patients were operated for a TSH. Forty out of 42 patients (95.2%) were treated with a laparoscopic approach. Follow up: 60 months. Study group: females (62.5%), mean BMI 29.1. According to EHS (European Hernia Society) classification, 35 patients had a midline defect. In 77.5% of cases a ePTFE/PP mesh was implanted. Mean hospitalization: 2 nights. The complication rate was low (1 surgical site infection, 1 seroma and 1 hematoma), without re-intervention. We observed 2 cases of recurrence (5%) developed after 5 months and 36 months, respectively. Conclusions Laparoscopic repair of TSH is a safe approach, in absence of specific contraindications. Our experience suggest that a laparoscopic approach could obtain satisfying results.

Esophageal adenocarcinoma (EAC) is one of the most aggressive gastrointestinal tumor. High mortality is due to difficulties in diagnosis at an early stage and to its biological aggressive features. Little is know about the association between esophageal microbiome dysbiosis and EAC pathogenesis. The aim of the study is the identification of a specific esophageal local microbiota that can be related to the pathogenesis and to the onset of EAC Methods We investigated the resident microbiome in 38 biopsies from Tumoral (T) and Non-Tumoral (NT) tissues obtained from 19 patients submitted to distal-EAC, cardiac-EAC, ESCC resection in Upper GI Surgery Division, Humanitas Research Hospital (Rozzano, Milano). We have analyzed the microbiota in biopsies obtained from EAC Tumoral tissues (T) and Non-Tumoral tissues (NT). After genomic DNA extraction the V3V4-hypervariable regions of the 16S-rRNA bacterial gene were amplified and sequenced on MiSeq Illumina sequencer. The Bioinformatic Data Analysis has been perfomed using the CLC Genomic Workbench. Results Alpha diversity analysis showed an increased microbial species richness in Esophageal Squamo-Cellular Carcinoma (ESCC) respect to distal/cardiac EAC and tissues without metaplasia. PERMANOVA statistical analysis was applied to estimate Beta Diversity significance. Bray-Curtis index showed a statistically significant different microbiome composition when comparing both cardiac and distal EAC versus ESCC (p-value 0.022 and 0.010 respectively) and when comparing samples with and without metaplasia. Relative abundances analysis obtained after the comparison of distal EAC, cardiac EAC and ESCC identified specific bacterial species in each group. Streptococcus genus is present only in cardiac EAC, Helicobacter pylori only in distal EAC. Conclusion Our study evidenced an increased microbial species richness in samples deriving from ESCC compared to EAC and samples without metaplasia. A significant difference was found comparing EAC with ESCC or with/without metaplasia tissues, mirroring a reduced biodiversity in EAC and metaplasia. We speculated a generalized alteration of the local microbiome from healthy to diseased tissue, characterized by certain bacterial strains that developed through the creation of a chronic inflammatory milieu that triggers the carcinogenic cascade.

New onset atrial fibrillation (AF) is observed in up to 37% of patients after esophagectomy for esophageal and esophago-gastric junction (EGJ) cancer. Little is known about risk factors for AF in this cohort of patients. Current literature describes an association between postoperative AF and other complications, notably anastomotic leaks and infective or pulmonary complications. The aim of this paper is to determine which factors relate to an increased risk of new-onset AF after esophagectomy. Methods We retrospectively analyzed a prospectively collected database in a high-volume, tertiary referral center for esophageal disease. All consecutive patients who underwent hybrid Ivor-Lewis (IL) esophagectomy for esophageal or EGJ cancer at the Upper GI surgery unit in Humanitas Research Hospital from January 2018 to august 2019 were evaluated for inclusion. Patients with a history of paroxysmal or chronic AF were excluded from the analysis. Complications were reported according to the ECCG classification. Association between variables and onset of AF was studied with univariable and multivariable logistic regression analysis. Results 89 IL cases among 125 esophagectomies were included for analysis. Overall complication rate was 29.2%. AF accounted for 9 cases (10.1%) and was the only complication in these patients. Anastomotic leak occurred in 2 patients (2.25%) both ECCG type 1, 3 developed significant pleural effusion (3.37%), 6 other infective conditions (6.7%). No postoperative deaths occurred. Significantly increased risk of AF was found in patients who underwent chemoradiotherapy(CRT) compared to those who received chemotherapy(CT) or no treatment(OR = 8.4, p = 0.02). If we compare only patients who received neoadjuvant treatment, a higher risk for CRT versus CT alone was found(OR = 5.5), with a trending significance(p = 0.08). Conclusion In this study, we did not find any association between AF and other complications. New-onset AF always presented as the only complication and it was significantly associated to neoadjuvant chemoradiotherapy. On the basis of this findings, we are designing a protocol with the aim of studying potential preventive intervention for postoperative FA after esophagectomy.