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Cizmic A, Romic I, Balla A, Barabino N, Anania G, Baiocchi GL, Bakula B, Balagué C, Berlth F, Bintintan V, Bracale U, Egberts JH, Fuchs HF, Gisbertz SS, Gockel I, Grimminger P, van Hillegersberg R, Inaki N, Immanuel A, Korr D, Lingohr P, Mascagni P, Melling N, Milone M, Mintz Y, Morales-Conde S, Moulla Y, Müller-Stich BP, Nakajima K, Nilsson M, Reeh M, Sileri P, Targarona EM, Ushimaru Y, Kim YW, Markar S, Nickel F, Mitra AT. An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer. Surg Endosc 2024; 38:488-498. [PMID: 38148401 PMCID: PMC10830761 DOI: 10.1007/s00464-023-10614-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Minimally invasive total gastrectomy (MITG) is a mainstay for curative treatment of patients with gastric cancer. To define and standardize optimal surgical techniques and further improve clinical outcomes through the enhanced MITG surgical quality, there must be consensus on the key technical steps of lymphadenectomy and anastomosis creation, which is currently lacking. This study aimed to determine an expert consensus from an international panel regarding the technical aspects of the performance of MITG for oncological indications using the Delphi method. METHODS A 100-point scoping survey was created based on the deconstruction of MITG into its key technical steps through local and international expert opinion and literature evidence. An international expert panel comprising upper gastrointestinal and general surgeons participated in multiple rounds of a Delphi consensus. The panelists voted on the issues concerning importance, difficulty, or agreement using an online questionnaire. A priori consensus standard was set at > 80% for agreement to a statement. Internal consistency and reliability were evaluated using Cronbach's α. RESULTS Thirty expert upper gastrointestinal and general surgeons participated in three online Delphi rounds, generating a final consensus of 41 statements regarding MITG for gastric cancer. The consensus was gained from 22, 12, and 7 questions from Delphi rounds 1, 2, and 3, which were rephrased into the 41 statetments respectively. For lymphadenectomy and aspects of anastomosis creation, Cronbach's α for round 1 was 0.896 and 0.886, and for round 2 was 0.848 and 0.779, regarding difficulty or importance. CONCLUSIONS The Delphi consensus defined 41 steps as crucial for performing a high-quality MITG for oncological indications based on the standards of an international panel. The results of this consensus provide a platform for creating and validating surgical quality assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.
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Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Ivan Romic
- Department of Hepatobiliary Surgery & Liver Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Barabino
- Department of Surgical Sciences & Integrated Diagnostic, University of Genoa, Genoa, Italy
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, 4121, Ferrara, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Branko Bakula
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Carmen Balagué
- Department of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Vasile Bintintan
- Department of Surgery, University Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Umberto Bracale
- General and Emergency Surgical Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, AOU San Giovanni and Ruggi D'Aragona, Salerno, Italy
| | | | - Hans F Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Peter Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Arul Immanuel
- Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Daniel Korr
- Department of Surgery, Israelit Hospital, Hamburg, Germany
| | - Philipp Lingohr
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Pietro Mascagni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131, Naples, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, University Hospital Virgen Macarena, School of Medicine of the University of Seville, Seville, Spain
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias Reeh
- Department of General, Visceral and Vascular Surgery, Marienkrankenhaus, Hamburg, Germany
| | - Pierpaolo Sileri
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | | | - Yuki Ushimaru
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Sheraz Markar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anuja T Mitra
- Department of Surgery & Cancer, Imperial College London, London, UK
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2
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Balla A, Saraceno F, Shalaby M, Gallo G, Di Saverio S, De Nardi P, Perinotti R, Sileri P. Surgeons' practice and preferences for the anal fissure treatment: results from an international survey. Updates Surg 2023; 75:2279-2290. [PMID: 37805973 DOI: 10.1007/s13304-023-01661-x] [Citation(s) in RCA: 1] [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: 08/28/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.
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Affiliation(s)
- Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy
| | - Mostafa Shalaby
- Department of General Surgery, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Paola De Nardi
- Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Roberto Perinotti
- General Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy
| | - Pierpaolo Sileri
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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3
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Abstract
Lay Summary
Muscular health, encompassing sarcopenia and myosteatosis, has a pivotal role in optimizing surgical outcomes in patients with Crohn’s disease. A comprehensive approach is advocated for improving patient well-being after surgery.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Pierpaolo Sileri
- Division of Coloproctology and IBD Surgery, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvio Danese
- Division of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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4
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Ortenzi M, Guerrieri M, Saraceno F, Reggiani A, Lepiane P, Sileri P, Balla A. Prospective Italian validation of the Vaizey and Wexner and fecal incontinence severity index (FISI) questionnaires. Updates Surg 2023; 75:1617-1623. [PMID: 37368229 DOI: 10.1007/s13304-023-01567-8] [Citation(s) in RCA: 1] [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: 04/04/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
Several objective severity measurement questionnaires of the fecal incontinence (FI), are available to describe type, frequency and degree of FI, and their impact on quality of life, aiming to establish baseline scores measure response to treatment over time and allow comparison among patients treated using different strategies. Presently, despite their widespread use in clinical practice, none of these questionnaire have been validated in the Italian language. The aim is to test the translated Italian version of the Vaizey and Wexner and Fecal Incontinence Severity Index (FISI) questionnaires assessing their reliability and validity among Italian-speaking patients. Two researchers proficient in spoken English and Italian translated both questionnaires in the Italian language. They independently translated the two questionnaires from English and then they met to produce a single version of the two questionnaires, to solve any possible discrepancy. A forward-backward translation was then obtained by a professional bilingual translator, so as to define the final version of the questionnaires. The questionnaires were independently administered twice to 100 Italian-speaking patients by two different and independent raters. Cronbach's α of the first and second Vaizey and Wexner questionnaire was 0.755 and 0.727, respectively. While Cronbach's α of the first and second FISI questionnaire was 0.810 and 0.806, respectively. Spearman correlation and inter-rater reliability were 0.937 and 0.913 for Vaizey and Wexner questionnaire, respectively, and 0.915 and 0.871 for FISI questionnaire, respectively. Italian version of the Vaizey and Wexner and FISI questionnaires proved good consistency, reliability, reproducibility, showing good psychometric properties.
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Affiliation(s)
- Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Angelica Reggiani
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Pierpaolo Sileri
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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5
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Balla A, Saraceno F, Rullo M, Morales-Conde S, Targarona Soler EM, Di Saverio S, Guerrieri M, Lepiane P, Di Lorenzo N, Adamina M, Alarcón I, Arezzo A, Bollo Rodriguez J, Boni L, Biondo S, Carrano FM, Chand M, Jenkins JT, Davies J, Delgado Rivilla S, Delrio P, Elmore U, Espin-Basany E, Fichera A, Flor Lorente B, Francis N, Gómez Ruiz M, Hahnloser D, Licardie E, Martinez C, Ortenzi M, Panis Y, Pastor Idoate C, Paganini AM, Pera M, Perinotti R, Popowich DA, Rockall T, Rosati R, Sartori A, Scoglio D, Shalaby M, Simó Fernández V, Smart NJ, Spinelli A, Sylla P, Tanis PJ, Valdes-Hernandez J, Wexner SD, Sileri P. Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective? Colorectal Dis 2022; 25:647-659. [PMID: 36527323 DOI: 10.1111/codi.16454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/20/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 12/30/2022]
Abstract
AIM The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. METHOD Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. RESULTS Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). CONCLUSION The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Marika Rullo
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', University of Sevilla, Sevilla, Spain
| | - Eduardo M Targarona Soler
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Michel Adamina
- Department of Surgery, Kantonsspital Winterthur and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', University of Sevilla, Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Jesus Bollo Rodriguez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Francesco Maria Carrano
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Manish Chand
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John T Jenkins
- Department of Colorectal Surgery, North West London NHS Trust, St Mark's Hospital, London, UK
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | | | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale Dei Tumori, IRCCS Fondazione Pascale, Napoli, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessandro Fichera
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Texas, Dallas, USA
| | - Blas Flor Lorente
- Digestive Surgery Department, 'La Fe' University Hospital, Valencia, Spain
| | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marcos Gómez Ruiz
- Colorectal Surgery Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.,Valdecilla Biomedical Research Institute, IDIVAL, Santander, Spain
| | | | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Carmen Martinez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Hôpital Beaujon, Clichy, France
| | - Carlos Pastor Idoate
- Division of Colorectal Surgery, Department of General Surgery, University Clinic of Navarre, Madrid, Spain
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy
| | - Miguel Pera
- Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Roberto Perinotti
- Department of General Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy
| | | | - Timothy Rockall
- General Surgery at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Alberto Sartori
- Department of General and Emergency Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Daniele Scoglio
- Department of General Surgery, AULSS 4 Veneto Orientale, San Donà di Piave General Hospital, San Donà di Piave, Italy
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | | | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy
| | | | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Javier Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Florida, Weston, USA
| | - Pierpaolo Sileri
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
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Bissacco D, Carrano FM, De Rossi LM, Abbatemarco N, Di Lorenzo N, Casana R, Sileri P. Blockchain technology in healthcare: Do we really need it? Health Policy and Technology 2022. [DOI: 10.1016/j.hlpt.2022.100716] [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: 12/24/2022]
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7
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Wexner S, Abu-Gazala M, Boni L, Buxey K, Cahill R, Carus T, Chadi S, Chand M, Cunningham C, Emile SH, Fingerhut A, Foo CC, Hompes R, Ioannidis A, Keller DS, Knol J, Lacy A, de Lacy FB, Liberale G, Martz J, Mizrahi I, Montroni I, Mortensen N, Rafferty JF, Rickles AS, Ris F, Safar B, Sherwinter D, Sileri P, Stamos M, Starker P, Van den Bos J, Watanabe J, Wolf JH, Yellinek S, Zmora O, White KP, Dip F, Rosenthal RJ. Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey. Surgery 2022; 172:S38-S45. [PMID: 36427929 DOI: 10.1016/j.surg.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable.
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Affiliation(s)
- Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
| | | | - Luigi Boni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Italy
| | - Kenneth Buxey
- Sandringham Hospital, Alfred Health, Melbourne, Australia
| | - Ronan Cahill
- UCD Centre of Precision Surgery, University College Dublin, Dublin, Ireland
| | - Thomas Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - Sami Chadi
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Roel Hompes
- Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | | | - Deborah S Keller
- University of California at Davis Medical Center, Sacramento, CA
| | - Joep Knol
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | - Antonio Lacy
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | | | - Gabriel Liberale
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Ido Mizrahi
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | - Frederic Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | | | | | | | | | | | | | - Jun Watanabe
- Yokohama City University Medical Center, Yokohama, Japan
| | - Joshua H Wolf
- Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, MD
| | | | | | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
| | - Fernando Dip
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Raul J Rosenthal
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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8
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Massimino L, Spanò S, Lamparelli LA, Fuggetta D, Peyrin-Biroulet L, Sileri P, Danese S, D'Alessio S, Ungaro F. Tofacitinib Inhibits Leukocyte Trafficking Across the Intestinal Endothelial Barrier in a Specific Cohort of Ulcerative Colitis Patients. Inflamm Bowel Dis 2022; 28:971-976. [PMID: 35032171 DOI: 10.1093/ibd/izab349] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 12/09/2022]
Abstract
Lay Summary
The JAK/STAT inhibitor tofacitinib, recently approved for the treatment of ulcerative colitis, is found to modulate the intestinal endothelial barrier functions in directing the leukocyte adhesion and transmigration in ulcerative colitis patients displaying high levels of endothelial STAT3/STAT6 phosphorylation.
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Affiliation(s)
- Luca Massimino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy
| | - Salvatore Spanò
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy
| | - Luigi Antonio Lamparelli
- Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Davide Fuggetta
- Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE, University of Lorraine, Vandoeuvre-les-Nancy, France.,Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - Pierpaolo Sileri
- Gastrointestinal Surgery Unit, IRCCS Ospedale San Raffaele, MilanItaly
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Federica Ungaro
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy.,Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
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9
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D'Amico F, Tasopoulou O, Fiorino G, Zilli A, Furfaro F, Allocca M, Sileri P, Spinelli A, Peyrin-Biroulet L, Danese S. Early Biological Therapy in Operated Crohn's Disease Patients Is Associated With a Lower Rate of Endoscopic Recurrence and Improved Long-term Outcomes: A Single-center Experience. Inflamm Bowel Dis 2022; 29:539-547. [PMID: 35640113 PMCID: PMC10069661 DOI: 10.1093/ibd/izac110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/25/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Two-thirds of Crohn's disease (CD) patients require surgery during their disease course. However, surgery is not curative, and endoscopic recurrence is observed in up to 90% of cases. Our aim was to investigate the impact of postoperative biological therapy on the incidence of endoscopic recurrence and long-term outcomes in CD patients. METHODS This retrospective cohort study was conducted at the Humanitas Research Hospital-IRCCS (Milan, Italy) between 2014 and 2021. All consecutive CD patients who underwent surgery and colonoscopy at 6-12 months postoperatively were eligible for inclusion. RESULTS A total of 141 patients were included (42.6% female, mean age 44 years). Median follow-up was 28 months. About one-third of patients were treated with biologics at baseline colonoscopy. A higher rate of endoscopic recurrence was detected in patients without biologic therapy at the time of colonoscopy compared with those treated (80.8% vs 45.2%, P < .0001). Hospitalization and surgery occurred more in untreated patients than in subjects undergoing biological therapy (12.1% vs 0.0%, P = .01). The Kaplan-Meier curves showed that the no treatment group at baseline had a >23.3% 5-year rate of hospitalization and surgery (log-rank P = .0221) and a >49.7% 5-year rate of medical therapy escalation (log-rank P = .0013) compared with the treatment arm. In the logistic regression model, absence of biologic therapy was independently associated with the risk of endoscopic disease recurrence (odds ratio, 0.22; 95% CI, 0.1-0.51; P = .0004). CONCLUSION Operated CD patients treated early with biologics experience decreased rates of endoscopic recurrence and improved long-term outcomes.
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Affiliation(s)
- Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Olga Tasopoulou
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Pierpaolo Sileri
- Gastrointestinal Surgery Unit, IRCCS Ospedale San Raffaele, Milan Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France.,University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
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10
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Scardino A, Tebala GD, Giuliani A, Sileri P, Pata F, Gallo G, Podda M, Quaresima S, Di Saverio S. Pushing the boundaries of TAMIS : Transanal minimally invasive surgery (TAMIS) resection of a very large circumferential rectal polyp with combined laparoscopy for a synchronous right colonic lesion. Tech Coloproctol 2022; 26:915-917. [PMID: 35608717 DOI: 10.1007/s10151-022-02619-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Andrea Scardino
- Department of General Surgery, Luigi Sacco Hospital, Università degli Studi of Milan, Milan, Italy
| | - Giovanni Domenico Tebala
- Surgical Emergency Unit, Department of General Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonio Giuliani
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University of Rome, Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, O.U. of General Surgery, University of Catanzaro, Catanzaro, Italy.,Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Salomone Di Saverio
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy. .,Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,General Surgery, AV5 Asur Marche, San Benedetto del Tronto, Italy.
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11
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Balla A, Saraceno F, Di Saverio S, Di Lorenzo N, Lepiane P, Guerrieri M, Sileri P. Correction to: Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study. Updates Surg 2022; 74:1175. [PMID: 35366182 PMCID: PMC8976266 DOI: 10.1007/s13304-022-01289-3] [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: 11/29/2022]
Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Pierpaolo Sileri
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
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12
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Balla A, Saraceno F, Di Saverio S, Di Lorenzo N, Lepiane P, Guerrieri M, Sileri P. Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study. Updates Surg 2022; 74:1017-1025. [PMID: 35322388 PMCID: PMC8942758 DOI: 10.1007/s13304-022-01274-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
Abstract
During the corona virus disease 2019 (COVID-19) pandemic, most of the surgical procedures were performed for emergencies or oncologic reasons to the detriment of the remaining elective procedures for benign conditions. Ileostomy or colostomy creation are sequelae of oncologic or emergency colorectal surgery, but their closure does not fall within the definition of oncologic or emergency surgery. The aim of this retrospective multicentre observational study is to report the impact of COVID-19 pandemic on the ostomy closure rate in Italy. Data regarding ileostomy and colostomy creation and closure from 24 Italian centres, during the study period (March 2020–February 2021) and during the control period (March 2019–February 2020) were collected. Three hospitals (12.5%) were COVID free. The number of colostomies and ileostomies created and closed in the same period was lower ( -18.8% and -30%, respectively) in the study period in comparison to the control period (p = 0.1915 and p = 0.0001, respectively), such as the ostomies closed in the analysed periods but created before (colostomy -36.2% and ileostomy -7.4%, p = 0.2211 and p = 0.1319, respectively). Overall, a 19.5% reduction in ostomies closed occurred in the study period. Based on the present study, a reduction in ostomy closure rate occurred in Italy between March 2020 and February 2021. During the pandemic, the need to change the clinical practice probably prolonged deterioration of quality of life in patients with ostomies, increasing number of stomas that will never be closed, and related management costs, even if these issues have not been investigated in this study.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Pierpaolo Sileri
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
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13
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Akingboye AA, Khalid S, Broggi R, Scorza A, Todero S, Sileri P, Di Saverio S. Perineal stapled prolapse resection (PSPR) for full thickness external large rectal prolapse in a frail elderly patient; An easy to teach and reproducible novel technique - a video vignette. Colorectal Dis 2021; 23:3040-3041. [PMID: 34449955 DOI: 10.1111/codi.15883] [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: 05/08/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Akinfemi A Akingboye
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Khalid
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Riccardo Broggi
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | - Antonella Scorza
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | - Sofia Todero
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | | | - Salomone Di Saverio
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.,Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy.,General Surgery Department, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy.,General Surgery, Dipartimento di Chirurgia Generale e Specialistica, Paride Stefanini La Sapienza University of Rome, Rome, Italy
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14
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Crispo A, Bimonte S, Porciello G, Forte CA, Cuomo G, Montagnese C, Prete M, Grimaldi M, Celentano E, Amore A, de Blasio E, Pentimalli F, Giordano A, Botti G, Baglio G, Sileri P, Cascella M, Cuomo A. Strategies to evaluate outcomes in long-COVID-19 and post-COVID survivors. Infect Agent Cancer 2021; 16:62. [PMID: 34717691 PMCID: PMC8556851 DOI: 10.1186/s13027-021-00401-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/16/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
SARS-CoV-2 infection can impact the physical, cognitive, mental health of patients, especially in those recovered in intensive care units. Moreover, it was proved that the effects of the virus may persist for weeks or months. The term long-COVID or post-COVID syndrome is commonly used for indicating a variety of physical and psychological symptoms that continue after the resolution of the acute phase. This narrative review is aimed at providing an updated overview of the impact of physical, cognitive, and psychological health disorders in COVID-19 survivors, by summarizing the data already published in literature in the last year. Studies cited were found through PubMed searches. We also presented an overview of the post-COVID-19 health consequences on three important aspects: nutritional status, neurological disorders, and physical health. Moreover, to activate a correct health planning policy, a multidisciplinary approach for addressing the post- COVID-19 issue, has been proposed. Finally, the involvement of health professionals is necessary even after the pandemic, to reduce expected post-pandemic psychosocial responses and mental health disorders.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy.
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Gaia Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Alfonso Amore
- SSD Chirurgia Melanoma E Dei Tumori Cutanei, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Elvio de Blasio
- Multidisciplinary Emergency Unit for COVID-19 Campania, 80100, Naples, Italy
| | - Francesca Pentimalli
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Antonio Giordano
- Ministry of Health, 00153, Rome, Italy.,Center for Biotechnology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA, 19122, USA
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giovanni Baglio
- Head of the Unit "Research and International Relations", Italian National Agency for Regional Health Services - AGENAS, 00187, Rome, Italy
| | | | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
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15
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Di Saverio S, Stasinos K, Stupalkowska W, Bracale U, Sileri P, Giuliani A, Nigri G, Kouroumpas E, Wheeler JMD, Tebala GD, Di Marzo F, De Simone B, Idoate CP, De Angelis N, Cirocchi R, Tejedor P. Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels. Langenbecks Arch Surg 2021; 407:421-428. [PMID: 34269879 PMCID: PMC8847254 DOI: 10.1007/s00423-021-02240-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/09/2021] [Indexed: 01/15/2023]
Abstract
Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02240-7.
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Affiliation(s)
- Salomone Di Saverio
- Department of General Surgery, University Hospital of Varese, University of Insubria, Varese, Italy. .,Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Box 201, Cambridge, CB2 0QQ, UK.
| | - Kostantinos Stasinos
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Box 201, Cambridge, CB2 0QQ, UK
| | - Weronyka Stupalkowska
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Box 201, Cambridge, CB2 0QQ, UK
| | | | | | | | | | - Efstratios Kouroumpas
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Box 201, Cambridge, CB2 0QQ, UK
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16
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Pengermä P, Katunin J, Turunen A, Sileri P, Giarratano G, Palomäki A, Kechagias A. Appendiceal perforation due to biliary stent migration in a neutropenic patient with lung cancer receiving chemotherapy: A case report. Mol Clin Oncol 2021; 15:136. [PMID: 34055351 DOI: 10.3892/mco.2021.2298] [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: 02/25/2020] [Accepted: 01/21/2021] [Indexed: 01/20/2023] Open
Abstract
The use of biliary stents has become a common and usually safe procedure. However, the migration of biliary stents is an uncommon but well-recognized event after endoscopic retrograde cholangiopancreatography. The migration of plastic stents usually does not result in complications and are spontaneously eliminated from the gastro-intestinal tract. Additionally, <1% of migrated stents result in intestinal perforation, which typically occurs at the duodenum. Chemotherapeutic agents may cause gastrointestinal toxicity and hematologic toxicity predisposing to neutropenic enterocolitis. The current study reports a patient with an unprecedented case of biliary stent migration resulting in appendiceal gangrene and perforation in a neutropenic patient under chemotherapy for metastatic small cell lung cancer.
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Affiliation(s)
- Pasi Pengermä
- Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna 13530, Finland.,Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio 70210, Finland
| | - Jevgeni Katunin
- Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna 13530, Finland
| | - Arto Turunen
- Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna 13530, Finland
| | - Pierpaolo Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milan I-20132, Italy
| | - Gabriella Giarratano
- Department of General Surgery, Casa di Cura Nuova Itor, Rome I-00158, Italy.,Department of General Surgery, University of Rome Tor Vergata, Rome I-00133, Italy
| | - Ari Palomäki
- Department of Emergency Medicine, Kanta-Häme Central Hospital, Hämeenlinna 13530, Finland
| | - Aristotelis Kechagias
- Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna 13530, Finland
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17
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Picciariello A, O'Connell PR, Hahnloser D, Gallo G, Munoz-Duyos A, Schwandner O, Sileri P, Milito G, Riss S, Boccasanta PA, Naldini G, Arroyo A, de laPortilla F, Tsarkov P, Roche B, Isbert C, Trompetto M, d'Hoore A, Matzel K, Xynos E, Lundby L, Ratto C, Consten E, Infantino A, Panis Y, Terrosu G, Espin E, Faucheron JL, Guttadauro A, Adamina M, Lehur PA, Altomare DF. Obstructed defaecation syndrome: European consensus guidelines on the surgical management. Br J Surg 2021; 108:1149-1153. [PMID: 33864061 DOI: 10.1093/bjs/znab123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Management of obstructed defaecation is challenging and remains controversial. No international guidelines have been published.
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Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Munoz-Duyos
- Department of General Surgery, Colorectal Unit, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - O Schwandner
- Department of Proctology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - P Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milano, Italy
| | - G Milito
- Department of Surgery, Tor Vergata University, Rome, Italy
| | - S Riss
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - P A Boccasanta
- Istituto Humanitas Gavazzeni & Castelli, Proctology and Perineology Surgical Unit, Bergamo, Italy
| | - G Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - A Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Alicante, Spain
| | - F de laPortilla
- Gastrointestinal Surgery Department, Coloproctology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - P Tsarkov
- I. M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia
| | - B Roche
- Division of Digestive Surgery, Proctology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - C Isbert
- Department of General, Gastrointestinal and Colorectal Surgery, Amalie Sieveking Hospital, Hamburg, Germany
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - A d'Hoore
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - K Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
| | - E Xynos
- Department of Surgery, Creta Interclinic Hospital of Heraklion, Heraklion, Greece
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - C Ratto
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - E Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Infantino
- Department of Surgery, General Surgery Unit, Santa Maria dei Battuti Hospital, Pordenone, Italy
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - G Terrosu
- General Surgery and Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy
| | - E Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France
| | - A Guttadauro
- General Surgery Department, University of Milano-Bicocca, Istituti Clinici Zucchi, Monza, Italy
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - P A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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18
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Di Saverio S, Gallo G, Davies RJ, Bergamaschi R, Wheeler J, Sileri P, Fearnhead N. Robotic-assisted transanal total mesorectal excision for rectal cancer: more questions than answers. Tech Coloproctol 2021; 25:987-988. [PMID: 33449254 DOI: 10.1007/s10151-020-02402-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/25/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
- S Di Saverio
- General Surgery Unit 1, Ospedale Di Circolo, Department of General Surgery, University of Insubria, University, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - R J Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK
| | - R Bergamaschi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - J Wheeler
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK
| | - P Sileri
- Colorectal Unit, University Vita-Salute San Raffaele, Milan, Italy
| | - N Fearnhead
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK
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19
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Stupalkowska W, Khalid S, Akingboye A, Sileri P, Di Carlo I, Di Saverio S. Laparoscopic reversal of Hartmann's procedure for perforated diverticulitis - a video vignette. Colorectal Dis 2021; 23:333. [PMID: 33128272 DOI: 10.1111/codi.15417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Weronika Stupalkowska
- Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah Khalid
- Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Akinfemi Akingboye
- Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pierpaolo Sileri
- Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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20
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Giarratano G, Shalaby M, Toscana C, Sileri P. Single-stapled parachute technique for grade IV prolapsed haemorrhoids - a video vignette. Colorectal Dis 2020; 22:1800-1801. [PMID: 32609921 DOI: 10.1111/codi.15226] [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: 05/03/2020] [Accepted: 06/09/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Giarratano
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy.,Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Shalaby
- Department of General Surgery, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - C Toscana
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy
| | - P Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milan, Italy
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21
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Giarratano G, Shalaby M, Toscana C, Sileri P. Video-assisted anal fistula treatment for complex anal fistula: a long-term follow-up study. Colorectal Dis 2020; 22:939-944. [PMID: 32030874 DOI: 10.1111/codi.15005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/25/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
AIM This prospective study aimed to evaluate the safety and efficacy of video-assisted anal fistula treatment (VAAFT) in complex fistula-in-ano (FIA). METHOD Consecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula. RESULTS Seventy-two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow-up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention. CONCLUSION VAAFT represents a promising, sphincter-saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter-saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.
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Affiliation(s)
- G Giarratano
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy.,Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Shalaby
- Department of General Surgery, Mansoura University, Mansoura, Egypt.,Department of General Surgery UOC C, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - C Toscana
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.,Department of General Surgery UOC C, Policlinico Tor Vergata University Hospital, Rome, Italy
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22
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Correale P, Mutti L, Pentimalli F, Baglio G, Saladino RE, Sileri P, Giordano A. HLA-B*44 and C*01 Prevalence Correlates with Covid19 Spreading across Italy. Int J Mol Sci 2020; 21:ijms21155205. [PMID: 32717807 PMCID: PMC7432860 DOI: 10.3390/ijms21155205] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
The spread of COVID-19 is showing huge, unexplained, differences between northern and southern Italy. We hypothesized that the regional prevalence of specific class I human leukocyte antigen (HLA) alleles, which shape the anti-viral immune response, might partly underlie these differences. Through an ecological approach, we analyzed whether a set of HLA alleles (A, B, C), known to be involved in the immune response against infections, correlates with COVID-19 incidence. COVID-19 data were provided by the National Civil Protection Department, whereas HLA allele prevalence was retrieved through the Italian Bone-Marrow Donors Registry. Among all the alleles, HLA-A*25, B*08, B*44, B*15:01, B*51, C*01, and C*03 showed a positive log-linear correlation with COVID-19 incidence rate fixed on 9 April 2020 in proximity of the national outbreak peak (Pearson’s coefficients between 0.50 and 0.70, p-value < 0.0001), whereas HLA-B*14, B*18, and B*49 showed an inverse log-linear correlation (Pearson’s coefficients between −0.47 and −0.59, p-value < 0.0001). When alleles were examined simultaneously using a multiple regression model to control for confounding factors, HLA-B*44 and C*01 were still positively and independently associated with COVID-19: a growth rate of 16% (95%CI: 0.1–35%) per 1% point increase in B*44 prevalence; and of 19% (95%CI: 1–41%) per 1% point increase in C*01 prevalence. Our epidemiologic analysis, despite the limits of the ecological approach, is strongly suggestive of a permissive role of HLA-C*01 and B*44 towards SARS-CoV-2 infection, which warrants further investigation in case-control studies. This study opens a new potential avenue for the identification of sub-populations at risk, which could provide Health Services with a tool to define more targeted clinical management strategies and priorities in vaccination campaigns.
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Affiliation(s)
- Pierpaolo Correale
- Unit of Medical Oncology, Oncology Department, Grand Metropolitan Hospital ‘Bianchi Melacrino Morelli’, I-89124 Reggio Calabria, Italy;
| | - Luciano Mutti
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
| | - Francesca Pentimalli
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, I-80131 Napoli, Italy;
| | | | - Rita Emilena Saladino
- Tissue Typing Unit, Grand Metropolitan Hospital ‘Bianchi Melacrino Morelli’, I-89124 Reggio Calabria, Italy;
| | | | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
- Department of Medical Biotechnologies, University of Siena, I-53100 Siena, Italy
- Correspondence: ; Tel.: +1-215-204-9520; Fax: +1-215-204-9522
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23
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Di Saverio S, Pata F, Gallo G, Carrano F, Scorza A, Sileri P, Smart N, Spinelli A, Pellino G. Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience. Colorectal Dis 2020; 22:625-634. [PMID: 32233064 DOI: 10.1111/codi.15056] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [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: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
AIM The current COVID-19 pandemic is challenging healthcare systems at a global level. We provide a practical strategy to reorganize pathways of emergency and elective colorectal surgery during the COVID-19 pandemic. METHOD The authors, all from areas affected by the COVID-19 emergency, brainstormed remotely to define the key-points to be discussed. Tasks were assigned, concerning specific aspects of colorectal surgery during the pandemic, including the administrative management of the crisis in Italy. The recommendations (based on experience and on the limited evidence available) were collated and summarized. RESULTS Little is known about the transmission of COVID-19, but it has shown a rapid spread. It is prudent to stop non-cancer procedures and prioritize urgent cancer treatment. Endoscopy and proctological procedures should be performed highly selectively. When dealing with colorectal emergencies, a conservative approach is advised. Specific procedures should be followed when operating on COVID-19-patients, using dedicated personal protective equipment and adhering to specific rules. Some policies are described, including minimally-invasive surgery. These policies outline the strict regulation of entry/ exit into theatres and operating building as well as advice on performing procedures safely to reduce risk of spreading the virus. It is likely that a reorganization of health system is required, both at central and local levels. A description of the strategy adopted in Italy is provided. CONCLUSION Evidence on the management of patients needing surgery for colorectal conditions during the COVID-19 pandemic is currently lacking. Lessons learnt from healthcare professionals that have managed high volumes of surgical patients during the pandemic could be useful to mitigate some risks and reduce exposure to other patients, public and healthcare staff.
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Affiliation(s)
- S Di Saverio
- Department of General Surgery, ASST Sette Laghi, University Hospital of Varese, University of Insubria, Regione Lombardia, Italy
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Rome, Italy
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Carrano
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital IRCCS, Milano, Italy
| | - A Scorza
- Department of General Surgery, ASST Sette Laghi, University Hospital of Varese, University of Insubria, Regione Lombardia, Italy
| | - P Sileri
- Vice Minister of Health, Italian Government, Rome, Italy.,San Raffaele Università Vita Salute, Milan, Italy
| | - N Smart
- Research Unit, Exeter Surgical Health Services, Royal Devon & Exeter Hospital, Exeter, Devon, UK.,Editor-in-Chief, Colorectal Disease
| | - A Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital IRCCS, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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24
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Milone M, Degiuli M, Allaix ME, Ammirati CA, Anania G, Barberis A, Belli A, Bianchi PP, Bianco F, Bombardini C, Burati M, Cavaliere D, Coco C, Coratti A, De Luca R, De Manzoni G, De Nardi P, De Rosa M, Delrio P, Di Cataldo A, Di Leo A, Donini A, Elmore U, Fontana A, Gallo G, Gentilli S, Giannessi S, Giuliani G, Graziosi L, Guerrieri M, Li Destri G, Longhin R, Manigrasso M, Mineccia M, Monni M, Morino M, Ortenzi M, Pecchini F, Pedrazzani C, Piccoli M, Pollesel S, Pucciarelli S, Reddavid R, Rega D, Rigamonti M, Rizzo G, Robustelli V, Rondelli F, Rosati R, Roviello F, Santarelli M, Saraceno F, Scabini S, Sica GS, Sileri P, Simone M, Siragusa L, Sofia S, Solaini L, Tribuzi A, Trompetto M, Turri G, Urso EDL, Vertaldi S, Vignali A, Zuin M, Zuolo M, D'Ugo D, De Palma GD. Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study. Eur J Surg Oncol 2020; 46:1683-1688. [PMID: 32220542 DOI: 10.1016/j.ejso.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/07/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
| | - M Degiuli
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - M E Allaix
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - C A Ammirati
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - A Barberis
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - A Belli
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - P P Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - F Bianco
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - C Bombardini
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - M Burati
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - D Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - C Coco
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - A Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - R De Luca
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - G De Manzoni
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - P De Nardi
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - P Delrio
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - A Di Cataldo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - A Di Leo
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - A Donini
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - U Elmore
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - A Fontana
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - S Gentilli
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - S Giannessi
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - G Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - L Graziosi
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - G Li Destri
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - R Longhin
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - M Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - M Mineccia
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - M Monni
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - F Pecchini
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - C Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - M Piccoli
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - S Pollesel
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - S Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - R Reddavid
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - D Rega
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - M Rigamonti
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - G Rizzo
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - V Robustelli
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - F Rondelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - R Rosati
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - F Roviello
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - M Santarelli
- Division of General and Emergency Surgery, Molinette Hospital, Turin, Italy
| | - F Saraceno
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Scabini
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G S Sica
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Simone
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - L Siragusa
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - S Sofia
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - L Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - A Tribuzi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - E D L Urso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - S Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Vignali
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M Zuin
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - M Zuolo
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - D D'Ugo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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25
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Shalaby M, Thabet W, Morshed M, Farid M, Sileri P. Preventive strategies for anastomotic leakage after colorectal resections: A review. World J Meta-Anal 2019; 7:389-398. [DOI: 10.13105/wjma.v7.i8.389] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023] Open
Abstract
Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.
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Affiliation(s)
- Mostafa Shalaby
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
- Department of General Surgery UOC C, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome 00133, Italy
| | - Waleed Thabet
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Mosaad Morshed
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Mohamed Farid
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Pierpaolo Sileri
- Department of General Surgery UOC C, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome 00133, Italy
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Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Outcome of laparoscopic ventral mesh rectopexy for full-thickness external rectal prolapse: a systematic review, meta-analysis, and meta-regression analysis of the predictors for recurrence. Surg Endosc 2019; 33:2444-2455. [PMID: 31041515 DOI: 10.1007/s00464-019-06803-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 12/17/2018] [Accepted: 04/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) has proved effective in the treatment of internal and external rectal prolapse. The present meta-analysis aimed to determine the predictive factors of recurrence of full-thickness external rectal prolapse after LVMR. METHODS An organized, systematic search of electronic databases including PubMed/Medline, Embase, Scopus, and Cochran library was conducted in adherence to PRISMA guidelines. Studies that reported the outcome of LVMR in patients with full-thickness external rectal prolapse were included according to predefined criteria. A meta-regression analysis and sub-group meta-analyses were performed to recognize the patient and technical factors that were associated with higher recurrence rates. RESULTS Seventeen studies comprising 1242 patients of a median age of 60 years were included. The median operation time was 122.3 min. Conversion to open surgery was required in 22 (1.8%) patients. The weighted mean complication rate across the studies was 12.4% (95% CI 8.4-16.4) and the weighted mean rate of recurrence of full-thickness external rectal prolapse was 2.8% (95% CI 1.4-4.3). The median follow-up duration was 23 months. Male gender (SE = 0.018, p = 0.008) and length of the mesh (SE = - 0.007, p = 0.025) were significantly associated with full-thickness recurrence of rectal prolapse. The weighted mean rates of improvement in fecal incontinence and constipation after LVMR were 79.3% and 71%, respectively. CONCLUSION LVMR is an effective and safe option in treatment of full-thickness external rectal prolapse with low recurrence and complication rates. Male patients and length of the mesh may potentially have a significant impact on recurrence of rectal prolapse after LVMR.
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Affiliation(s)
- Sameh Hany Emile
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, PO: 35516, 60 Elgomhuoria Street, Mansoura, Egypt.
| | - Hossam Elfeki
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, PO: 35516, 60 Elgomhuoria Street, Mansoura, Egypt.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, PO: 35516, 60 Elgomhuoria Street, Mansoura, Egypt.,Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ahmad Sakr
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, PO: 35516, 60 Elgomhuoria Street, Mansoura, Egypt.,Colorectal Surgery Department, Yonsei University College of Medicine, Seoul, South Korea
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Giarratano G, Toscana C, Toscana E, Shalaby M, Sileri P. Stapled transanal rectal resection for the treatment of rectocele associated with obstructed defecation syndrome: a large series of 262 consecutive patients. Tech Coloproctol 2019; 23:231-237. [PMID: 30778786 DOI: 10.1007/s10151-019-01944-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/26/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aims to investigate functional results and recurrence rate after stapled transanal rectal resection (STARR) for rectocele associated with obstructive defection syndrome (ODS). METHODS A study was conducted on patients with ODS symptoms associated with symptomatic rectocele ≥ 3 cm on dynamic defecography who had STARR at our institution between 01/2007 and 12/2015. Data were prospectively collected and analyzed. ODS was evaluated using the Wexner constipation score. Primary outcomes were functional results, determined by the improvement in 6-month postoperative Wexner constipation score, and 1-year recurrence. Secondary outcomes were operative time, time to return to work, pain intensity measured using the visual analogue scale (VAS), patient satisfaction, and overall postoperative morbidity and mortality at 30 days. RESULTS Two-hundred-sixty-two consecutive female patients [median age 54 years (range 20-78)] were enrolled in the study. The median duration of follow-up was 79 months (range 30-138). Sixty (23%) patients experienced postoperative complications, but only 9 patients required reinterventions for surgical hemostasis (n = 7), fecal diversion for anastomotic leakage (n = 1), and recto-vaginal fistula repair (n = 1). Only 1 intraoperative complication (stapler misfire) was reported, and there were no deaths. There was a statistically significant (p < 0.001) reduction in the median (range) Wexner constipation score from 19 (14-24) preoperatively to 9 (5-15) 6 months postoperatively. Only 10 (4%) patients experienced recurrence and only 3 of them required additional reintervention. Patient satisfaction at 1 year was excellent in 86%, good in 13%, and poor in 1% of patients. CONCLUSIONS STARR is a safe, effective, and minimally invasive technique for the treatment of rectocele associated with ODS.
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Affiliation(s)
- G Giarratano
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy
| | - C Toscana
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy
| | - E Toscana
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy.
| | - M Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Dakahlia, Egypt.,Department of General Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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Sileri P, Mastrovito S, Nicoli F, Orlandi A, Shalaby M. Autotransplantation of autologous adipose tissue-derived mesenchymal stem cells to treat complex fistula-in-ano - the FLiRT technique - a video vignette. Colorectal Dis 2019; 21:247-249. [PMID: 30548913 DOI: 10.1111/codi.14531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Sileri
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy
| | - S Mastrovito
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy
| | - F Nicoli
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A Orlandi
- Department of Biomedicine and Prevention, Anatomic Pathology Section, University of Rome Tor Vergata, Rome, Italy
| | - M Shalaby
- Department of General Surgery UOC C, University of Rome Tor Vergata, Rome, Italy.,Department of General Surgery '8', University of Mansoura, Mansoura, Egypt
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Shalaby M, Thabet W, Rulli F, Palmieri F, Saraceno F, Capuano I, Buonomo O, Giarratano G, Petrella G, Morshed M, Farid M, Sileri P. Anastomotic leakage following laparoscopic resection of low and mid rectal cancer. Ann Ital Chir 2019; 90:57-67. [PMID: 30862768] [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: 06/09/2023]
Abstract
PURPOSE Anastomotic leakage is considered the commonest major complication after surgery for rectal cancer. MATERIALS AND METHODS Patients who underwent laparoscopic LAR or ULAR for rectal cancer were recruited. The primary outcome was the incidence of the AL during 30 days postoperative. RESULTS Fifty-nine consecutive patients were included in the study. Fifty-three patients underwent LAR with stapled colorectal anastomoses, while the remaining 6 patients underwent ULAR with hand-sewn coloanal anastomoses. The median duration of operation was 195 minutes (range; 120-315). The defunctioning ileostomy was created in 24 (7%) patients. Overall, there was no recorded mortality. Only 10 (17%) patients developed complications. There were only 4 patients who developed AL. Three patients had a subclinical AL as they had defunctioning ileostomy at the time of the initial procedure, the diagnosis was made by CT with rectal contrast. They were treated conservatively with transanal anastomotic drainage under endoscopic guidance. One patient had a clinically significant AL, demonstrated as a peritonitis. This patient required reoperation during which pelvic abscess was drained, resection of the previous anastomosis, and hartmann's colostomy was performed. CONCLUSION Standardization of a definition, as well as, criteria for the diagnosis of AL, will help in comparison of the results and the surgical techniques in order to optimize the required care offered to rectal cancer patients. On expert hands, it is feasible to perform a laparoscopic sphincter-saving total mesorectal excision, additionally, it provides the advantages of a clear view of the deep pelvis and facilitates a precise sharp dissection. KEY WORDS Anastomosis, Anastomotic Leakage, Rectal cancer, Total mesorectal excision.
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Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P. Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open 2018; 3:153-160. [PMID: 30957061 PMCID: PMC6433422 DOI: 10.1002/bjs5.50124] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022] Open
Abstract
Background Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leakage. The aim of this study was to evaluate the safety and efficacy of EVT in the treatment of anastomotic leakage and rectal stump insufficiency after Hartmann's procedure. Methods A systematic search of MEDLINE, Scopus and Cochrane databases was performed using search terms related to EVT and anastomotic leakage or rectal stump insufficiency in line with the PRISMA checklist. Observational studies, RCTs and case series studies published to July 2017 were included. Primary outcomes of the review were the success of EVT, defined as complete or partial healing of the anastomotic defect and associated cavity, and the rate of stoma reversal after EVT. Secondary outcomes included the duration of treatment to complete healing, complications of treatment and the need for further intervention. A meta-analysis was conducted. The potential effect of clinical confounders on the failure of EVT was investigated using the random-effects meta-regression model. Results Of 476 articles identified, 17 studies reporting on 276 patients were ultimately included. The weighted mean rate of success was 85·3 (95 per cent c.i. 80·1 to 90·5) per cent, with a median duration from inception of EVT to complete healing of 47 (range 40-105) days. The weighted mean rate of stoma reversal across the studies was 75·9 (64·6 to 87·2) per cent. Twenty-five patients (9·1 per cent) required additional interventions after EVT. Thirty-eight patients (13·8 per cent) developed complications. The weighted mean complication rate across the studies was 11·1 (6·0 to 16·2) per cent. Variables significantly associated with failure included preoperative radiotherapy, absence of diverting stoma, complications and male sex. Conclusion EVT is associated with a high rate of complete healing of anastomotic leakage and stoma reversal. It is an effective option in appropriately selected patients with anastomotic leakage.
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Affiliation(s)
- M Shalaby
- Department of General Surgery, Colorectal Surgery Unit Mansoura University Mansoura Egypt.,Department of General Surgery Rome Tor Vergata University Rome Italy
| | - S Emile
- Department of General Surgery, Colorectal Surgery Unit Mansoura University Mansoura Egypt
| | - H Elfeki
- Department of General Surgery, Colorectal Surgery Unit Mansoura University Mansoura Egypt.,Department of Surgery, Colorectal Surgery Unit Aarhus University Aarhus Denmark
| | - A Sakr
- Department of General Surgery, Colorectal Surgery Unit Mansoura University Mansoura Egypt
| | - S D Wexner
- Department of Colorectal Surgery Cleveland Clinic Florida Weston Florida USA
| | - P Sileri
- Department of General Surgery Rome Tor Vergata University Rome Italy
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Shalaby M, Thabet W, Buonomo O, Lorenzo ND, Morshed M, Petrella G, Farid M, Sileri P. Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection. Ann Coloproctol 2018; 34:317-321. [PMID: 30572421 PMCID: PMC6347340 DOI: 10.3393/ac.2017.10.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.
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Affiliation(s)
- Mostafa Shalaby
- Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy.,Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Waleed Thabet
- Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Oreste Buonomo
- Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Lorenzo
- Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mosaad Morshed
- Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Giuseppe Petrella
- Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mohamed Farid
- Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Pierpaolo Sileri
- Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy
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Lucchetti J, Formica V, Giuliano G, Coletta D, Gargano L, Morosetti D, Sileri P, Palmieri G, Roselli M. Case Report of a Patient with Breast Metastasis from Gastric Cancer Treated with Paclitaxel and Ramucirumab Plus Regional Hyperthermia. Anticancer Res 2018; 38:6561-6564. [PMID: 30396986 DOI: 10.21873/anticanres.13022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast metastases from extra mammary tumors are extremely rare. CASE REPORT Here we report the case of a 50-year-old female with histologically-confirmed gastric cancer metastasis to the breast who was adequately treated with loco-regional hyperthermia plus standard second-line chemotherapy (paclitaxel plus ramucirumab). The best response achieved was a relatively long disease stabilization. CONCLUSION Chemotherapy plus regional hyperthermia has been shown to have a synergistic antitumor effect and possible favorable immunomodulatory effects. Such an approach merits further investigation especially for the treatment of rare superficial metastatic sites.
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Affiliation(s)
| | | | - Greta Giuliano
- Medical Oncology Unit, Tor Vergata University, Rome, Italy
| | | | | | | | | | | | - Mario Roselli
- Medical Oncology Unit, Tor Vergata University, Rome, Italy
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Sileri P, Shalaby M. Correction to: Biological mesh extrusion months after laparoscopic ventral rectopexy. Tech Coloproctol 2018; 22:827. [PMID: 30324410 DOI: 10.1007/s10151-018-1868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/26/2022]
Abstract
Unfortunately, the 2nd affiliation of Dr. M. Shalaby has been missed out in the original publication. The complete 2nd affiliation of the same is given below.
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Affiliation(s)
- P Sileri
- University of Rome Tor Vergata, Rome, Italy.
| | - M Shalaby
- University of Rome Tor Vergata, Rome, Italy
- Department of General Surgery, Mansoura University, Mansoura, Egypt
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Shalaby M, Polisca P, Missori G, Sileri P. Correction to: Hiatal hernia, mitral valve prolapse and defecatory disorders: An underlying rectal prolapse? Tech Coloproctol 2018; 22:825. [PMID: 30324409 DOI: 10.1007/s10151-018-1867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/30/2022]
Abstract
Unfortunately, the 2nd affiliation of Shalaby has been missed out in the original publication.
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Affiliation(s)
- M Shalaby
- Department of General Surgery, Policlinico Tor Vergata di Roma UOC B, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - P Polisca
- Department of Internal Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - G Missori
- Department of General Surgery, Policlinico Tor Vergata di Roma UOC B, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - P Sileri
- Department of General Surgery, Policlinico Tor Vergata di Roma UOC B, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
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Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Correction to: Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33:1315. [PMID: 29987359 DOI: 10.1007/s00384-018-3127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/04/2023]
Abstract
The authors of the published version of this article missed to add the second affiliation of Mostafa Shalaby. The new affiliation is now added and presented correctly in this article. The remainder of the article remains unchanged.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - José D Subiela
- Department of Urology, Fundació Puigvert, Carrer de Cartegena 340, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. No Mystification, Perhaps Some Misunderstanding. Surg Innov 2018; 25:538-539. [PMID: 30020030 DOI: 10.1177/1553350618788941] [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: 11/15/2022]
Affiliation(s)
| | | | | | | | - Mostafa Shalaby
- 2 University of Rome Tor Vergata, Rome, Italy.,3 Mansoura University, Mansoura, Dakahlia, Egypt
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Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33:835-847. [PMID: 29744578 DOI: 10.1007/s00384-018-3082-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE "Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. METHODS We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. RESULTS Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71 days. CONCLUSIONS Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - José D Subiela
- Department of Urology, Fundació Puigvert, Carrer de Cartegena 340, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Formica V, Benassi M, Del Vecchio Blanco G, Doldo E, Martano L, Portarena I, Nardecchia A, Lucchetti J, Morelli C, Giudice E, Rossi P, Anselmo A, Sileri P, Sica G, Orlandi A, Santoni R, Roselli M. Hemoglobin level and XRCC1 polymorphisms to select patients with locally advanced rectal cancer candidate for neoadjuvant chemoradiotherapy with concurrent capecitabine and a platinum salt. Med Oncol 2018; 35:83. [PMID: 29721745 DOI: 10.1007/s12032-018-1141-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
A platinum salt (oxaliplatin or cisplatin) is widely used to enhance chemoradation (CRT) response. The potential of cisplatin in neoadjuvant CRT for locally advanced rectal cancer (LARC) has not been fully investigated. Consecutive patients with histologically confirmed LARC were treated with standard pelvic radiotherapy and concurrent cisplatin plus capecitabine (CisCape CRT). Surgery and eight cycles of adjuvant FOLFOX4 were offered to all patients after CRT. Common biochemical variables and key germline genetic polymorphisms were analyzed as predictors of pathological complete response (pCR). Fifty-one patients were enrolled. pCR (regression AJCC grade 0) was documented in 7 patients (14%), nearly complete response (AJCC grade 1) in 10 pts. There was a strong association between disease-free survival and AJCC grade (p 0.0047). Grade 3-4 toxicities (mainly diarrhea) was observed in 41% of patients. Among all analyzed variables, baseline hemoglobin (Hb) was significantly associated with AJCC grade 0-1 response (p 0.027). As for the pharmacogenetic analysis, XRCC1 rs25487 polymorphism was significantly associated with AJCC grade 0-1, Odds Ratio 25.8, p 0.049. AJCC grade 0-1 response rate for patients with high Hb and/or XRCC1 rs25487 G/G genotype was as high as 57%. Baseline Hb and XRCC1 polymorphisms are valuable selection criteria for the CisCape CRT regimen, given its otherwise meaningful toxicity.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy.
| | - Michaela Benassi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | | | - Elena Doldo
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Laura Martano
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Antonella Nardecchia
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Jessica Lucchetti
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Emilia Giudice
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Piero Rossi
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | | | - Pierpaolo Sileri
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Giuseppe Sica
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Riccardo Santoni
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, Seisay S, Lieske B, Ortega I, Jeyakumar J, Senanayake KJ, Abdulbagi O, Cengiz Y, Raptis D, Altinel Y, Kong C, Teasdale E, Irwin G, Stoddart M, Kabariti R, Suresh S, Gash K, Narayanan R, Maimbo M, Grizhja B, Ymeri S, Galiqi G, Klappenbach R, Antezana D, Mendoza Beleño AE, Costa C, Sanchez B, Aviles S, Fermani CG, Balmaceda R, Villalobos S, Carmona JM, Hamill D, Deutschmann P, Sandler S, Cox D, Nataraja R, Sharpin C, Ljuhar D, Gray D, Haines M, Iyer D, Niranjan N, D'Amours S, Ashtari M, Franco H, Rahman Mitul A, Karim S, Aman NF, Estee MM, Salma U, Razzaque J, Hamid Kanta T, Tori SA, Alamin S, Roy S, Al Amin S, Karim R, Haque M, Faruq A, Iftekhar F, O'Shea M, Padmore G, Jonnalagadda R, Litvin A, Filatau A, Paulouski D, Shubianok M, Shachykava T, Khokha D, Khokha V, Djivoh F, Dossou F, Seto DM, Gbessi DG, Noukpozounkou B, Imorou Souaibou Y, Keke KR, Hodonou F, Ahounou EYS, Alihonou T, Dénakpo M, Ahlonsou G, Ginbo Bedada A, Nsengiyumva C, Kwizera S, Barendegere V, Choi P, Stock S, Jamal L, Azzie G, Kushwaha S, Chen TL, Yip C, Montes I, Zapata F, Sierra S, Villegas Lanau MI, Mendoza Arango MC, Mendoza Restrepo I, Restrepo Giraldo RS, Domini E, Karlo R, Mihanovic J, Youssef M, Elfeki H, Thabet W, Sanad A, Tawfik G, Zaki A, Abdel-Hameed N, Mostafa M, Omar MFW, Ghanem A, Abdallah E, Denewer A, Emara E, Rashad E, Sakr A, Elashry R, Emile S, Khafagy T, Elhamouly S, Elfarargy A, Mamdouh Mohamed A, Saied Nagy G, Esam A, Elwy E, Hammad A, Khallaf S, Ibrahim E, Said Badr A, Moustafa A, Eldosouky Mohammed A, Elgheriany M, Abdelmageed E, Al Raouf EA, Samir Elbanby E, Elmasry M, Morsy Farahat M, Yahya Mansor E, Magdy Hegazy E, Gamal E, Gamal H, Kandil H, Maher Abdelrouf D, Moaty M, Gamal D, El-Sagheer N, Salah M, Magdy S, Salah A, Essam A, Ali A, Badawy M, Ahmed S, Mohamed M, Assal A, Sleem M, Ebidy M, Abd-Elrazek A, Zahran D, Adam N, Nazir M, Hassanein AB, Ismail A, Elsawy A, Mamdouh R, Mabrouk M, Ahmed LAM, Hassab Alnaby M, Magdy E, Abd-Elmawla M, Fahim M, Mowafy B, Ibrahim Mahmoud M, Allam M, Alkelani M, Halim El Gendy N, Saad Aboul-Naga M, Alaa El-Din R, Elgendy AH, Ismail M, Shalaby M, Adel Elsharkawy A, Elsayed Moghazy M, Hesham Elbisomy K, Abdel Gawad Shakshouk H, Hamed MF, Ebidy MM, Abdelkader M, Karkeet M, Ahmed H, Adel I, Omar ME, Ibrahim M, Ghoneim O, Hesham O, Gamal S, Hilal K, Arafa O, Adel Awad S, Salem M, Abdellatif Elsherif F, Elsabbagh N, Aboelsoud MR, Hossam Eldin Fouad Rida A, Hossameldin A, Hany E, Hosny Asar Y, Anwar N, Gadelkarim M, Abdelhady S, Mohamed Morshedy E, Saad R, Soliman N, Salama M, Ezzat E, Mohamed A, Ibrahim A, Fergany A, Mohammed S, Reda A, Allam Y, Saad HA, Abdelfatah A, Fathy AM, El-Sehily A, Abdalmageed Kasem E, Hassan ATA, Mohammed AR, Saad AG, Elfouly Y, Elfouly N, Ibrahim A, Hassaan A, Mohammed MM, Elhoseny G, Magdy M, Abd Elkhalek E, Zakaria Y, Ezzat T, Abo El Dahab A, Kelany M, Arafa S, Mokhtar Mohamed Hassan O, Mohamed Badwi N, Saber Sleem A, Ahmed H, Abdelbadeai K, Abozed Abdullah M, Lokman MAA, Bahar S, Rady Abdelazeam A, Adelshone A, Bin Hasnan M, Zulkifli A, Kamarulzamil SNA, Elhendawy A, Latif A, Bin Adnan A, Shaharuddin S, Haji Abdul Majid AH, Amreia M, Al-Marakby D, Salma M, Ismail MJB, Mohd Basir ER, Mohd Ali CD, Ata AY, Nasr M, Rezq A, Sheta A, Tariq S, Sallam AE, Darwish AKZ, Elmihy S, Elhadry S, Farag A, Hajeh H, Abdelaal A, Aglan A, Zohair A, Essam M, Moussa O, El-Gizawy E, Samy M, Ali S, El Halawany E, Ata A, El Halawany M, Nashat M, Soliman S, Elazab A, Samy M, Abdelaziz MA, Ibrahim K, Ibrahim AM, Gado A, Hantour U, Alm Eldeen E, Loaloa MR, Abouzaid A, Ahmed Bahaa Eldin M, Hashad E, Sroor F, Gamil D, Mahmoud Abdulhakeem E, Zakaria M, Mohamed F, Abubakr M, Ali E, Magdy H, Ramadan MT, Abdelaty Mohamed M, Mansour S, Abdul Aziz Amin H, Rabie Mohamed A, Saami M, Ahmed Reda Elsayed N, Tarek A, Mohy Eldeen Mahmoud S, Magdy El Sayed I, Reda A, Yusuf Shawky M, Mousa Salem M, Alaa El-Din S, Abdullah Soliman N, Talaat M, Alaael-Dein S, Abd Elmoen Elhusseiny A, Abdullah N, Elshaar M, Abdelfatah Ibraheem A, Abdulaziz H, Kamal Ismail M, Hamdy Madkor M, Abdelaty M, Mahmoud Abdel-Kader S, Mohamed Salah O, Eldafrawy M, Zaki Eldeeb A, Mahmoud Eid M, Attia A, Salah El-Dien K, Shwky A, Badenjki MA, Soliman A, Mahmoud Al Attar S, Sayed F, Abdel Sabour F, Azizeldine MG, Shawqi M, Hashim A, Aamer A, Abdelraouf AM, Abdelshakour M, Ibrahim A, Mahmoud B, Ali Mahmoud M, Qenawy M, Rashed AM, Dahy A, Sayed M, Shamsedine AW, Mohamed B, Hasan A, Saad MM, Abdul Bassit K, Khalid Abd El-Latif N, Elzahed N, El Kashash A, Bekhet NM, Hafez S, Gad A, Maher ME, Abd El-Sameea A, Hafez M, Sabe A, Ahmed A, Shahine A, Dawood K, Gaafar S, Husseiny R, Aboelmagd O, Soliman A, Mesbah N, Emadeldin H, Al Meligy A, Bekhet AH, Hasan D, Alhady K, Sabe AK, Elnajjar MA, Aboelella M, Hamsho W, Hassan I, Saad H, Abdelazim G, Mahmoud H, Wael N, Kandil AM, Magdy A, Said Elkholy S, Adel BE, Dabbour K, Elsherbiney S, Mattar O, Khaled AbdRabou A, Aly MYM, Geuoshy A, Elnagar A, Ahmed S, Abdelmotaleb I, Saleh AA, Mohammed Bakry H, Saeed M, Mahmoud S, Tawfik BA, Ismail SA, Zakaria E, Gad MO, Salah Elhelbawy M, Bassem M, Maraie N, Medhat Elhadary N, Semeda N, Rabie Mohamed S, Bakry HM, Essam AA, Tarek D, Ashour K, Elhadad A, Abdel-Aty A, Rakha I, Mamdouh Matter S, Abdelhamed R, Abdelkader O, Hassaan A, Soliman Y, Mohamed A, Ghanem S, Amr Mohamed Farouk S, Ibrahim EM, El-Taher E, Mostafa M, Mahrous Badr MF, Elsemelawy R, El-Sawy A, Bakr A, Al Rafati AAR, Saar S, Reinsoo A, Seyoum N, Worku T, Fitsum A, Tolonen M, Leppäniemi A, Sallinen V, Parmentier B, Peycelon M, Irtan S, Dardenne S, Robert E, Maillot B, Courboin E, Arnaud AP, Hascoet J, Abbo O, Ait Kaci A, Prudhomme T, Ballouhey Q, Grosos C, Fourcade L, Cecilia T, Jean-Francois C, Helene FC, Delforge X, Haraux E, Dousset B, Schiavone R, Gaujoux S, Marret JB, Haffreingue A, Rod J, Renaux-Petel M, Lecompte JF, Bréaud J, Gastaldi P, Taieb C, Claire R, Anis E, Bustangi N, Lopez M, Scalabre A, Grella MG, Mariani A, Podevin G, Schmitt F, Hervieux E, Broch A, Muller C, Bandoh D, Abantanga F, Kyereh M, Asumah H, Appiah EK, Wondoh P, Gyedu A, Dally C, Agbedinu K, Amoah M, Yifieyeh A, Agbedinu K, Owusu F, Amoako-Boateng M, Dayie M, Hagan R, Debrah S, Ohene-Yeboah M, Clegg-Lampety JN, Etwire V, Dakubo J, Essoun S, Bonney W, Glover-Addy H, Osei-Nketiah S, Amoako J, Adu-Aryee N, Appeadu-Mensah W, Bediako-Bowan A, Dedey F, Ekow M, Akatibo E, Yakubu M, Kordorwu HEK, Asare-Bediako K, Tackie E, Aaniana K, Acquah E, Opoku-Agyeman R, Avoka A, Kusi K, Maison K, Gyamfi FE, Naa Barnabas G, Abdul-Latif S, Taah Amoako P, Davor A, Dassah V, Dagoe E, Kwakyeafriyie P, Akoto E, Ackom E, Mensah E, Atkins ET, Coompson CL, Ivros N, Ferousis C, Kalles V, Agalianos C, Kyriazanos I, Barkolias C, Tselos A, Tzikos G, Voulgaris E, Lytras D, Bamicha A, Psarianos K, Stefanopoulos A, Patoulias I, Sfougaris D, Valioulis I, Balalis D, Korkolis D, Manatakis DK, Kyrou G, Karabelias G, Papaskarlatos IA, Konstantina K, Zampitis N, Germanos S, Papailia A, Theodosopoulos T, Gkiokas G, Mitroudi M, Panteli C, Feidantsis T, Farmakis K, Kyziridis D, Ioannidis O, Parpoudi S, Gemenetzis G, Parasyris S, Anthoulakis C, Nikoloudis N, Margaritis M, Aguilera-Arevalo ML, Coyoy-Gaitan O, Rosales J, Tale L, Soley R, Barrios E, Rodriguez STT, Paz Galvez C, Herrera Cruz D, Sanchez Rosenberg G, Matheu A, Cohen DM, Paul M, Charles A, Lam JCY, Yeung MHA, Fok CYJ, Li KHG, Lai ACH, Cheung YHE, Wong HY, Leung KW, Lee TSB, Lam WH, Dao W, Kwok SHW, Chan TYK, Ng YK, Mak TWC, Foo CC, Yang J, Bhatnagar A, Upadhyaya V, Muddebihal U, Dar W, Janardhan KC, Aruldas N, Adella FJ, Rulie AS, Iskandar F, Setiawan J, Evajelista CV, Natalie H, Suyadi A, Gunawan R, Karismaningtyas H, Mata LPS, Andika FFA, Hasanah A, Widiastini TA, Purwaningsih NA, Mukin ADF, Rahmah DF, Nurqistan HD, Arsyad HM, Adhitama N, Jeo WS, Sutandi N, Clarissa A, Gultom PA, Billy M, Haloho A, Johanna N, Lee F, Radin Dorani RMN, Glynn M, Alherz M, Goh W, Shiwani HA, Sproule L, Conlon KC, Bala M, Kedar A, Turati L, Bianco 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Amole I, Abiola O, Olaolorun A, Veen T, Kanani A, Styles K, Herikstad R, Wiik Larsen J, Søreide JA, Jensen E, Gran M, Aahlin EK, Gaarder T, Monrad-Hansen PW, Næss PA, Lauzikas G, Wiborg J, Holte S, Augestad KM, Banipal GS, Monteleone M, Moe TT, Schultz JK, Nadeem N, Saqlain M, Abbasy J, Alvi AR, Shahzad N, Bhopal KF, Iftikhar Z, Butt MT, ul Razi SA, Ahmed A, Khan Niazi A, Raza I, Baluch F, Raza A, Bani-Sadar A, Adil M, Raza A, Javaid M, Waqar M, Khan MA, Arshad MM, Amjad MA, Al-taher T, Hamdan A, Salman A, Saadeh R, Musleh A, Jaradat D, Abushamleh S, Hanoun S, Abu Qumbos A, Hamarshi A, Taher AA, Qawasmi I, Qurie K, Altarayra M, Ghannam M, Shaheen A, Herebat A, Abdelhaq A, Shalabi A, Abu-toyour M, Asi F, Shamasneh A, Atiyeh A, Mustafa M, Zaa'treh R, Dabboor M, Alaloul E, Baraka H, Meqbil J, Al-Buhaisi A, Elshami M, Afana S, Jaber S, Alyacoubi S, Abuowda Y, Idress T, Abuqwaider E, Al-saqqa S, Bowabsak A, El Jamassi A, Hasanain D, Al-Farram H, Salah M, Firwana A, Hamdan M, Awad I, Ashour A, Al Barrawi FE, Alkhatib A, Al-Faqawi M, Fares M, Elmashala A, Adawi M, Adawi I, Khreishi R, Khreishi R, Ashour A, Ghaben A, Machain Vega GM, Cardozo JT, Roche MO, Pertersen Servin GR, Segovia Lohse HA, Páez Lopez LI, Cardozo RAM, Espinoza F, Pérez Rojas AD, Sanchez D, Samaniego CS, Guevara Torres S, Calua AC, Razuri C, Ortiz N, Rodriguez X, Carrasco N, Saravia F, Shibao Miyasato H, Valcarcel-Saldaña M, Bermúdez YEA, Carpio J, Ruiz Panez W, Toribio Orbegozo PA, Guzmán Dueñas C, Turpo Espinoza K, Sandoval Barrantes AM, Chungui Bravo JA, Fuentes-Rivera L, Fernández C, Málaga B, Ye J, Velasquez R, Salcedo J, Contreras-Vergara AL, Vergara Mejia AG, Gonzales Montejo MS, Escalante Salas MDC, Alcca Ticona W, Vargas M, Manrique Sila GC, Mas R, del Pilar Paucar A, Román Velásquez AJ, Robledo-Rabanal A, Solis LAZ, Turpo Espinoza K, Hamasaki Hamaguchi JL, Florez Farfan ES, Madrid Barrientos LA, Herrera Matta JJ, Mora JJV, Redota MAP, Roxas MF, Maño MJB, Parreno-Sacdalan MD, Almanon CL, Walędziak M, Roszkowski R, Janik M, Lasek A, Radkowiak D, Rubinkiewicz M, Fernandes C, Costa-Maia J, Melo R, Muntean L, Mironescu AS, Vida LC, Popa M, Mircea H, Vartic M, Diaconescu B, Bratu MR, Negoi I, Beuran M, Ciubotaru C, Uzabumwana N, Duhoranenayo D, Jovine E, Zanini N, Landolfo G, Aljiffry M, Idris F, Alghamdi MSA, Maghrabi A, Altaf A, Alkaaki A, Khoja A, Nawawi A, Turkustani S, Khalifah E, Albiety A, Sahel S, Alshareef R, Najjar M, Alzahrani A, Alghamdi A, Alhazmi W, Al Saied G, Alamoudi M, Riaz MM, Hassanain M, Alhassan B, Altamimi A, Alyahya R, Al Subaie N, Al Bastawis F, Altamimi A, Nouh T, Khan R, Radojkovic M, Jeremic L, Nestorovic M, Law JH, Tan KSK, Tan RCK, Tan JK, Joel LWL, Chan XW, Leong FQH, Chong CS, Koh S, Lee KY, Lee KC, Pluke K, Dedekind B, Nashidengo P, Hampton MI, Joosten J, Sobnach S, Roodt L, Sander A, Pape J, Maistry N, Ndwambi P, Kinandu K, Tun M, Du Toit F, Ellison Q, Burger S, Grobler DC, Khulu LB, Moore R, Jennings V, Leusink A, Kariem N, Gouws J, Chu K, Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Orsaria P, Caredda E, Genova F, Materazzo M, Capuano I, Vanni G, Granai AV, DE Majo A, Portarena I, Sileri P, Petrella G, Palombi L, Buonomo OC. Additional Nodal Disease Prediction in Breast Cancer with Sentinel Lymph Node Metastasis Based on Clinicopathological Features. Anticancer Res 2018; 38:2109-2117. [PMID: 29599329 DOI: 10.21873/anticanres.12451] [Citation(s) in RCA: 14] [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: 01/02/2018] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 11/10/2022]
Abstract
AIM The standard-of-care in breast cancer (BC) with positive sentinel lymph node (SLN) metastasis includes complete axillary lymph node dissection (ALND); however, almost half of such cases have no further tumor burden. This study aimed to assess the clinicopathological factors that predict non-SLN metastasis to define subgroups of SLN-positive patients in whom the axilla may be staged by SLN biopsy alone, while avoiding unnecessary overtreatment. PATIENTS AND METHODS The records of 191 patients with histologically-proven primary BC who underwent a positive (SLN) biopsy between 2005 and 2017 were reviewed. Patients with at least one tumor-involved SLN who underwent completion ALND were enrolled. Demographic and clinicopathological characteristics, including age, primary tumor size and histological grade, lymphovascular invasion, ratio of positive SLNs to the harvested SLNs, SLN metastasis size, and molecular subtype classification according to immunohistochemical biomarker status [estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)], were evaluated. Data were collected retrospectively and analyzed using the Mann-Whitney and Chi-square tests (statistical significance: p<0.05). RESULTS The incidence of non-SLN metastasis associated with positive SLN was 48.6% (93/191). The risk of additional nodal spread correlated with high sentinel nodal ratio >0.67 [odds ratio (OR)=2.55, p=0.032], luminal BC subtype (OR=2.67, p=0.06), HER2 overexpression (OR=0.4, p=0.016), and ER+PR-HER2- profile (OR=2.95, p=0.027). There was a tendency (statistically insignificant; p>0.05) toward higher incidence of non SLN metastasis with increasing age and histological grade, which could be attributed to the small sample size. CONCLUSION According to this study, sentinel nodal ratio and BC subtypes as per ER, PR, and HER2 status significantly predicted the likelihood of additional lymphatic involvement. Validation of these parameters in prospective studies is indicated, and may help individualize treatment modalities.
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Affiliation(s)
- Paolo Orsaria
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Emanuele Caredda
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Federica Genova
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Marco Materazzo
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Capuano
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Gianluca Vanni
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | | | - Adriano DE Majo
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Internal Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Pierpaolo Sileri
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
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Abstract
BACKGROUND AND OBJECTIVES Pilonidal sinus is a common problem in the sacrococcygeal region, especially in obese, sedentary young men. The ideal surgical solution is still under debate, and there is a high rate of recurrence. In the present study, we analyzed the long-term results of a video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease: endoscopic pilonidal sinus treatment (EPSiT). METHODS From October 2013 through November 2015, a total of 77 consecutive patients (69 Males and 8 Females, median age: 23 y) were referred to our colorectal units. Sixty-eight patients had a primary sacrococcygeal pilonidal sinus, and 9 had recurrent pilonidal sinus; all underwent EPSiT. A fistuloscope was introduced through an external opening and the sinus cavity was completely ablated under direct vision. Postoperative complications, wound infection rate, recurrence rate, time until return to work, and patient satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7, 15, and 30 days and at 6, 12, and 24 months after surgery. RESULTS All patients completed the follow-up (median follow-up was 25 (range, 17-40) months. Median operative time was 18 (range, 12-30) minutes. The median hospital stay was 6.5 (range, 5-9) hours, and the median time to return to work was 5 days. Median healing time was 26 (range, 15-45) days. There were no major or minor complications. Six patients experienced recurrence. The overall satisfaction rate was 97%. CONCLUSIONS The ideal surgical treatment for pilonidal sinus disease should be simple and effective. In our experience, EPSiT can be performed as a day surgery, with early return to daily activities. This technique is an uneventful procedure, with good aesthetic results and a low recurrence rate.
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Affiliation(s)
| | - Claudio Toscana
- Department of Surgery, Casa di Cura Villa Tiberia, Rome, Italy
| | - Mostafa Shalaby
- Department of Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Oreste Buonomo
- Department of Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Petrella
- Department of Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Pierpaolo Sileri
- Department of Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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Capuano I, Orsaria P, Caredda E, Foglio F, Saraceno F, Sileri P, Petrella G, Buonomo O. One-stage versus two-stage implant-based breast reconstruction after breast surgery for cancer. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30323-x] [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: 12/01/2022]
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Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD. Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 2018; 32:3754-3762. [DOI: 10.1007/s00464-018-6157-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/21/2018] [Indexed: 01/01/2023]
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Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study. Surg Innov 2018; 25:236-241. [DOI: 10.1177/1553350618761757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim. This study aims to compare the early and late outcomes of transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) for the treatment of hemorrhoidal disease. Methods. From January 2013 to December 2014, 100 patients—50 patients on each arm—were randomly allocated to THD or SH groups. The inclusion criteria were grade III and IV hemorrhoids diagnosed by clinical examination and proctoscopy. The primary outcome was to compare the recurrence rate with a minimum follow-up of 2 years, and the secondary outcome was to compare complications rate, time to return to work postsurgery, procedure length, and patient’s satisfaction between the 2 techniques. Results. The mean follow-up period was 33.7 ± 7.6. The recurrence rate was 4% in the SH group and 16% in the THD group ( P = .04). There was no difference in the intraoperative and postoperative complications rate; the pain score was significantly higher in the THD group. The mean operative time was significantly shorter in the SH group compared with the THD group. Patients in the THD group returned to work or routine activities significantly later compared with patients in the SH group. The overall satisfaction rate was also higher in the SH group. Conclusion. Both procedures are simple and easy to perform for the treatment of grade III and IV hemorrhoids. SH showed better results in terms of lower rate of recurrence, lower postoperative pain, quicker return to work, and higher patient satisfaction.
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Giordano P, Sileri P, Buntzen S, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Vujovic Z, Stuto A. Final results of a European, multicentre, prospective, observational study of Permacol™ collagen paste injection for the treatment of anal fistula. Colorectal Dis 2018; 20:243-251. [PMID: 28493393 DOI: 10.1111/codi.13715] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/07/2016] [Indexed: 12/22/2022]
Abstract
AIM Permacol™ collagen paste (Permacol™ paste) is an acellular cross-linked porcine dermal collagen matrix suspension for use in soft-tissue repair. The use of Permacol™ paste in the filling of anorectal fistula tract is a new sphincter-preserving method for fistula repair. The MASERATI100 study was a prospective, observational clinical study with the objective to assess the efficacy of Permacol™ collagen paste for anal fistula repair in 100 patients. METHOD Patients (n = 100) with anal fistula were treated, at 10 European surgical sites, with a sphincter-preserving technique using Permacol™ paste. Fistula healing was assessed at 1, 3, 6 and 12 months post-treatment, with the primary end-point being healing at 6 months. Faecal continence and patient satisfaction were surveyed at each follow-up; adverse events (AEs) were monitored throughout the follow-up. RESULTS At 6 months postsurgery, 56.7% of patients were healed and the percentage healed was largely maintained, with 53.5% healed at 12 months. Regarding AEs, 29.0% of patients had at least one AE, and 16.0% of patients had one or more procedure-related AE. Most AEs reported were minor and similar to those commonly observed after fistula treatment, and the incidence of serious adverse events was low (4.0% of patients). Regardless of treatment outcome, 73.0% of patients were satisfied or very satisfied with the procedure. CONCLUSION Permacol™ paste is a promising sphincter-preserving treatment for anal fistulae and has minimal adverse side-effects.
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Affiliation(s)
- P Giordano
- Colorectal Department, Whipps Cross University Hospital, Barts Health, London, UK
| | - P Sileri
- Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Buntzen
- Colorectal Surgery, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - J Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - L Lenisa
- General Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
| | - B Singh
- Leicester General Hospital, Leicester, UK
| | - O Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Z Vujovic
- Ninewells Hospital & Medical School, Dundee, Scotland, UK
| | - A Stuto
- Coloproctology and Pelvic Floor Surgery, Policlinico Abano Terme, Padova, Italy
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Balla A, Quaresima S, Smolarek S, Shalaby M, Missori G, Sileri P. Corrigendum: Correction of the Fourth Author's Affiliation. Synthetic Versus Biological Mesh-Related Erosion After Laparoscopic Ventral Mesh Rectopexy: A Systematic Review. Ann Coloproctol 2018; 33:253. [PMID: 29354610 PMCID: PMC5768482 DOI: 10.3393/ac.2017.33.6.253] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | | | - Sebastian Smolarek
- Pelvic Oncology Fellow, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | | | - Giulia Missori
- Department of Surgery, Tor Vergata University, Rome, Italy
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Shalaby M, Di Lorenzo N, Franceschilli L, Perrone F, Angelucci GP, Quaresima S, Gaspari AL, Sileri P. Corrigendum: Correction of the First Author's Affiliation. Outcome of Colorectal Surgery in Elderly Populations. Ann Coloproctol 2018; 33:254. [PMID: 29354611 PMCID: PMC5768483 DOI: 10.3393/ac.2017.33.6.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
[This corrects the article on p. 139 in vol. 32, PMID: 27626024.].
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Affiliation(s)
- Mostafa Shalaby
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Lorenzo
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Luana Franceschilli
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Federico Perrone
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Giulio P Angelucci
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Quaresima
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Achille L Gaspari
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Muzi MG, Mascagni P, Buonomo O, Cianfarani A, Mosconi C, Colella M, Balla A, Petrella G, Quaresima S, Sileri P. Muzi's Tension Free Primary Closure of Pilonidal Sinus Disease: Updates on Long-Term Results on 514 Patients. J Gastrointest Surg 2018; 22:133-137. [PMID: 28752401 DOI: 10.1007/s11605-017-3502-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/05/2017] [Accepted: 07/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the long-term results of Muzi's tension free primary closure technique for pilonidal sinus disease (PSD), in terms of patients' discomfort and recurrence rate. METHODS This study is a retrospective analysis of prospectively collected data. Five hundred fourteen patients were treated. Postoperative pain (assessed by a visual analog scale, VAS), complications, time needed to return to full-day activities, and recurrence rate were recorded. At 12, 22, and 54 months postoperative, patients' satisfaction was evaluated by a questionnaire scoring from 0 (not satisfied) to 12 (greatly satisfied). RESULTS The median operative time was 30 min. The overall postoperative complication rate was 2.52%. Median VAS score was 1. The mean of resumption to normal activity was 8.1 days. At median follow-up of 49 months, recurrence rate was 0.4% (two patients). At 12 months' follow-up, the mean satisfaction score was 10.3 ± 1.7. At 22 and 54 months' follow-up, the score was confirmed. CONCLUSIONS Muzi's tension free primary closure technique has proved to be an effective treatment, showing in the long-term follow-up low recurrence rate and high degree of patient satisfaction. Therefore, we strongly recommend this technique for the treatment of PSD.
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Affiliation(s)
- Marco Gallinella Muzi
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Pietro Mascagni
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Oreste Buonomo
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Agnese Cianfarani
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Claudia Mosconi
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Marco Colella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Silvia Quaresima
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Crafa F, Smolarek S, Missori G, Shalaby M, Quaresima S, Noviello A, Cassini D, Ascenzi P, Franceschilli L, Delrio P, Baldazzi G, Giampiero U, Megevand J, Maria Romano G, Sileri P. Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study. Surg Innov 2017; 24:483-491. [PMID: 28514887 DOI: 10.1177/1553350617709182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anastomotic leakage is one of the most serious complications after rectal cancer surgery. METHOD A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. RESULT Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m2 (range = 20-35 kg/m2). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). CONCLUSION Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paolo Delrio
- 5 Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
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Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Perineal resectional procedures for the treatment of complete rectal prolapse: A systematic review of the literature. Int J Surg 2017; 46:146-154. [PMID: 28890414 DOI: 10.1016/j.ijsu.2017.09.005] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Several procedures for the treatment of complete rectal prolapse (CRP) exist. These procedures are performed via the abdominal or perineal approach. Perineal procedures for rectal prolapse involve either resection or suspension and fixation of the rectum. The present review aimed to assess the outcomes of the perineal resectional procedures including Altemeier procedure (AP), Delorme procedure (DP), and perineal stapled prolapse resection (PSR) in the treatment of CRP. PATIENTS AND METHODS A systematic search of the current literature for the outcomes of perineal resectional procedures for CRP was conducted. Databases queried included PubMed/MEDLINE, SCOPUS, and Cochrane library. The main outcomes of the review were the rates of recurrence of CRP, improvement in bowel function, and complications. RESULTS Thirty-nine studies involving 2647 (2390 females) patients were included in the review. The mean age of patients was 69.1 years. Recurrence of CRP occurred in 16.6% of patients. The median incidences of recurrence were 11.4% for AP, 14.4% for DP, and 13.9% for PSR. Improvement in fecal incontinence occurred in 61.4% of patients after AP, 69% after DP, and 23.5% after PSR. Complications occurred in 13.2% of patients. The median complication rates after AP, DP and PSR were 11.1%, 8.7%, and 11.7%, respectively. CONCLUSION Perineal resectional procedures were followed by a relatively high incidence of recurrence, yet an acceptably low complication rate. Definitive conclusions on the superiority of any procedure cannot be reached due to the significant heterogeneity of the studies.
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Affiliation(s)
- Sameh Hany Emile
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Hossam Elfeki
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Mostafa Shalaby
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Ahmad Sakr
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States.
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