Objective: To evaluate the surgical techniques necessary to complete total laparoscopic segmentectomy (LS) of all liver segments (I–VIII). Background: When compared to open surgery, preservation of functional hepatic volume may be more difficult during laparoscopic hepatectomy. LS is a possible alternative to hemihepatectomy, but laparoscopic surgical techniques to complete anatomically accurate segmentectomy have not yet been well established. Methods: Data of a total of 342 consecutive patients who underwent laparoscopic hepatectomy were reviewed. LS was defined as complete removal of the Couinaud's segment, in which the corresponding hepatic veins are exposed on the raw surface. The laparoscopic approach was facilitated by using intraoperative ultrasonography for each segment and by placing intercostal trocars to expose the root of the right hepatic vein for segmentectomy VII and VIII. Results: LS was completed in 62 patients: 36 segmentectomies (from I–VIII), 16 bisegmentectomies of the right lobe, and 10 subsegmentectomies were performed. Conversion to open surgery was required in 3 patients (IVa, VI, and VII). When 26 LS of the superior/posterior hepatic (sub)segments (I, IVa, VII, and VIII) were compared with the remaining 36 LS, the former group required a longer operation time (240 [132–390] minutes vs 155 [90–360]) minutes, P < 0.01) and showed an increased amount of blood loss (350 [20–1500] mL vs 100 [10–1100] mL, P = 0.02). Conclusions: LS is feasible and has become an essential surgical technique that can minimize the loss of functional liver volume without reducing curability, although further technical advancements are needed to enhance the accuracy of the resection, especially for the superior/posterior segments.

Expression of molecules with antiparasitic activity by genetically transformed symbiotic bacteria of disease-transmitting insects may serve as a powerful approach to control certain arthropod-borne diseases. The endosymbiont of the Chagas disease vector, Rhodnius prolixus , has been transformed to express cecropin A, a peptide lethal to the parasite, Trypanosoma cruzi . In insects carrying the transformed bacteria, cecropin A expression results in elimination or reduction in number of T. cruzi . A method has been devised to spread the transgenic bacteria to populations of R. prolixus , in a manner that mimics their natural coprophagous route of symbiont acquisition.

Background: Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of the different definitions used. The aim of this study was to compare several definitions of PF encountered in the current literature and to demonstrate that the PF rate in the same group of patients treated in a high volume center is dependent upon the definition applied. Methods: A Medline search of the last 10 years was performed as regards the definition of PF. A score was assigned to the reproducible definitions based upon two basic parameters: daily output (cm3) and duration of the fistula represented by the number of days between the postoperative day of onset and the duration of the complication. Four definitions were formulated and were then applied to a group of 242 patients that underwent pancreatic head or intermediate resections with pancreatico-jejunal anastomosis in our Pancreatic Unit between November 1996 and December 2000. Statistical analysis was carried out using the Yates correct χ2 test with statistical significance set at p < 0.05. Results: Among 26 different definitions identified, 14 were found suitable for the applied score. We formulated four final definitions summarizing the current concepts of PF. The incidence of PF ranged between 9.9 and 28.5% according to the different definitions applied with highly statistical differences between them. Conclusions: The PF rate after pancreatic resections is strictly dependent upon the definition used. An overall general agreement for an internationally accepted definition is urgently needed to correctly compare different experiences.