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Cornish SE, Chua TC. Endoscopic stapled appendicectomy mishap. ANZ J Surg 2023; 93:2995-2996. [PMID: 37568260 DOI: 10.1111/ans.18652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Stephanie E Cornish
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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2
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Sghaier A, Lamloum E, Debaibi M, Sridi A, Chouchene A. Closed loop small bowel obstruction due to small intestine volvulus associated with early adhesion after laparoscopic appendectomy: Case report and review of the literature. Int J Surg Case Rep 2023; 106:108217. [PMID: 37075504 DOI: 10.1016/j.ijscr.2023.108217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Nowadays the majority of appendectomies are undertaken laparoscopically. The associated per and postoperative complications are well established and known. However, some rare postoperative complications continue to be reported such as small bowel volvulus. CASE PRESENTATION We report the case of 44-year-old women who developed a small bowel obstruction from acute small bowel volvulus due to early postoperative flanges five days after a laparoscopic appendectomy. CLINICAL DISCUSSION Laparoscopy is associated with less adherences and morbidity however we must be careful in post operative course. Mechanical obstruction can happen even with laparoscopy procedure. CONCLUSION Occlusion earlier after surgery even with laparoscopy procedure must be explored. Volvulus can be incriminated.
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Affiliation(s)
- Asma Sghaier
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Eya Lamloum
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mehdi Debaibi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Azza Sridi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Adnene Chouchene
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Zeineddin S, Hu A, Linton S, Zhang V, De Boer C, Raval MV, Abdullah F, Goldstein SD. Association between appendiceal stump closure method and post-operative bowel obstruction after laparoscopic appendectomy. J Pediatr Surg 2023; 58:643-647. [PMID: 36670005 DOI: 10.1016/j.jpedsurg.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is one of the most common urgent pediatric surgical operations. Endoscopic surgical staplers and pre-tied endoloop ligatures are both routinely used for closure of the appendiceal stump in children. Practice patterns vary for a number of reasons, including cost, size, and ease of use. While stapling is standard for some pediatric surgeons, others believe that staples can act as a nidus for small bowel obstruction (SBO). However, studies comparing closure methods have been conflicting in their results and limited in size. Therefore, we aim to determine if there is an association between appendiceal stump closure method and SBO using a national comparative pediatric database. METHODS We queried the Pediatric Health Information System (PHIS) for patients ages 3-18 years who underwent laparoscopic appendectomy for appendicitis between 1/1/2016 - 12/31/2020. We included hospitals that had greater than 50 patients with billing data and excluded patients with inflammatory bowel disease and simultaneous abdominal operations. We used billing data for the patient's appendectomy to determine if a stapler or a suture ligature was used during the case. Our primary outcome of interest was post-operative SBO or reoperation for lysis of adhesion or intestinal surgery within the first 30 post-operative days. Multivariable regression analyses were used to estimate the association between stump closure method and post-operative SBO or reoperation in addition to cost while adjusting for patient demographics and appendiceal perforation. RESULTS In total, 49,191 patients from 37 hospitals were included, of which, 29,733 (60.44%) were male, 21,403 (43.51%) were non-Hispanic white, and 18,291 (37.18%) had a diagnosis of complicated appendicitis. The median [IQR] age of the cohort was 11 [8-14] years. A surgical stapler was used during laparoscopic appendectomy in 35,788 (72.75%) patients, and early SBO or reoperation occurred in 653 (1.33%) patients. In adjusted analysis controlling for demographics and complicated appendicitis there was no statistically significant difference in the odds of SBO or reoperation between the two groups. (OR 1.17; 99% CI 0.86 - 1.6). Complicated appendicitis was the factor most associated with post-operative SBO or reoperation (OR 4.4; 99% CI 3.01 - 6.44). Median cumulative cost was slightly higher on unadjusted analysis in the stapler group ($10,329.3 vs $9,569.2). However, there was no significant difference on adjusted analysis. CONCLUSION SBO or reoperation following laparoscopic appendectomy for appendicitis is uncommon. Complicated appendicitis is the most predictive factor of this outcome. Adjusting for available patient, disease, and hospital characteristics, use of a surgical stapler does not appear to be meaningfully associated with the development of acute SBO or reoperation. Surgeon preference remains the mainstay for safe appendiceal stump closure method. LEVEL OF EVIDENCE Level III. STUDY TYPE Retrospective Comparative Study.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Veronica Zhang
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Borkar N, Sharma C, Mohanty D, Singha SK. A Systematic Review and Meta-Analysis of Harmonic Scalpel Versus Conventional Techniques of Appendiceal Stump Closure in Laparoscopic Appendicectomy. Cureus 2022; 14:e28759. [PMID: 36159348 PMCID: PMC9498932 DOI: 10.7759/cureus.28759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/13/2022] Open
Abstract
Acute appendicitis is one of the most commonly encountered surgical emergencies worldwide. The laparoscopic approach for managing acute appendicitis is gaining popularity over open appendicectomy in the current surgical practice. The advantages of laparoscopic appendectomy are early recovery, fewer wound complications, less pain and better cosmesis. One of the most critical steps in laparoscopic appendicectomy is a secure appendicular stump closure. Life-threatening postoperative complications are often encountered following the breakdown of appendicular stump closure. There are several methods to achieve appendicular stump closure such as intra-corporeal knotting, endoloops, external corporeal knotting and pushing knot inside, endoscopic linear cutting stapler (endo GIA), and endoclips. A meta-analysis on the technique of appendicular stump closure in laparoscopic appendicectomy failed to demonstrate the superiority of one method over the other. In the last few years, many authors have evaluated the outcome of sutureless appendicectomy performed using devices like a harmonic scalpel. This systematic review and meta-analysis is aimed to summarise the current evidence regarding the utility and safety of harmonic scalpel in sutureless appendicectomy. This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic database, including Medline, Embase, CENTRAL, Scopus, Google scholar and clinical trial registry. Studies were selected and compared based on outcomes such as operative time, hospital stay, postoperative paralytic ileus, wound infection, and total complications. Statistical analysis was performed using the random effect model, fixed-effect model, pooled risk ratio, pooled mean difference and I2 heterogeneity. Four comparative studies with a total of 642 patients (376 male and 266 females) were included in the analysis. There were 359 patients in the conventional technique of appendicular stump closure group and 283 patients in the harmonic scalpel for appendicular stump closure group. Pooled analysis of the outcome measure of total complications showed that the use of harmonic scalpel for closure of appendiceal stump does not result in an increased incidence of complications as compared to the conventional technology of appendiceal stump closure. Pooled analysis of the outcome measure of mean operative time revealed a statistically significant reduction in the operative time in the patients where harmonic scalpel has been used for the management of appendiceal stump as compared to conventional methods (pooled mean difference of -12.96 with 95% CI -15.42, -10.50). Appendiceal stump closure during laparoscopic appendectomy by harmonic scalpel (HS) is comparable with the conventional techniques in terms of hospital stay, wound infection, postoperative paralytic ileus, and total complications. The use of a harmonic scalpel for closure of appendicular stump is associated with a reduction of the mean operative time of laparoscopic appendicectomy.
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5
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Yuen AYL, Chua TC. Ileal perforation from a dropped endoscopic staple. ANZ J Surg 2022; 92:2749-2750. [PMID: 35384227 DOI: 10.1111/ans.17682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander Y L Yuen
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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6
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Rogue Staples: a Culprit in Post-operative Small Bowel Obstruction. Obes Surg 2022; 32:1394-1396. [DOI: 10.1007/s11695-022-05925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022]
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7
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González-Urquijo M, Quevedo-Fernández E, Morales-Morales CA, Alejandro-Rodríguez H, Leyva-Alvizo A. Small bowel volvulus after laparoscopic appendectomy. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:445-448. [PMID: 34391703 DOI: 10.1016/j.rgmxen.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- M González-Urquijo
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - E Quevedo-Fernández
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - C A Morales-Morales
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - H Alejandro-Rodríguez
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - A Leyva-Alvizo
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico.
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8
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González-Urquijo M, Quevedo-Fernández E, Morales-Morales CA, Alejandro-Rodríguez H, Leyva-Alvizo A. Small bowel volvulus after laparoscopic appendectomy. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:S0375-0906(21)00034-3. [PMID: 33902977 DOI: 10.1016/j.rgmx.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M González-Urquijo
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - E Quevedo-Fernández
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - C A Morales-Morales
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - H Alejandro-Rodríguez
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Leyva-Alvizo
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, México.
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9
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Smith AM, O'Neil AC, Obiora C, Hope WW. Closed Loop Bowel Obstruction From a Loose Staple After Laparoscopic Appendectomy. Am Surg 2020:3134820972978. [PMID: 33350860 DOI: 10.1177/0003134820972978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander M Smith
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Ariel C O'Neil
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Chukwuemeka Obiora
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - William W Hope
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
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10
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Ly M, Van Kessel C, Hong JS. Rare case of staple-related small bowel obstruction 1 month after laparoscopic appendicectomy. ANZ J Surg 2020; 91:1618-1620. [PMID: 33289921 DOI: 10.1111/ans.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Ly
- Department of Colorectal surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Charlotte Van Kessel
- Department of Colorectal surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan S Hong
- Department of Colorectal surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
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11
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DiChiacchio L, O'Neill NA, Kligman M, Bafford AC. Postoperative small bowel obstruction secondary to single malformed staple following laparoscopic total abdominal colectomy. J Surg Case Rep 2020; 2020:rjaa361. [PMID: 33133498 PMCID: PMC7584459 DOI: 10.1093/jscr/rjaa361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022] Open
Abstract
Surgical staplers are ubiquitous in gastrointestinal surgery, especially laparoscopy. Intraperitoneal staples are designed to be inert and are generally regarded as benign; however, complications from primarily malformed staples can rarely occur. Here, we present a case of early mechanical postoperative small bowel obstruction due to a surgical staple following laparoscopic total abdominal colectomy and end ileostomy creation performed for medically refractory ulcerative colitis. Management consisted of diagnostic laparoscopy and careful extraction of a malformed surgical staple tethering a loop of small bowel to the rectal stump. Eight similar cases following gastrointestinal surgery have been identified in the literature, all occurring in the first 2 weeks following laparoscopic appendectomy. To our knowledge, this is the first case described following laparoscopic total abdominal colectomy, with high-grade small bowel obstruction at the level of the rectal stump staple line.
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Affiliation(s)
- Laura DiChiacchio
- Department of Surgery, University of Maryland School of Medicine, Baltimore MD, USA
| | - Natalie A O'Neill
- Department of Surgery, University of Maryland School of Medicine, Baltimore MD, USA
| | - Mark Kligman
- Department of Surgery, University of Maryland School of Medicine, Baltimore MD, USA
| | - Andrea C Bafford
- Department of Surgery, University of Maryland School of Medicine, Baltimore MD, USA
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12
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Tamura K, Nakayama H, Kono H, Kuroki R, Maeyama R, Yamamoto H, Ueki T, Okido M, Ichimiya H. Atypical clinical presentation of mechanical small bowel obstruction with superior mesenteric vein occlusion caused by a retained free intraperitoneal staple after laparoscopic appendectomy: A case report. Asian J Endosc Surg 2020; 13:556-559. [PMID: 32185867 DOI: 10.1111/ases.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Mechanical small bowel obstruction (SBO) is a common postoperative complication, and most cases are caused by postoperative adhesions. We herein report a case of SBO with superior mesenteric vein occlusion caused by a metal staple after laparoscopic appendectomy. A 35-year-old Japanese woman presented to our department with severe upper abdominal pain and vomiting. She had undergone laparoscopic appendectomy using a linear stapler 7 years before. Abdominal CT showed mild small intestinal dilation with mesenteric edema and volvulus of the small bowel mesentery. Moreover, occlusion of the superior mesenteric vein was observed. Emergency exploratory laparoscopy revealed a strangulated SBO caused by a free unformed staple. The obstruction was released by a laparoscopic technique without bowel resection. The number of laparoscopic surgeries has recently been increasing, and complications specific to laparoscopic surgery have been recognized. All spilled and unformed staples should be removed to the greatest extent possible during laparoscopic operations.
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Affiliation(s)
- Koji Tamura
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Hiroshi Kono
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Rumi Kuroki
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Ryo Maeyama
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Takashi Ueki
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Masayuki Okido
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
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Birindelli A, Dester SE, Compagnoni B, Carrara B, Taglietti L. Retrograde technique with intra-corporeal tie in difficult laparoscopic appendectomy - a video vignette. Colorectal Dis 2020; 22:845-846. [PMID: 31994301 DOI: 10.1111/codi.14990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
Affiliation(s)
- A Birindelli
- General Surgery Unit, Department of Surgery, Esine General Hospital, ASST Valcamonica, Breno, Italy
| | - S E Dester
- General Surgery Unit, Department of Surgery, Esine General Hospital, ASST Valcamonica, Breno, Italy
| | - B Compagnoni
- General Surgery Unit, Department of Surgery, Esine General Hospital, ASST Valcamonica, Breno, Italy
| | - B Carrara
- General Surgery Unit, Department of Surgery, Esine General Hospital, ASST Valcamonica, Breno, Italy
| | - L Taglietti
- General Surgery Unit, Department of Surgery, Esine General Hospital, ASST Valcamonica, Breno, Italy
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