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Vettoretto N, Foglia E, Ferrario L, Gerardi C, Molteni B, Nocco U, Lettieri E, Molfino S, Baiocchi GL, Elmore U, Rosati R, Currò G, Cassinotti E, Boni L, Cirocchi R, Marano A, Petz WL, Arezzo A, Bonino MA, Davini F, Biondi A, Anania G, Agresta F, Silecchia G. Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary. Surg Endosc 2021; 34:3270-3284. [PMID: 32274626 DOI: 10.1007/s00464-020-07542-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery. METHODS A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model. RESULTS From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature. CONCLUSION The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.
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Affiliation(s)
- N Vettoretto
- Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy.
| | - E Foglia
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - L Ferrario
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - C Gerardi
- Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - B Molteni
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Nocco
- Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - E Lettieri
- School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy
| | - S Molfino
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - G L Baiocchi
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - G Currò
- Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy
| | - E Cassinotti
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - L Boni
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - A Marano
- Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - W L Petz
- Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - M A Bonino
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Davini
- Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Biondi
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Anania
- Chirurgia Generale, University of Ferrara, Ferrara, Italy
| | - F Agresta
- Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy
| | - G Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
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Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, Boselli C, Carlini L, Trastulli S, D'Andrea V, Bruzzone P. Authors' Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis. World J Surg 2021; 45:2631-2632. [PMID: 34031712 DOI: 10.1007/s00268-021-06167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Inguinal Nerve Working Group, Perugia, Italy.
| | - Marco Sutera
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Perugia, Italy
| | - Piergiorgio Fedeli
- Inguinal Nerve Working Group, Perugia, Italy
- Department of Surgery, University of Ferrara, Ferrara, Italy
| | - Gabriele Anania
- Institute of Legal Medicine, University of Camerino, Camerino, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Suadoni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Perugia, Italy
| | - Luigi Carlini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Vito D'Andrea
- Inguinal Nerve Working Group, Perugia, Italy
- Department of Surgical Science, Sapienza Università di Roma, Rome, Italy
| | - Paolo Bruzzone
- Inguinal Nerve Working Group, Perugia, Italy
- Dipartimento Di Chirurgia Generale E Specialistica "Paride Stefanini", Sapienza Università di Roma, Rome, Italy
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Cirocchi R, Popivanov G, Konaktchieva M, Chipeva S, Tellan G, Mingoli A, Zago M, Chiarugi M, Binda GA, Kafka R, Anania G, Donini A, Nascimbeni R, Edilbe M, Afshar S. The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:867-879. [PMID: 33089382 PMCID: PMC8026449 DOI: 10.1007/s00384-020-03784-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II-IV complicated acute diverticulitis (CAD). METHODS A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). RESULTS Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%]. CONCLUSIONS The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.
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Affiliation(s)
- Roberto Cirocchi
- Department of General Surgery, University of Perugia, 06123 Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
| | - Marina Konaktchieva
- Department of Gastroenterology and Hepatology, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
| | - Sonia Chipeva
- Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria
| | - Guglielmo Tellan
- Department of Emergency and Acceptance, Critical Areas and Trauma, “Umberto I” University Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea Mingoli
- Dipartimento di Chirurgia “P. Valdoni”, Sapienza Università di Roma, Viale del Policlinico155, 00161 Rome, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery - A.Manzoni Hospital, Lecco, Italy
| | - Massimo Chiarugi
- Emergency Surgery & Trauma Center, Cisanello University Hospital, 56124 Pisa, Italy
| | | | - Reinhold Kafka
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, 4121 Ferrara, Italy
| | - Annibale Donini
- Department of General Surgery, University of Perugia, 06123 Perugia, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
| | - Mohammed Edilbe
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Sorena Afshar
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
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Fiori E, Crocetti D, Sapienza P, Miccini M, Cirocchi R, Sterpetti AV, DE Felice F, Costi S, Brachini G, Mingoli A, Lamazza A, DE Toma G. Colon or Rectal Stent Positioning for Advanced Cancer Influences Quality of Life: A Critical Point of View. Anticancer Res 2021; 41:1945-1950. [PMID: 33813400 DOI: 10.21873/anticanres.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Endoluminal self-expanding metallic stents (SEMS) may overcome the risk of mortality and morbidity of acute intestinal obstruction because of stage IV colon (CC) or rectal (RC) cancer. We evaluated the QoL in these groups of patients. PATIENTS AND METHODS Forty-eight patients were enrolled in a prospective longitudinal cohort single-center trial to undergo SEMS positioning. Twenty-five patients had a CC and 23 RC. Karnofsky performance scale, Visual Analogue Scale and the EQ-5D- 5L™ questionnaire were administered before treatment and at 1, 3 and 6 months. RESULTS Harmonized to the Italian population, the index values showed a statistically significant deterioration of the QoL in patients with RC when compared to those with CC at 1-, 3- and 6-months (1 month: p=0.001; 3- month: p=0.001; 6-month: p=0.045). Similarly, Visual Analogue Scale showed variations at 1- (p=0.008), 3- (p=0.001) and 6-months (p=0.020). Rectal stent deployment was the only independent predictor for a worse QoL in all domains (p<0.017; OR=0.196; 95%CI=0.51-0.749). CONCLUSION Patients affected with stage IV CC had a better QoL after SEMS placement when compared to those affected with RC. The persistency of the primary tumor at the rectal level, even if irradiated, might negatively affect QoL.
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Affiliation(s)
- Enrico Fiori
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy;
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Michelangelo Miccini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Perugia University, Terni, Italy
| | - Antonio V Sterpetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Francesca DE Felice
- Department of Radiology, Radiotherapy, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy
| | - Silvano Costi
- Department of Economics and Finance, LUISS Guido Carli, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Antonietta Lamazza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giorgio DE Toma
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
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Bruzzone P, Bini F, Lancia M, Popivanov G, Giustozzi M, Marinozzi F, D'Andrea V, Cirocchi R. The role of computed tomography angiography 3D imaging in postoperative hemorrhage after groin mesh hernioplasty during anticoagulation therapy. Minerva Surg 2021; 76:286-287. [PMID: 33855375 DOI: 10.23736/s2724-5691.21.08704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Bruzzone
- Paride Stefanini Department of General and Specialist Surgery, Sapienza University, Rome, Italy -
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Sapienza University, Rome, Italy
| | - Massimo Lancia
- Department of General Surgery, Hospital of Terni, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Michela Giustozzi
- Unit of Internal Vascular and Emergency Medicine and Stroke, University of Perugia, Perugia, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Sapienza University, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Roberto Cirocchi
- Department of General Surgery, Hospital of Terni, University of Perugia, Terni, Italy
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Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, Boselli C, Carlini L, Trastulli S, D'Andrea V, Bruzzone P. Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis. World J Surg 2021; 45:1750-1760. [PMID: 33606079 PMCID: PMC8093155 DOI: 10.1007/s00268-021-05968-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. METHODS We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. RESULTS In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28-0.54; Z = 5.60 (P < 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94-2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24-1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13-0.63; Z = 3.10 (P = 0.002)]. CONCLUSION Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Inguinal Nerve Working Group, Terni, Italy.
| | - Marco Sutera
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Terni, Italy
| | - Piergiorgio Fedeli
- Inguinal Nerve Working Group, Terni, Italy
- School of Law, Legal Medicine, University of Camerino, Camerino, Italy
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Suadoni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Terni, Italy
| | - Luigi Carlini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Vito D'Andrea
- Inguinal Nerve Working Group, Terni, Italy
- Department of Surgical Science, Sapienza Università Di Roma, Rome, Italy
| | - Paolo Bruzzone
- Inguinal Nerve Working Group, Terni, Italy
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza Università di Roma, Rome, Italia
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Vaccari S, Lauro A, Cervellera M, Bellini MI, Palazzini G, Cirocchi R, Tonini V, D'Andrea V. Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center's study. Updates Surg 2021; 73:1767-1774. [PMID: 33582984 DOI: 10.1007/s13304-021-00994-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative outcomes in patients with ATT undergoing EC. We retrospectively evaluated 538 patients who underwent laparoscopic EC for AC between May 2015 and December 2019 at two referral centers. 89 of them (17%) were on ATT. We defined postoperative complication rates, including bleeding, as our primary outcome. Mortality was higher in the ATT group. Morbidity was higher in the ATT group as well; however, the difference was not statistically significant. 12 patients (2%) experienced intraoperative blood loss over 500 ml and ten (2%) had postoperative bleeding complications. Two patients (< 1%) experienced both intraoperative and postoperative bleeding. On multivariate analysis, ATT was not significantly associated with worse postoperative outcomes. Antithrombotic therapy is not an independently associated factor of severe postoperative complications (including bleeding) or mortality. However, these patients still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.
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Affiliation(s)
- Samuele Vaccari
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | - Augusto Lauro
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy.
| | - Maurizio Cervellera
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy
| | - Maria Irene Bellini
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | - Giorgio Palazzini
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | | | - Valeria Tonini
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
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Artico M, Santarelli MT, Stevanato G, Cirocchi R, D'Andrea V, Nicolai A, Cialone G, Monteleone G, Pindinello I, Taurone S. The role of congenital malformations of the thoracic egress in the development of the syndrome. Folia Morphol (Warsz) 2021; 81:117-123. [PMID: 33438186 DOI: 10.5603/fm.a2020.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Thoracic Outlet Syndrome (TOS) represents a clinical condition caused by compression of the neurovascular structures that cross the thoracic outlet. TOS can be classified in: 1) NTOS (neurogenic TOS), 2) VTOS (venous TOS), 3) ATOS (arterial TOS). Many different causes can determine the Syndrome: Congenital Malformations, Traumas, and Functional Impairments. This manuscript reviews how the congenital malformations play an important role in adult age; however, TOS also affects patients of all ages. Radiological imaging like RX (radiography), MR (Magnetic Resonance) and CT (Computed Tomography) can provide useful information to assess TOS causes and decide a potential surgery.79% of the patientsincluded in the first two stages of NAV staging experienced excellent results with FKT; whereas patients included in the third and fourth stage of NAV staging were subject to surgery.The treatment of acute forms of TOS involves thrombolysis and anticoagulant therapy; surgery is appropriate for true neurogenic TOS, vascular TOS and in some cases when conservative treatment fails.
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Affiliation(s)
- M Artico
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - M T Santarelli
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Stevanato
- Neurosurgery Unit, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - A Nicolai
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Cialone
- Unit of Radiology Regina Coeli, Rome, Italy
| | - G Monteleone
- Department of Biomedicine and Preventive Medicine, Tor Vergata University of Rome, Italy
| | - I Pindinello
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, Italy
| | - S Taurone
- Department of Sensory Organs, "Sapienza" University of Rome, Italy.
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Cirocchi R, Randolph J, Cheruiyot I, Davies RJ, Wheeler J, Gioia S, Reznitskii P, Lancia M, Carlini L, Fedeli P, di Saverio S, Henry BM. Surgical anatomy of sigmoid arteries: A systematic review and meta-analysis. Surgeon 2021; 19:e485-e496. [PMID: 33414045 DOI: 10.1016/j.surge.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/07/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to determine the prevalence of the number of sigmoid arteries (SA) and variations in their origins. METHODS A thorough systematic search of literature through February 2020 was conducted on major electronic databases to identify eligible studies. Data were extracted and pooled into a meta-analysis using Metafor package in R. The primary outcome was the variations in the SA origin (according to modified Zebrowski classification), and the secondary outcome was the prevalence of the number of SA. RESULTS A total of 22 studies (n = 2653 patients) were included. Type 1 modified Zebrowski (separated origins or common trunk of the SA originating from descending recto-sigmoid trunk (DRST)) was the most common origin type of the SA (pooled prevalence estimate (PPE) = 49.67% (95% CI 32. 67- 66.71)), while type 3 (separated origins or common trunk of 1 or 2 SA originating from DRST or superior rectal artery (SRA) and 1 or 2 SA originating from DRST or SRA) was the least common (PPE = 0.18%; 95% CI 0.00-2.82)). Of the Type 1 variants, the not specified (N.S) variant was by far the most prevalent. The number of SA ranged from one to five, with three being the mode (PPE = 42.3%). CONCLUSION This is the most comprehensive analysis of arterial vascular anatomy of the sigmoid colon. In light of the highly variable anatomical pattern displayed by the SA, thorough pre-operative knowledge of their anatomy can be crucial in minimizing incidences of iatrogenic injury.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza Dell'Universitá, 06123, Perugia, PG, Italy
| | - Jutsus Randolph
- Georgia Baptist College of Nursing. Mercer University, Atlanta, USA
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, P.O. Box 30197, Nairobi, 00100, Kenya; International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland.
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - James Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Sara Gioia
- Department of Surgical Science, University of Perugia, Piazza Dell'Universitá, 06123, Perugia, PG, Italy
| | - Pavel Reznitskii
- N.V. Sklifosovsky Research Institute for Emergency Medicine, B. Sucharevskaya Pl. 3/1, 129090, Moscow, Russian Federation
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Piazza Dell'Universitá, 06123, Perugia, PG, Italy
| | - Luigi Carlini
- Department of Surgical Science, University of Perugia, Piazza Dell'Universitá, 06123, Perugia, PG, Italy
| | | | - Salomone di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Brandon Michael Henry
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Anania G, Davies RJ, Arezzo A, Bagolini F, D’Andrea V, Graziosi L, Di Saverio S, Popivanov G, Cheruiyot I, Cirocchi R, Donini A. Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients. Int J Colorectal Dis 2021; 36:2321-2333. [PMID: 34125269 PMCID: PMC8505280 DOI: 10.1007/s00384-021-03946-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
UNLABELLED The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer. METHODS A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer. RESULTS Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND. CONCLUSION Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND.
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Affiliation(s)
- Gabriele Anania
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - Richard Justin Davies
- Cambridge Colorectal Unit - Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126 Torino, Italy
| | - Francesco Bagolini
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Luigina Graziosi
- Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
| | - Salomone Di Saverio
- Department of General Surgery (S.D.S., G.I., E.Z., G.C.), University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Roberto Cirocchi
- Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
| | - Annibale Donini
- Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
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Abosamak MF, Henry BM, Ali MF, Cirocchi R, Wong LM, Lippi G, Ahmed SA, Mikos M. The role for pre-operative CT chest scans in suspected COVID-19 patients requiring emergent surgery. Egyptian Journal of Anaesthesia 2021. [DOI: 10.1080/11101849.2021.1927417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Brandon M. Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Roberto Cirocchi
- Department of Surgical and Medical Sciences, University of Perugia, Terni, Italy
| | - Linda M. Wong
- Department of Anesthesia, The Christ Hospital, Cincinnati, Ohio, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Marcin Mikos
- Department of Bioinformatics and Public Health, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
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Anania G, Arezzo A, Davies RJ, Marchetti F, Zhang S, Di Saverio S, Cirocchi R, Donini A. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. Int J Colorectal Dis 2021; 36:1609-1620. [PMID: 33644837 PMCID: PMC8280018 DOI: 10.1007/s00384-021-03891-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. METHODS PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. RESULTS Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. CONCLUSIONS Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.
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Affiliation(s)
- Gabriele Anania
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Alberto Arezzo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Richard Justin Davies
- grid.24029.3d0000 0004 0383 8386Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Marchetti
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Shu Zhang
- grid.452404.30000 0004 1808 0942Department of Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Salomone Di Saverio
- grid.18147.3b0000000121724807Department of General Surgery, University of Insubria, Varese, Italy
| | - Roberto Cirocchi
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
| | - Annibale Donini
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
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Anania G, Davies RJ, Arezzo A, Bagolini F, D’Andrea V, Graziosi L, Di Saverio S, Popivanov G, Cheruiyot I, Cirocchi R, Donini A. Correction to: Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients. Int J Colorectal Dis 2021; 36:2335. [PMID: 34401973 PMCID: PMC9172862 DOI: 10.1007/s00384-021-04010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gabriele Anania
- grid.8484.00000 0004 1757 2064Dipartimento di Scienze Mediche, Università Degli Studi di Ferrara, Ferrara, Italy
| | - Richard Justin Davies
- grid.24029.3d0000 0004 0383 8386Cambridge Colorectal Unit - Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alberto Arezzo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126 Torino, Italy
| | - Francesco Bagolini
- grid.8484.00000 0004 1757 2064Dipartimento di Scienze Mediche, Università Degli Studi di Ferrara, Ferrara, Italy
| | - Vito D’Andrea
- grid.7841.aDepartment of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Luigina Graziosi
- grid.9027.c0000 0004 1757 3630Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
| | - Salomone Di Saverio
- grid.18147.3b0000000121724807Department of General Surgery (S.D.S, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, G.I., E.Z., G.C.) Italy
| | - Georgi Popivanov
- grid.413126.30000 0004 0621 0228Department of Surgery, Ul. “Sv. Georgi Sofiyski” 3, Military Medical Academy, 1606 Sofia, Bulgaria
| | - Isaac Cheruiyot
- grid.10604.330000 0001 2019 0495Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Roberto Cirocchi
- grid.9027.c0000 0004 1757 3630Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
| | - Annibale Donini
- grid.9027.c0000 0004 1757 3630Department of Surgery and Biomedical Sciences, University of Perugia, 06121 Perugia, Italy
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Popivanov G, Stoyanova D, Konaktchieva M, Cirocchi R, Penchev D, Kjossev K, Tonchev P, Mutafchiyski V. Crohn's Disease Complicated by Ileosigmoid Fistula - Synchronous Resection or Primary Sigmoid Repair, One or Two-stage Procedure? A systematic review of the literature and prospective case series. Folia Med (Plovdiv) 2020; 62:703-711. [PMID: 33415914 DOI: 10.3897/folmed.62.e49517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Although ileosigmoid fistulas (ISFs) in Crohn's disease (CD) are rare they can be quite challenging, especially for the inexperienced surgeons. Furthermore, current guidelines offer no clear recommendation regarding the surgical strategy in such cases. A systematic review of the literature to determine the best surgical strategy and a prospective case series are presented herein. MATERIALS AND METHODS The systematic review was performed according to PRISMA guidelines. A single-center prospective data-base from January 1, 2014 to August 20, 2019 is presented. Age, duration of CD, and the rates of ISF, emergency, preoperative diagnosis, type of surgery, type of stoma, and complications were analyzed and a prospective case series. RESULTS Eleven of 69 papers with a total of 505 patients were included in the systematic analysis. The rate of ISF was 3-5% of all CD patients. The combined preoperative detection rate of all modalities was 71%. Primary repair was performed in 42% of the cases; the rate of stoma was 31.5% with a similar proportion in primary repair and sigmoid resection.In the presented series, 35 of 176 patients with CD were operated (51% in an emergency setting). There were 7 cases with ISFs (4% of all and 20% of the operated patients). Preoperative diagnosis was made at 57%. Primary repair was performed in 71%, and a two-stage intervention with a stoma - in 58% of patients. CONCLUSIONS Primary repair should be attempted in all cases in which the sigmoid colon is disease-free or is not involved in the adja-cent abscess. The synchronous resections are not a mandatory indication for the stoma, but rather a tailored approach is recommended with an evaluation of the risk factors. Based on the available literature, no clear recommendation regarding the type of stoma can be made.
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Cirocchi R, Mercurio I, Nazzaro C, De Sol A, Boselli C, Rettagliata G, Vanacore N, Santoro A, Mascagni D, Renzi C, Lancia M, Suadoni F, Zanghì G, Palumbo P, Bruzzone P, Tellan G, Fedeli P, Marsilio F, D'Andrea V. Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair. BMC Surg 2020; 20:319. [PMID: 33287793 PMCID: PMC7720581 DOI: 10.1186/s12893-020-00988-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Isabella Mercurio
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy. .,Inguinal NerveWorking Group, Terni, Italy.
| | - Claudio Nazzaro
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Angelo De Sol
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Carlo Boselli
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | | | | | - Alberto Santoro
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Domenico Mascagni
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Renzi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Fabio Suadoni
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Guido Zanghì
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgery, Policlinico Vittorio Emanuele University Hospital-General Surgery and Oncology Unit, University of Catania, Catania, Sicily, Italy
| | - Piergaspare Palumbo
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Paolo Bruzzone
- Inguinal NerveWorking Group, Terni, Italy.,Dipartimento Di Chirurgia Generale E Specialistica "Paride Stefanini", Viale del Policlinico, 155, 00186, Rome, Italy
| | - Guglielmo Tellan
- Inguinal NerveWorking Group, Terni, Italy.,Department of Emergency and Acceptance, Critical Areas and Trauma, "Umberto I" University Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Piergiorgio Fedeli
- Inguinal NerveWorking Group, Terni, Italy.,Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Francucci Marsilio
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Vito D'Andrea
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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Nascimbeni R, Amato A, Cirocchi R, Serventi A, Laghi A, Bellini M, Tellan G, Zago M, Scarpignato C, Binda GA. Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper. Tech Coloproctol 2020; 25:153-165. [PMID: 33155148 PMCID: PMC7884367 DOI: 10.1007/s10151-020-02346-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann’s procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.
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Affiliation(s)
- R Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124, Brescia, Italy.
| | - A Amato
- Unit of Coloproctology, Department of Surgery, Borea Hospital, Sanremo, Italy
| | - R Cirocchi
- Department of Surgical and Medical Sciences, University of Perugia, Terni, Italy
| | - A Serventi
- Department of Surgery, Galliano Hospital, Acqui Terme, Italy
| | - A Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Tellan
- Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Zago
- Department of Robotic and Emergency Surgery, Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - C Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta
- Faculty of Medicine, Chinese University of Hong Kong, ShaTin, Hong Kong
| | - G A Binda
- General Surgery, Biomedical Institute, Genoa, Italy
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Arezzo A, Bonino MA, Ris F, Boni L, Cassinotti E, Foo DCC, Shum NF, Brolese A, Ciarleglio F, Keller DS, Rosati R, De Nardi P, Elmore U, Fumagalli Romario U, Jafari MD, Pigazzi A, Rybakov E, Alekseev M, Watanabe J, Vettoretto N, Cirocchi R, Passera R, Forcignanò E, Morino M. Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc 2020; 34:4281-4290. [PMID: 32556696 DOI: 10.1007/s00464-020-07735-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/09/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fluorescence imaging by means of Indocyanine green (ICG) has been applied to intraoperatively determine the perfusion of the anastomosis. The purpose of this Individual Participant Database meta-analysis was to assess the effectiveness in decreasing the incidence of anastomotic leak (AL) after rectal cancer surgery. METHODS We searched PubMed, Embase, Cochrane Library and ClinicalTrial.gov, EU Clinical Trials and ISRCTN registries on September 1st, 2019. We considered eligible those studies comparing the assessment of anastomotic perfusion during rectal cancer surgery by intraoperative use of ICG fluorescence compared with standard practice. We defined as primary outcome the incidence of AL at 30 days after surgery. The studies were assessed for quality by means of the ROBINS-I and the Cochrane risk tools. We calculated odds ratios (ORs) using the Individual patient data analysis, restricted to rectal lesions, according to original treatment allocation. RESULTS The review of the literature and international registries produced 15 published studies and 5 ongoing trials, for 9 of which the authors accepted to share individual participant data. 314 patients from two randomized trials, 452 from three prospective series and 564 from 4 non-randomized studies were included. Fluorescence imaging significantly reduced the incidence of AL (OR 0.341; 95% CI 0.220-0.530; p < 0.001), independent of age, gender, BMI, tumour and anastomotic distance from the anal verge and neoadjuvant therapy. Also, overall morbidity and reintervention rate were positively influenced by the use of ICG. CONCLUSIONS The incidence of AL may be reduced when ICG fluorescence imaging is used to assess the perfusion of a colorectal anastomosis. Limitations relate to the consistent number of non-randomized studies included and their heterogeneity in defining and assessing AL. Ongoing large randomized studies will help to determine the exact role of routine ICG fluorescence imaging may decrease the incidence of AL in surgery for rectal cancer.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Marco Augusto Bonino
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and medical school, Geneva, Switzerland
| | - Frédéric Ris
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and medical school, Geneva, Switzerland
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Nga Fan Shum
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | | | - Deborah S Keller
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola De Nardi
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Mehraneh Dorna Jafari
- Colon and Rectal Surgery, General Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Alessio Pigazzi
- Colon and Rectal Surgery, General Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Evgeny Rybakov
- Surgical Department of Oncoproctology - State Scientific Centre of Coloproctology, Moscow, Russian Federation
| | - Mikhail Alekseev
- Surgical Department of Oncoproctology - State Scientific Centre of Coloproctology, Moscow, Russian Federation
| | - Jun Watanabe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nereo Vettoretto
- General Surgery, Montichiari Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Oncology, Hospital of Terni, University of Perugia, Terni, Italy
| | - Roberto Passera
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Edoardo Forcignanò
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
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Sommariva A, Ansaloni L, Baiocchi GL, Cascinu S, Cirocchi R, Coccolini F, Deraco M, Fiorentini G, Gelmini R, Di Giorgio A, Lippolis PV, Pasqual EM, Sassaroli C, Macrì A, Sammartino P, Scaringi S, Valle M, Vaira M. Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology. Eur J Surg Oncol 2020; 47:164-171. [PMID: 33028502 DOI: 10.1016/j.ejso.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/04/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
AIM the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. METHOD a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. RESULTS two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. CONCLUSION a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.
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Affiliation(s)
- Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Stefano Cascinu
- Department of Medical Oncology Vita-Salute, San Raffaele University IRCCS, Milan, Italy
| | - Roberto Cirocchi
- General Surgery and Clinical Anatomy, University of Perugia, Perugia, Italy
| | | | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Gianmaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | | | - Enrico Maria Pasqual
- Advanced Surgical Oncology Unit, Department Area Medica, University of Udine, Italy
| | - Cinzia Sassaroli
- Abdominal Oncology Department, Fondazione Giovanni Pascale, IRCCS, Naples, Italy
| | - Antonio Macrì
- Department of Human Pathology, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Italy
| | - Paolo Sammartino
- Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy
| | - Stefano Scaringi
- Digestive Surgery Unit - IBD Unit, Careggi University Hospital, Florence, Italy
| | - Mario Valle
- Surgical Oncology Peritoneum and Abdomen Pathologies, National Cancer Institute "Regina Elena" Rome, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy
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Parisi A, Desiderio J, Cirocchi R, Trastulli S. Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery. Obes Surg 2020; 30:5071-5085. [PMID: 32981000 DOI: 10.1007/s11695-020-05000-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our aim was to conduct an up-to-date systematic review of randomised controlled trials (RCTs) to determine the benefits and harms of enhanced recovery after surgery (ERAS) programme in bariatric surgery. METHODS MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library were searched for RCTs on ERAS versus standard care (SC) until April 2020. The primary endpoint was the length of hospital stay (LOS). RESULTS Five RCTs included a total of 610 procedures. ERAS adoption is capable of significantly reducing LOS (MD of - 0.51; 95% CI - 0.92 to - 0.10; P = 0.01) and postoperative nausea and vomiting (PONV) (OR 0.42; 95% CI 0.19 to 0.95; P = 0.04). No significant differences in terms of adverse events and readmissions. CONCLUSIONS The implementation of ERAS in bariatric surgery produces a significant reduction in LOS and PONV.
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Affiliation(s)
- Amilcare Parisi
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy
| | - Jacopo Desiderio
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, St. Mary's Hospital, 05100, Terni, Italy
| | - Stefano Trastulli
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy.
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Amato B, Patrone R, Quarto G, Compagna R, Cirocchi R, Popivanov G, Granata V, Belli A, Izzo F. Surgical treatment for common hepatic aneurysm. Original one-step technique. Open Med (Wars) 2020; 15:898-904. [PMID: 33336047 PMCID: PMC7712245 DOI: 10.1515/med-2020-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/09/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Hepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons. Materials and methods A new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer. Results The duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure. Discussion This original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies. Conclusions The authors believe that this "one shot" technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Renato Patrone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Gennaro Quarto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Rita Compagna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Vincenza Granata
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Andrea Belli
- Department of Surgical Oncology, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Francesco Izzo
- Department of Surgical Oncology, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
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Andreasi V, Partelli S, Crippa S, Balzano G, Tamburrino D, Muffatti F, Belfiori G, Cirocchi R, Falconi M. A systematic review and meta-analysis on the role of omental or falciform ligament wrapping during pancreaticoduodenectomy. HPB (Oxford) 2020; 22:1227-1239. [PMID: 32631806 DOI: 10.1016/j.hpb.2020.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of wrapping in the setting of pancreaticoduodenectomy (PD) is controversial. This study aimed to assess whether the use of omental or falciform ligament wrapping of pancreatic anastomosis and/or vessels could reduce the rate of POPF and postpancreatectomy hemorrhage (PPH) after PD. METHODS Studies comparing PD with (PD-W) and without wrapping (PD-nW) were included. Primary outcomes were POPF and extraluminal PPH. Dichotomous variables were analyzed for risk ratios (RR) with 95% Confidence Intervals. RESULTS Nine studies involving 4384 patients were considered. The risk of POPF and clinically relevant POPF (CR-POPF) was similar between patients with and without omental wrapping of pancreatic anastomosis when considered as overall. A significant benefit from wrapping in terms of CR-POPF (RR 0.14, P = 0.002) was reported for patients who underwent PD with pancreaticojejunostomy (PJ). The risk of extraluminal PPH was slightly lower in patients who underwent vessels wrapping compared to those who did not (RR 0.58, P = 0.020). Similar extraluminal PPH rates were reported for patients with and without wrapping of pancreatic anastomosis (P = 0.620). DISCUSSION Data from low-evidence studies suggest that omental wrapping of PJ may reduce the incidence of CR-POPF, whereas vessels wrapping may have a slight effect for preventing extraluminal PPH.
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Affiliation(s)
- Valentina Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Tamburrino
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Belfiori
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Oncology, University of Perugia, Hospital of Terni, Terni, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, Martella LA, Costantini M, Mariottini A, Andreani P, Bruzzone P, Suadoni F, Francucci M, Cirocchi R, Cappanera S. Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work? J Clin Med 2020; 9:jcm9092744. [PMID: 32854334 PMCID: PMC7563368 DOI: 10.3390/jcm9092744] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 12/22/2022] Open
Abstract
The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.
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Affiliation(s)
- Beatrice Tiri
- Antimicrobial Stewardship Unit, Department of medicine, St. Maria Hospital, 05100 Terni, Italy;
| | - Emanuela Sensi
- Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy; (E.S.); (V.M.); (M.C.)
| | - Viola Marsiliani
- Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy; (E.S.); (V.M.); (M.C.)
| | - Mizar Cantarini
- Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy; (E.S.); (V.M.); (M.C.)
| | - Giulia Priante
- Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy; (G.P.); (C.V.); (L.A.M.)
| | - Carlo Vernelli
- Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy; (G.P.); (C.V.); (L.A.M.)
| | - Lucia Assunta Martella
- Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy; (G.P.); (C.V.); (L.A.M.)
| | | | - Alessandro Mariottini
- Hematology and Microbiology Laboratory, St. Maria Hospital, 05100 Terni, Italy; (A.M.); (P.A.)
| | - Paolo Andreani
- Hematology and Microbiology Laboratory, St. Maria Hospital, 05100 Terni, Italy; (A.M.); (P.A.)
| | - Paolo Bruzzone
- Department of General and Specialist Surgery “Paride Stefanini”, 00185 Rome, Italy;
| | - Fabio Suadoni
- Section of Legal Medicine, St. Maria Hospital, 05100 Terni, Italy;
| | - Marsilio Francucci
- Department of General and Oncologic Surgery, St. Maria Hospital, 05100 Terni, Italy;
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, 05100 Terni, Italy;
| | - Stefano Cappanera
- Antimicrobial Stewardship Unit, Department of medicine, St. Maria Hospital, 05100 Terni, Italy;
- Correspondence: ; Tel.: +39-0744-205089
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Cirocchi R, Kwan SH, Popivanov G, Ruscelli P, Lancia M, Gioia S, Zago M, Chiarugi M, Fedeli P, Marzaioli R, Di Saverio S. Routine drain or no drain after laparoscopic cholecystectomy for acute cholecystitis. Surgeon 2020; 19:167-174. [PMID: 32713729 DOI: 10.1016/j.surge.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/29/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is considered to be the gold standard in the early management of acute cholecystitis however, recommendations for routine drain insertion in the acute setting are unavailable. STUDY DESIGN A systematic review of literature review and metanalysis was conducted. All studies comparing drain versus no drain after LC for acute cholecystitis were included. RESULTS Seven studies, with 1274 patients, were included. Postoperative wound infection rates (relative risk (RR) 0.30, 95% confidence interval (CI) 0.10 to 0.88; I2 = 0%) and postoperative abdominal collection requiring drainage (RR 1.20, 95% CI 0.35 to 4.12; I 2 = 0%) were lower in the no-drain group, but this was only significant for wounded infections on subgroup analysis of RCTs. Length of stay hospital (mean difference (MD) -0.49, 95% CI -0.89 to -0.09; I 2 = 69%) and operative time (MD -8.13, 95% CI -13.87 to -2.38; I 2 = 92%) were significantly shorter in the no drain group however this was in the context of significant heterogeneity. CONCLUSION The available data suggests that acute cholecystitis is not an indication for routine drain placement after LC. However, these results must be interpreted with caution due to the limitations of the included studies. In effect, the main issue of this meta-analysis lies on the limitations of the included studies themselves, because of a considerable heterogeneity among the included works, particularly for the inclusion criteria of patients and reported severity of acute cholecystitis. Further work is required to produce evidence which will definitively alter clinical practice. LEVEL OF EVIDENCE Level 2a (systematic review of cohort studies). Oxford CEBM levels of evidence.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Sherman H Kwan
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria.
| | - Paolo Ruscelli
- Emergency Surgery Unit, Faculty of Medicine and Surgery, Torrette Hospital, Polytechnic University of Marche, Ancona, Italy.
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Sara Gioia
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Mauro Zago
- Department of General Surgery, San Pietro Polyclinic, Ponte San Pietro, Italy.
| | | | - Piergiorgio Fedeli
- School of Law - Legal Medicine, University of Camerino, Camerino, Italy.
| | - Rinaldo Marzaioli
- Department of Emergency and Organ Transplantation (DETO), University Medical School "A. Moro" Bari, Bari, Italy.
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; University of Insubria, Surgery I unit, University Hospital of Varese, Italy.
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Fedeli P, Justin Davies R, Cirocchi R, Popivanov G, Bruzzone P, Giustozzi M. Total parenteral nutrition-induced Wernicke's encephalopathy after oncologic gastrointestinal surgery. Open Med (Wars) 2020; 15:709-713. [PMID: 33336027 PMCID: PMC7712225 DOI: 10.1515/med-2020-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.
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Affiliation(s)
| | - Richard Justin Davies
- Department of General Surgery, Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Paolo Bruzzone
- Dipartimento di Chirurgia Generale e Specialistica “Paride Stefanini”, Sapienza Università di Roma, Rome, Italy
| | - Michela Giustozzi
- Department of Medicine, Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy
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Cirocchi R, Randolph J, Panata L, Verdelli AM, Mascagni D, Mingoli A, Zago M, Chiarugi M, Lancia M, Fedeli P, Davies J, Occhionorelli S. The tip of the iceberg of colorectal perforation from enema: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:1109-1119. [DOI: 10.1007/s10151-020-02294-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/05/2020] [Indexed: 01/19/2023]
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Cirocchi R, Randolph J, Cheruiyot I, Davies JR, Wheeler J, Lancia M, Gioia S, Carlini L, di Saverio S, Henry BM. Systematic review and meta-analysis of the anatomical variants of the left colic artery. Colorectal Dis 2020; 22:768-778. [PMID: 31655010 DOI: 10.1111/codi.14891] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Abstract
AIM To provide a comprehensive evidence-based assessment of the anatomical variations of the left colic artery (LCA). METHOD A thorough systematic search of the literature up until 1 April 2019 was conducted on the electronic databases PubMed, SCOPUS and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using the Metafor package in R. The primary outcomes of interest were the absence of the LCA and the anatomical variants of its origin. The secondary outcomes were the distance (mean ± SD) between the origin of the inferior mesenteric artery (OIMA) and the origin of the left colic artery (OLCA). RESULTS A total of 19 studies (n = 2040 patients) were included. The pooled prevalence estimate (PPE) of LCA absence was 1.2% (95% CI 0.0-3.6%). Across participants with either a Type I or Type II LCA, the PPE of a Type I LCA was 49.0% (95% CI 40.2-57.8%). The PPE of a Type II LCA was therefore 51.0%. The pooled mean distance from the OIMA to the OLCA was 40.41 mm (95 CI% 38.69-42.12 mm). The pooled mean length of a Type I LCA was 39.12 mm (95% CI 36.70-41.53 mm) while the pooled mean length of a Type IIa and Type IIb LCA was 41.43 mm (95% CI 36.90-43.27 mm) and 39.64 mm (95% CI 37.68-41.59 mm), respectively. CONCLUSION Although the absence of the LCA is a rare occurrence (PPE 1.2%), it may be associated with an important risk of anastomotic leakage as a result of insufficient vascularization of the proximal colonic conduit. It is also necessary to distinguish variants I and II of Latarjet, the frequency of which is identical, with division of the LCA being technically more straightforward in variant I of Latarjet. Surgeons should be aware that technical difficulties are likely to be more common with variant II of Latarjet, as LCA ligation may be more difficult due to its close proximity to the inferior mesenteric vein (IMV).
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Affiliation(s)
- R Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - I Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - J R Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - M Lancia
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - S Gioia
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - L Carlini
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - S di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - B M Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Popivanov GI, Mutafchiyski VM, Cirocchi R, Chipeva SD, Vasilev VV, Kjossev KT, Tabakov MS. Response to Dioscoridi et al. Colorectal Dis 2020; 22:841-842. [PMID: 32040265 DOI: 10.1111/codi.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G I Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - V M Mutafchiyski
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - R Cirocchi
- General Surgery, Terni Hospital, Terni, Italy
| | - S D Chipeva
- Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria
| | - V V Vasilev
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - K T Kjossev
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - M S Tabakov
- Department of Surgery, UHAT 'Sv. Ivan Rilski', Sofia, Bulgaria
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78
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Cochetti G, Abraha I, Randolph J, Montedori A, Boni A, Arezzo A, Mazza E, Rossi De Vermandois JA, Cirocchi R, Mearini E. Surgical wound closure by staples or sutures?: Systematic review. Medicine (Baltimore) 2020; 99:e20573. [PMID: 32569183 PMCID: PMC7310845 DOI: 10.1097/md.0000000000020573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To compare the effects of sutures and staples for skin closure of surgical wounds. MATERIAL AND METHODS We included published and unpublished randomized controlled trials (RCTs) and cluster-randomized trials comparing staples with sutures. Patients were adults (aged 18 years or over) who had undergone any type of surgery. The primary outcomes were risk of overall and severe wound infection. Secondary outcomes included length of hospital stay, readmission rate, adverse events, patient satisfaction with cosmetic results, postoperative pain. RESULTS Forty-two very low to low quality RCTs with a total of 11,067 patients were included. Sutures resulted in slightly fewer overall wound infections (4.90%) compared to staples (6.75%) but it is uncertain whether there is a difference between the groups (risk ratio [RR] 1.20, 95% confidence intervals [CI] 0.80-1.79; patients = 9864; studies = 34; I = 70%). The evidence was also insufficient to state a difference in terms of severe wound infection (staples 1.4% vs sutures 1.3%; RR 1.08, 95% CI 0.61-1.89; patients = 3036; studies = 17; I = 0%), grade of satisfaction (RR 0.99, 95% CI 0.91-1.07; patients = 3243; studies = 14; I = 67%) and hospital stay. Staples may increase the risk of adverse events (7.3% for staples vs 3.5% for sutures; RR 2.00, 95% CI 1.44-2.79; patients = 6246; studies = 21; I = 33%), readmission rate (RR 1.28, 95% CI 0.18-9.05; patients = 2466; studies = 5; I = 66%) and postoperative pain (standardized mean difference [SMD] 0.41,95%CI -0.35 to 1.16; I = 88%, patients = 390 patients, studies = 5). CONCLUSIONS Due to the lack of high quality evidence, we could not state if sutures are better than staples in terms of wound infection, readmission rate, adverse events, and postoperative pain. With a low quality of evidence, sutures reduce postoperative pain and improve grade of satisfaction with the cosmetic outcome.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Justus Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | | | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin
| | - Elena Mazza
- Department of Surgical Sciences, University of Torino, Turin
| | | | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia
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79
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Cheruiyot I, Nyaanga F, Kipkorir V, Munguti J, Ndung'u B, Henry B, Cirocchi R, Tomaszewski K. The prevalence of the Rouviere's sulcus: A meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat 2020; 34:556-564. [PMID: 32285514 DOI: 10.1002/ca.23605] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Rouvière's sulcus (RS) is increasingly being recognized as an important extra-biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random-effects meta-analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra-biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
| | - Fiona Nyaanga
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Vincent Kipkorir
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Jeremiah Munguti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Bernard Ndung'u
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Brandon Henry
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland.,Cincinnati Children's Medical Centre, Cincinnati, Ohio, USA
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Krzysztof Tomaszewski
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
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80
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Popivanov G, Fedeli P, Cirocchi R, Lancia M, Mascagni D, Giustozzi M, Teodosiev I, Kjossev K, Konaktchieva M. Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR-A Proposal for a Decision-Making Algorithm. ACTA ACUST UNITED AC 2020; 56:medicina56060269. [PMID: 32486112 PMCID: PMC7353849 DOI: 10.3390/medicina56060269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023]
Abstract
Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. Results: The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases - transabdominal surgery (3 colostomies, 1 Hartmann' procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. Conclusions: Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars -hemodynamic stability and the finding of contrast CT.
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Affiliation(s)
- Georgi Popivanov
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
- Correspondence:
| | - Piergiorgio Fedeli
- Institute of Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, 06100 Perugia, Italy; (R.C.); (M.L.)
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, 06100 Perugia, Italy; (R.C.); (M.L.)
| | - Domenico Mascagni
- Department of Surgical Science, Surgical Proctology Unit, Sapienza University of Rome, 00100 Rome, Italy;
| | - Michela Giustozzi
- Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, 06100 Perugia, Italy;
| | - Ivan Teodosiev
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
| | - Kirien Kjossev
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
| | - Marina Konaktchieva
- Department of Gastroenterology, Military Medical Academy, 1606 Sofia, Bulgaria;
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81
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Mutafchiyski VM, Popivanov GI, Tabakov MS, Vasilev VV, Kjossev KT, Cirocchi R, Philipov AT, Vaseva VS, Baitchev GT, Ribarov R, Konaktchieva MN. Cystic Echinococcosis of the Breast - Diagnostic Dilemma or just a Rare Primary Localization. Folia Med (Plovdiv) 2020; 62:23-30. [DOI: 10.3897/folmed.62.e47740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and treatment options.Materials and methods: We performed a literature search in PUBMED using the key words ‘hydatid disease’, ‘cystic echinococcosis’ and ‘breast echinococcosis’ without time limitation. Only studies reporting breast cystic echinococcosis were included.Results: Overall, 121 cases with cystic echinococcosis and 2 with alveolar echinococcosis were reported. A total of 52 cases were included in the analysis. The mean size of cysts was 5.5 cm (range 1.7-12). The most common clinical presentation was painless lump presented from 4 months to 19 years before the final diagnosis. Most cases had isolated breast CE, few cases had synchronous localizations – femoral, thigh and lung, and previous liver CE. Most were active CL and CE1-2 cysts (72%). Ultrasound was used in 83%, followed by mammography (35%). Fine needle aspiration was reported in 27 cases with positive finding in 59%.Conclusions: In cases with cystic breast lesions from endemic regions we recommend the US as a gold standard. CT and MRT are more accurate but expensive tools without the potential to change the surgical tactic. In contrast to the other localizations of CE, complete excision of the cysts is the best diagnostic and treatment approach.
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82
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Huisman MG, Ghignone F, Ugolini G, Sidorenkov G, Montroni I, Vigano A, de Liguori Carino N, Farinella E, Cirocchi R, Audisio RA, de Bock GH, van Leeuwen BL. Long-Term Survival and Risk of Institutionalization in Onco-Geriatric Surgical Patients: Long-Term Results of the PREOP Study. J Am Geriatr Soc 2020; 68:1235-1241. [PMID: 32155289 PMCID: PMC7318670 DOI: 10.1111/jgs.16384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate long-term survival and institutionalization in onco-geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score. DESIGN Prospective cohort study with long-term follow-up. SETTING International and multicenter locations. PARTICIPANTS Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229). MEASUREMENTS We assessed long-term survival and institutionalization using the Preoperative Risk Estimation for Onco-geriatric Patients (PREOP) score, developed to predict the 30-day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal. RESULTS We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7-4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7-3.8]; 2 y, 2.2 [95% CI = .9-5.5]). CONCLUSION A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235-1241, 2020.
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Affiliation(s)
- Monique G Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Federico Ghignone
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Giampaolo Ugolini
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isacco Montroni
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University, Montreal, Canada
| | - Nicola de Liguori Carino
- Manchester Royal Infirmary, Department of Hepato-Pancreato-Biliary Surgery, Central Manchester University Hospitals, Manchester, UK
| | - Eriberto Farinella
- Department of General Surgery and Surgical Oncology, University of Perugia, Hospital of Terni, Terni, Italy
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Oncology, University of Perugia, Hospital of Terni, Terni, Italy
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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83
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Vaccari S, Cervellera M, Lauro A, Palazzini G, Cirocchi R, Gjata A, Dibra A, Ussia A, Brighi M, Isaj E, Agastra E, Casella G, Di Matteo FM, Santoro A, Falvo L, Tarroni D, D'andrea V, Tonini V. Laparoscopic cholecystectomy: which predicting factors of conversion? Two Italian center's studies. MINERVA CHIR 2020; 75:141-152. [PMID: 32138473 DOI: 10.23736/s0026-4733.20.08228-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy represents the gold standard technique for the treatment of lithiasic gallbladder disease. Although it has many advantages, laparoscopic cholecystectomy is not risk-free and in special situations there is a need for conversion into an open procedure, in order to minimize postoperative complications and to complete the procedure safely. The aim of this study was to identify factors that can predict the conversion to open cholecystectomy. METHODS We analyzed 1323 patients undergoing laparoscopic cholecystectomy over the last five years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome. Among these, 116 patients (8.7%) were converted into laparotomic cholecystectomy. Clinical, demographic, surgical and pathological data from these patients were included in a prospective database. A univariate analysis was performed followed by a multivariate logistic regression. RESULTS On univariate analysis, the factors significantly correlated with conversion to open were the ASA score higher than 3 and the comorbidity, specifically cardiovascular disease, diabetes and chronic renal failure (P<0.001). Patients with a higher mean age had a higher risk of conversion to open (61.9±17.1 vs. 54.1±15.2, P<0.001). Previous abdominal surgery and previous episodes of cholecystitis and/or pancreatitis were not statistically significant factors for conversion. There were four deaths in the group of converted patients and two in the laparoscopic group (P<0.001). Operative morbility was higher in the conversion group (22% versus 8%, P<0.001). Multivariate analysis showed that the factors significantly correlated to conversion were: age <65 years old (P=0.031 OR: 1.6), ASA score 3-4 (P=0.013, OR:1.8), history of ERCP (P=0.16 OR:1.7), emergency procedure (P=0.011, OR:1.7); CRP higher than 0,5 (P<0.001, OR:3.3), acute cholecystitis (P<0.001, OR:1.4). Further multivariate analysis of morbidity, postoperative mortality and home discharge showed that conversion had a significant influence on overall post-operative complications (P=0.011, OR:2.01), while mortality (P=0.143) and discharge at home were less statistically influenced. CONCLUSIONS Our results show that most of the independent risk factors for conversion cannot be modified by delaying surgery. Many factors reported in the literature did not significantly impact conversion rates in our results.
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Affiliation(s)
- Samuele Vaccari
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Maurizio Cervellera
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Augusto Lauro
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy -
| | - Giorgio Palazzini
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | | | - Arben Gjata
- Department of General Surgery, University of Medicine, Tirana, Albania
| | - Arvin Dibra
- Department of General Surgery, University of Medicine, Tirana, Albania
| | - Alessandro Ussia
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Manuela Brighi
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Elton Isaj
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Ervis Agastra
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
| | - Giovanni Casella
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Filippo M Di Matteo
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Laura Falvo
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Danilo Tarroni
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Vito D'andrea
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University, Rome, Italy
| | - Valeria Tonini
- Department of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, Bologna, Italy
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84
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Popivanov GI, Mutafchiyski VM, Cirocchi R, Chipeva SD, Vasilev VV, Kjossev KT, Tabakov MS. Endoluminal negative pressure therapy in colorectal anastomotic leaks. Colorectal Dis 2020; 22:243-253. [PMID: 31274227 DOI: 10.1111/codi.14754] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022]
Abstract
AIM The aim of the present work was to perform an up-to-date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. METHOD An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. RESULTS Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9-10) and 6.0 cm (5-8.1) respectively. In 84.5% (78%-91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%-60%). Median 7 sponges (2-34) were used with median negative pressure 150 mmHg (125-700) for a median of 31 days (14-127). The success rate was 85.4% (80%-91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%-25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). CONCLUSIONS The initial experience looks promising with an 85% success rate, which precludes risky re-resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high-quality comparative studies.
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Affiliation(s)
- G I Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - V M Mutafchiyski
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - R Cirocchi
- Department of Surgery and Surgical Science, University of Perugia, Perugia, Italy
| | - S D Chipeva
- Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria
| | - V V Vasilev
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - K Ts Kjossev
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - M S Tabakov
- Clinic of Abdominal Surgery, MHAT 'Sv. Ivan Rilski', Sofia, Bulgaria
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85
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Amato A, Mataloni F, Bruzzone M, Carabotti M, Cirocchi R, Nascimbeni R, Gambassi G, Vettoretto NP, Pinnarelli L, Cuomo R, Annibale B, Fontana V, Binda GA. Hospital admission for complicated diverticulitis is increasing in Italy, especially in younger patients: a national database study. Tech Coloproctol 2020; 24:237-245. [PMID: 32016708 DOI: 10.1007/s10151-020-02150-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epidemiological studies show an increasing trend of hospitalization for acute diverticulitis (AD), but data regarding the trend in hospitalization for complicated AD in Italy are scarce. The aim of this study was to analyze the Italian trend in hospitalization for complicated AD, from 2008 to 2015. METHODS Using the Italian Hospital Information System, we identified all patients with complicated colonic AD as a discharge diagnosis. Age- and sex-specific rates for AD as well as type of hospital admission (emergency/elective), type of complication (peritonitis, obstruction, bleeding, abscess, fistula, perforation, sepsis) and type of treatment (medical/surgical), were analyzed. RESULTS A total of 41,622 patients with a discharge diagnosis of complicated AD were identified. Over the study period the admission rate grew from 8.8 to 11.8 per 100,000 inhabitants. The hospitalization rate was highest for patients ≥ 70 years, but the increase in the admission rate was higher among patients aged ≤ 60 years. There were more males in the group < 60 years and more females in the group ≥ 60 years old. The rate of emergency admissions associated with surgery showed a significant mean annual increase (+ 3.9% per year) in the rate of emergency admissions associated with surgery, whereas elective admissions for surgery remained stable. Peritonitis was the most frequent complication (35.5%). The rate of surgery increased in AD complicated by peritonitis (+ 5.1% per year), abscess (+ 5.8% per year) and decreased for obstruction (- 1.8% per year). CONCLUSIONS From 2008 to 2015, we documented an increasing rate of hospitalization for complicated AD, especially for younger patients, with an increase in surgery for peritonitis and abscess. Further studies are needed to clearly assess the risk factors for complications and risk of surgery.
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Affiliation(s)
- A Amato
- Department of Surgery, Borea Hospital, Sanremo, Italy.
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy.
| | - F Mataloni
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - M Bruzzone
- Clinical Epidemiology Unit, Ospedale Policlinico S. Martino, Genoa, Italy
| | - M Carabotti
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - R Cirocchi
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Department of General Surgery and Surgical Oncology, Hospital of Terni, University of Perugia, Terni, Italy
| | - R Nascimbeni
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Department of Molecular and Transational Medicine, University of Brescia, Brescia, Italy
| | - G Gambassi
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRRCS, Rome, Italy
| | - N P Vettoretto
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Department of Surgery, Montichiari, Ospedali Civili di Brescia, Brescia, Italy
| | - L Pinnarelli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - R Cuomo
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - B Annibale
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - V Fontana
- Clinical Epidemiology Unit, Ospedale Policlinico S. Martino, Genoa, Italy
| | - G A Binda
- Italian Group of Diverticular Disease (GRIMAD), Rome, Italy
- Colorectal Surgery, Biomedical Institute, Genoa, Italy
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86
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Crippa S, Cirocchi R, Weiss MJ, Partelli S, Reni M, Wolfgang CL, Hackert T, Falconi M. A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy. Updates Surg 2020; 72:39-45. [PMID: 31997233 DOI: 10.1007/s13304-020-00710-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Recent studies considered surgery as a treatment option for patients with pancreatic ductal adenocarcinoma (PDAC) and synchronous liver metastases. The aim of this study was to evaluate systematically the literature on the role of surgical resection in this setting as an upfront procedure or following primary chemotherapy. A systematic search was performed of PubMed, Embase and the Cochrane Library in accordance with PRISMA guidelines. Only studies that included patients with synchronous liver metastases published in the era of multiagent chemotherapy (after 2011) were considered, excluding those with lung/peritoneal metastases or metachronous liver metastases. Median overall survival (OS) was the primary outcome. Six studies with 204 patients were analyzed. 63% of patients underwent upfront pancreatic and liver resection, 35% had surgery after primary chemotherapy with strict selection criteria and 2% had an inverse approach (liver surgery first). 38 patients (18.5%) did not undergo any liver resection since metastases disappeared after chemotherapy. Postoperative mortality was low (< 2%). Median OS ranged from 7.6 to 14.5 months after upfront pancreatic/liver resection and from 34 to 56 months in those undergoing preoperative treatment. This systematic review suggests that surgical resection of pancreatic cancer with synchronous liver oligometastases is safe, and it can be associated with improved survival, providing a careful selection of patients after primary chemotherapy.
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Affiliation(s)
- Stefano Crippa
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.,Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy
| | - Matthew J Weiss
- Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefano Partelli
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reni
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Christopher L Wolfgang
- Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Massimo Falconi
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy. .,Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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87
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Amato B, Farina MA, Campisi S, Ciliberti M, Donna VD, Florio A, Grasso A, Miranda R, Pompeo F, Farina E, Serra R, Cirocchi R, Calemma F, Rocca A, Compagna R. CGF Treatment of Leg Ulcers: a Randomized Controlled Trial. Open Med (Wars) 2020; 14:959-967. [PMID: 31934641 PMCID: PMC6947757 DOI: 10.1515/med-2019-0113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/04/2019] [Indexed: 01/14/2023] Open
Abstract
Background Concentrated Growth Factors (CGF) is a concentration of second generation autologous growth factors compared to platelet rich plasma (PRP) and represents a multifactorial stimulation system that can be used for the management and treatment of chronic skin ulcers. Aim The aim of this work is to evaluate the additional benefits of the CGF compared to the standard of dressing and its effects on the dynamics of the healing process. Methods Autologous CGFs were obtained from 100 patients with chronic mixed ulcers (venous ulcers in patients with II stage claudication) of the lower limbs in a multicentric controlled randomized study. Results The results showed a significant advantage in the use of CGF in association with cleansing and selective compression in the healing time and stabilization of mixed ulcers of the lower extremities. Conclusions These results support the CGF’s clinical use for improving clinical outcomes in mixed ulcers of the legs.
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | | | - Silvana Campisi
- Transfusion Immunohematology Service, S.Andrea Hospital, 00192 Rome, Italy
| | | | | | - Anna Florio
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonino Grasso
- Vascular Surgery Unit, University of Catania, "Policlinico, Vittorio Emanuele" P.O. G. Rodolico , Catania, Italy
| | - Rosario Miranda
- Angiology Service ASL NA 3 Sud, Nola District, 80035 Nola, Napoli, Italy
| | - Francesco Pompeo
- Vascular Surgery Unit, Neurologic Mediterranean Institute Neuromed, 86077 Pozzilli, Isernia, Italy
| | - Eleonora Farina
- Vascular Surgery Unit, Villa Del Sole Hospital 81100 Caserta, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy.,Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Division of Week surgery, S. Maria Hospital, Terni, Italy
| | - Francesca Calemma
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy, via S. Pansini, 5, 80131 Naples, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy.,Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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88
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Popivanov G, Cirocchi R, Popov G, Stefanovski P, Andonova R, Kjossev K, Tonchev P, Tabakov M, Penkov M, Ivanov P, Mutafchiyski V. An analysis of missed cases with surgical emergencies admitted in non-surgical departments. Case series and а review of the literature. G Chir 2020; 41:66-72. [PMID: 32038014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The delayed diagnosis in emergency surgery can be associated with significant morbidity and mortality and often lead to litigations. The aim of the present work is to analyse the outcome in cases with non-trauma surgical emergencies wrongly admitted in non-surgical departments. METHODS A retrospective trial in two independent University hospitals was conducted. The first group encompassed the patients worked-up in the Surgical unit of Emergency department (2014-2018). The second one included all cases visited Emergency department (2018). Only cases with acute abdomen and delayed diagnosis and operation were included. The analysis included the proportion of the delayed diagnosis, time between admission and operation, intraoperative diagnosis, complications and mortality rate. RESULTS In the first group there were 30 194 visits in the surgical unit with 15 836 hospitalizations (52.4%). Twenty patients of the last (0.13%) were admitted in the Clinic of Infectious disease and subsequently operated. The mean delay between hospitalization and operation was 3 days (1-10). Seventeen patients (85%) were operated with mortality of 10%. In the second group, there were a total of 22 760 visits with 11 562 discharged cases. Of the last, 1.7% (n=192) were re-admitted in a surgical ward, 25 of which underwent urgent surgery (0.2%). CONCLUSIONS The missed surgical cases represent only a small proportion of the patients in emergency department. The causes for wrong initial admissions in our series were misinterpretation of the symptoms, insufficient clinical examination and underuse of US and CT. The careful clinical assessment, point-of care US and CT may decrease the rate of the delayed diagnosis.
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89
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Zingaro MD, Boni A, Vermandois JARD, Paladini A, Lepri E, Ursi P, Cirocchi R, Turco M, Gaudio G, Nogara A, Mearini E. Fournier's Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature. Open Med (Wars) 2019; 14:694-710. [PMID: 31934634 PMCID: PMC6947763 DOI: 10.1515/med-2019-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Nogara
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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90
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Covarelli P, Barberini F, Cannavicci D, Cirocchi R, Rulli A, Boselli C, De Giorgi V. Reduction of postoperative lymphorrhoea in patients undergoing radical lymphadenectomy for stage III melanoma: prospective study using collagen-fibrin patches. MINERVA CHIR 2019; 75:111-116. [PMID: 31820617 DOI: 10.23736/s0026-4733.19.08114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical lymph nodes dissection (RLND) is the standard procedure for regional control of disease in patients with metastatic melanoma (stage III). Because of its aggressiveness, lymphorrhoea is a constant problem in postoperative. METHODS In this prospective nonrandomized study with a retrospective analysis of data, patients undergoing surgical treatment of axillary or iliac-inguinal RLND received standard treatment plus a collagen-fibrin sealant patch (TachoSil) (N.=50) or standard treatment alone (N.=50). The first endpoint was the comparison between the treated population and the control group, in terms of persistence of drainage and average daily volume of lymphorrhoea. The second aim was to relate patients' BMI, volume of lymphorrhoea and time of drainage in the two groups. RESULTS In the comparison between the two groups receiving or not the treatment with collagen-fibrin patch, we found an average difference both in the volume of daily lymphorrhoea (42.91±6.61 cc) and in the persistence of drainage (9.292±1.644 days) with P value <0.0001. Besides, the collagen-fibrin patch was actually effective in reducing lymphorrhoea and time of drainage, regardless of patients' BMI. CONCLUSIONS The results of this study confirm and support the starting thesis: TachoSil is an effective tissue sealant able to reduce lymphorrhoea and drainage removal times following a radical lymphadenectomy, independently from the BMI.
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Affiliation(s)
- Piero Covarelli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy -
| | - Francesco Barberini
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Cannavicci
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Rulli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Cirocchi R, Fearnhead N, Vettoretto N, Cassini D, Popivanov G, Henry BM, Tomaszewski K, D'Andrea V, Davies J, Di Saverio S. The role of emergency laparoscopic colectomy for complicated sigmoid diverticulits: A systematic review and meta-analysis. Surgeon 2019; 17:360-369. [PMID: 30314956 DOI: 10.1016/j.surge.2018.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting. METHODS A systematic literature search was performed for randomized controlled trials (RCTs) and non-RCTs published in PubMed, SCOPUS and Web of Science. RESULTS The search yielded four non-RCTs encompassing 436 patients undergoing either laparoscopic (181 patients, 41.51%) versus open sigmoid resection (255 patients, 58.49%). All studies reported ASA scores, but only four studies reported other severity scoring systems (Mannheim Peritonitis Index, P-POSSUM). Level of surgical expertise was reported in only one study. Laparoscopy improves slightly the rates of overall post-operative complications and post-operative hospital stay, respectively (RR 0.62, 95% CI 0.49 to 0.80 and MD -6.53, 95% CI -16.05 to 2.99). Laparoscopy did not seem to improve the other clinical outcomes: rate of Hartmann's vs anastomosis, operating time, reoperation rate and postoperative 30-day mortality. CONCLUSION In this review four prospective studies were included, over 20 + year period, including overall 400 + patients. This meta-analysis revealed significant advantages associated with a laparoscopic over open approach to emergency sigmoidectomy in acute diverticulitis in terms of postoperative complication rates, although no differences were found in other outcomes. The lack of hemodynamic data and reasons for operative approach hamper interpretation of the data suggesting that patients undergoing open surgery were sicker and these results must be considered with extreme caution and this hypothesis requires confirmation by future prospective randomised controlled trials.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy.
| | - Nicola Fearnhead
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | | | - Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria.
| | | | | | - Vito D'Andrea
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
| | - Justin Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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92
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Cirocchi R, Nascimbeni R, Binda GA, Vettoretto N, Cuomo R, Gambassi G, Amato A, Annibale B. Surgical treatment of acute complicated diverticulitis in the elderly. MINERVA CHIR 2019; 74:465-471. [PMID: 30306769 DOI: 10.23736/s0026-4733.18.07744-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although the true prevalence is unknown, colonic diverticulosis is one of the most common disease of the digestive tract in Western countries. Based on administrative data of hospitalized patients, the incidence of diverticulitis has been increasing in last decades. In general, elderly patients undergo less frequently an elective colonic resection; but a substantial part of emergency surgeries is performed in elderly patients. In these older patients the choice of any clinical and surgical option is to be correlated not only to the severity of diverticulitis, but also to general status and the co-existing comorbidities. In this regard, it is mandatory that all patients undergo a multidimensional, comprehensive geriatric assessment to correctly identify those who are fit, vulnerable or frail. The analysis of data currently available highlights three relevant elements: type and severity of peritoneal contamination, hemodynamic conditions (stable or unstable), and concomitant comorbidities (fit or frail status). There is no single ideal surgical treatment that can be considered as gold standard for all clinical presentations; the final clinical decision-making should always be based on patient's general health status, severity of peritonitis and of sepsis. In a septic elderly patient who is hemodynamically unstable, treatment should be as prompt as possible independent of the Hinchey's stage, and could include either a Mickulicz stoma or a DCS strategy. In an elderly patient who is fit and hemodynamically stable, the surgical options are similar to those in a younger patient. If a patient is frail but hemodynamically stable, he should be treated with a Hartmann's procedures.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy -
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gian A Binda
- Department of General Surgery, Galliera Hospital, Genoa, Italy
| | - Nereo Vettoretto
- Unit of Laparoscopic Surgery, Department of Surgery, M. Mellini Hospital, Chiari, Brescia, Italy
| | - Rosario Cuomo
- Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Gambassi
- Department of Internal Medicine, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Amato
- Department of Surgery, Hospital of Sanremo, Sanremo, Imperia, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Science and Translational Medicine, Sapienza University, Rome, Italy
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93
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Cirocchi R, Popivanov G, Corsi A, Amato A, Nascimbeni R, Cuomo R, Annibale B, Konaktchieva M, Binda GA. The Trends of Complicated Acute Colonic Diverticulitis-A Systematic Review of the National Administrative Databases. Medicina (Kaunas) 2019; 55:medicina55110744. [PMID: 31744067 PMCID: PMC6915450 DOI: 10.3390/medicina55110744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The diverticular disease includes a broad spectrum of different "clinical situations" from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diverticulitis through a comparative analysis of the hospitalizations based on the national administrative databases. Materials and Methods: A review of the international and national administrative databases concerning admissions for complicated AD was performed. Results: Ten studies met the inclusion criteria and were included in the analysis. No definition of acute complicated diverticulitis was reported in any study. Complicated AD accounted for approximately 42% and 79% of the hospitalizations. The reported rates of abscess varied between 1% and 10% from all admissions for AD and 5-29% of the cases with complicated AD. An increasing temporal trend was found in one study-from 6% to 10%. The rates of diffuse peritonitis ranged from 1.6% to 10.2% of all hospitalizations and 11% and 47% of the complicated cases and were stable in the time. Conclusions: The available data precluded definitive conclusions because of the significant discrepancy between the included studies. The leading cause was the presence of heterogeneity due to coding inaccuracies in all databases, absence of ICD codes to distinguish the different type of complications, and the lack of coding data about some general conditions such as sepsis, shock, malnutrition, steroid therapy, diabetes, pulmonary, and heart failure.
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Affiliation(s)
- Roberto Cirocchi
- Department of General Surgery and Surgical Oncology, Hospital of Terni, University of Perugia, 05100 Terni, Italy;
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
- Correspondence:
| | - Alessia Corsi
- Chirurgia Generale, Ospedale della Media Valle del Tevere, via del Buda, 06059 Todi, Italy;
| | - Antonio Amato
- Unit of Coloproctology, Department of Surgery, Borea Hospital, 18038 Sanremo, Italy;
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Rosario Cuomo
- Gastroenterology and Digestive Endoscopy Unit, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Bruno Annibale
- Department of Medical Surgery, Sciences and Translational Medicine University Sapienza, 00189 Rome, Italy;
| | - Marina Konaktchieva
- Department of Gastroenterology and Hepatology, Military Medical Academy, ul. “Sv. Georgi Sofiiski“ 3, 1606 Sofia, Bulgaria;
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Cochetti G, Zingaro MD, Boni A, Allegritti M, de Vermandois JAR, Paladini A, Egidi MG, Poli G, Ursi P, Cirocchi R, Mearini E. Renal Artery Embolization Before Radical Nephrectomy for Complex Renal Tumour: Which are the True Advantages? Open Med (Wars) 2019; 14:797-804. [PMID: 31737784 PMCID: PMC6843490 DOI: 10.1515/med-2019-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Renal artery embolization is performed before radical nephrectomy (RN) for renal mass in order to induce preoperative infarction and to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, in metastatic renal cancer it seems to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported. The role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefits are still unclear. Nevertheless, in huge and complex renal masses, which are often characterized by a high and anarchic blood supply and rapid local invasion, radical nephrectomy can be challenging even for skilled surgeons. The aim of this prospective randomized study was to evaluate the effectiveness and safety of PRAE in complex masses by comparing perioperative outcomes of RN with and without PRAE. Materials and methods From December 2015 to May 2018 we enrolled prospectively 64 patients who underwent RN for localized (T2a-b) or locally advanced (T3 and T4) or advanced (N+, M+) renal cancers. Patients were divided in two groups. The first group included 30 patients who underwent PRAE; in the second group we enrolled 34 patients who did not undergo RN without PRAE. Perioperative outcomes in terms of operative time, blood loss, transfusion rate and length of hospitalization were evaluated. Statistical analysis was performed using GraphPad Prism 6.0 software. Results Median blood loss was 250 ml (50-500) and 400 ml (50-1000) in the first and second group, respectively, with a statistically significant difference (p=0.0066). Median surgical time was 200 min (90-390) and 240 min (130-390) in PRAE and No-PRAE group (p=0.06), respectively. No major complications occurred after embolization. Overall complication rate in Group 1 and 2 was 46.7% (14/30) and 50% (17/34), respectively (p=0.34). No major complications occurred in both groups. The mean follow up was 21,5 months. Conclusions Our results prove PRAE to be a safe procedure with low complications rate. To our experience, PRAE seems to be a useful tool in surgical management of a large mass and advanced disease.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | | | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Maria Giulia Egidi
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Giulia Poli
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery Paride Stefanini, Umberto I Policlinico Roma, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Division of Week surgery, S. Maria Hospital, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
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95
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Lancia M, Suadoni F, Rosati V, Franceschetto L, Cirocchi R, Carlini L. Homicide by drinking glass with peculiar findings: Let’s create safer drinking environments to reduce alcohol-related murders. Forensic Science International: Reports 2019. [DOI: 10.1016/j.fsir.2019.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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96
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Del Zingaro M, Boni A, Paladini A, Rossi De Vermandois JA, Ciarletti S, Felici G, Ursi P, Cirocchi R, Mearini E. Fournier's gangrene secondary to locally advanced prostate cancer: case report and review of the Literature. G Chir 2019; 40:481-496. [PMID: 32007109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fournier's gangrene is a rare and potentially lethal condition. Previously described as an idiopathic process, this necrotising fasciitis is secondary to infection and in 95% of cases the cause arises from ano-rectum (30-50%), uro-genitalia (20-40%) or genital skin (20%). Cancer could lead to a Fournier's gangrene thanks a Romacompromised host immunity condition. In the past the rate of death was high ranging from 20% to 80%, while currently mortality is decreasing to 10%. We report a case of a 76-years-old man with Fournier's Gangrene due to locally advanced prostate cancer. The multimodal therapeutic management included broad-spectrum antibiotic therapy, intravenous fluid resuscitation and surgical debridement that was delayed by the will of the patient. To our knowledge, this is the first case of Fournier's gangrene caused by prostate cancer without common predisposing factors. In order to improve the knowledge about this rare disease, we performed a narrative review of the literature.
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97
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Palumbo P, Usai S, Amatucci C, Cerasari S, Perotti B, Ruggeri L, Cirocchi R, Tellan G. Tailored Surgery in Inguinal Hernia Repair. The Role of Subarachnoid Anesthesia: A Retrospective Study. Open Med (Wars) 2019; 14:639-646. [PMID: 31667353 PMCID: PMC6818077 DOI: 10.1515/med-2019-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 01/16/2023] Open
Abstract
Safety and effectiveness evaluation of subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose (30mg) in combination with Fentanyl (20mcg), for the purpose of ensuring an optimal analgesia in open inguinal hernia repair. Although the local anesthesia is the first line treatment for open inguinal hernia repair, a minority of patients is not eligible because of obesity or big groin hernia, requiring a high dose of local anesthetic. Subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose in combination with Fentanyl may be a good alternative. Thirty patients were treated with intrathecal association of Prilocaine 30 mg and Fentanyl 20 mcg (group PF); they were compared to a group of fifty three ones, previously treated with a classic procedure with intrathecal Prilocaine 60 mg (group P). The sensitive blockage remained within an higher limit at T12 level in the patients of PF group, and a lower limit at S1 level 50 minutes after the anesthesia, while in the P group the anesthetic tended to migrate (p<0.0001). In PF group 70 minutes after the anesthesia 21 patients had a Bromage score equal to 0 and 9 patients equal to 9 (in P group, 19 patients had a score equal to 3, 8 to 2 and 3 to 1, p<0.0001). Subarachnoid anesthesia using Prilocaine 30 mg + Fentanyl 20 mcg could be stated as a viable alternative to local anesthesia in selected patients.
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Affiliation(s)
| | - Sofia Usai
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Chiara Amatucci
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Saverio Cerasari
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Bruno Perotti
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Luca Ruggeri
- Department of Emergency, Anesthesia and Critical Care, “Sapienza” University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - Guglielmo Tellan
- Department of Emergency, Anesthesia and Critical Care, “Sapienza” University of Rome, Rome, Italy
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98
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Sanguinetti A, Puma F, Lucchini R, Santoprete S, Cirocchi R, Corsi A, Triola R, Avenia N. [Retraction] Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature. Oncol Lett 2019; 18:6305. [PMID: 31788109 PMCID: PMC6865728 DOI: 10.3892/ol.2019.10965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Francesco Puma
- Thoracic Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Lucchini
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Stefano Santoprete
- Thoracic Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberto Cirocchi
- General Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Alessia Corsi
- General Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Triola
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
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99
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de Vermandois JAR, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, Marsico M, Gaudio G, Paladini A, Guiggi P, Cirocchi R, Mearini E. Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery. Open Med (Wars) 2019; 14:711-718. [PMID: 31572804 PMCID: PMC6749724 DOI: 10.1515/med-2019-0081] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Surgical Site Infection (SSI) is the most frequent source of infection in surgical patients and the second most frequent cause of hospital-acquired infection. The primary aim of this prospective study was to compare SSI occurrences between minimally invasive surgery (MIS) and open urological surgery. Secondly, perioperative outcomes were evaluated in two different approaches. A consecutive group of 60 patients undergoing urological surgery were prospectively enrolled in a single high-volume center between May and October 2018. We included procedures that were performed by minimally invasive or traditional techniques. We evaluated and compared the incidence of SSI and perioperative outcomes in terms of intraoperative bleeding, post-operative complications, postoperative pain, patient satisfaction with the analgesic treatment, time to flatus, time of oral intake and mobilization, and length of hospital stay. The two groups were homogeneous with regard to demographic data. Superficial incisional SSIs were diagnosed in 10% of cases (3/30) in the second group and 0% in the first (p<0.05); space/organ SSIs developed in 4 patients, which were diagnosed by ultrasound scan and confirmed by abdominal CT: 1 patient (3.3%) in group 1 showed an infected lymphocele, whereas 1 case of infected lymphocele and 2 cases of pelvic abscess were detected in group 2 (10%, p<0.05). All the perioperative outcomes as well as were overall complication rate favored MIS (p<0.05). The use of minimally invasive techniques in urological surgery reduced the risk of SSI by comparison with a traditional approach. In addition, MIS was associated with better perioperative outcomes and a lower overall complication rate.
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Affiliation(s)
| | - Giovanni Cochetti
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Michele Del Zingaro
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alberto Santoro
- Department of General Surgery and Surgical Specialties "Paride Stefanini";, Sapienza University of Rome, Rome, Italy
| | - Mattia Panciarola
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Andrea Boni
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Matteo Marsico
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Gianluca Gaudio
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alessio Paladini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Paolo Guiggi
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
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100
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Sanguinetti A, Puma F, Lucchini R, Santoprete S, Cirocchi R, Corsi A, Triola R, Avenia N. [Retracted] Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature. Oncol Lett 2019. [DOI: 10.3892/ol.2019.10714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Francesco Puma
- Thoracic Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Lucchini
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Stefano Santoprete
- Thoracic Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberto Cirocchi
- General Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Alessia Corsi
- General Surgery Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Roberta Triola
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
| | - Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Umbria, Terni 06100, Italy
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