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Cirocchi R, Matteucci M, Randolph J, Duro F, Properzi L, Avenia S, Amato B, Iandoli R, Tebala G, Boselli C, Covarelli P, Sapienza P. Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis. World J Surg Oncol 2024; 22:92. [PMID: 38605346 PMCID: PMC11007944 DOI: 10.1186/s12957-024-03374-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023. MATERIALS AND METHODS The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google. RESULTS We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I2 = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%). CONCLUSIONS The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy.
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - Francesca Duro
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Bruno Amato
- Department of Public Health, University of Naples "Federico II", Naples, 80131, Italy
| | - Ruggiero Iandoli
- Department of General Surgery, P.O Frangipane Ariano Irpino, Avellino, 83031, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, AOSP of Terni, Terni, 05100, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Paolo Sapienza
- Department of Surgery, "Sapienza" University of Rome, Roma, 00161, Italy
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Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Correction: Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:2305. [PMID: 38379007 PMCID: PMC10978648 DOI: 10.1007/s00464-024-10750-w] [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: 02/22/2024]
Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Maria Chiara Cianci
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Lavinia Amato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, S. Maria Hospital, Perugia, Italy
| | - Massimo Buononato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Ruggero Iandoli
- General Surgery P.O. Frangipane Ariano Irpino Asl AV, Ariano Irpino, Italy
| | | | | | - Riccardo Coletta
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
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Coccolini F, Cucinotta E, Mingoli A, Zago M, Altieri G, Biloslavo A, Caronna R, Cengeli I, Cicuttin E, Cirocchi R, Cobuccio L, Costa G, Cozza V, Cremonini C, Del Vecchio G, Dinatale G, Fico V, Galatioto C, Kuriara H, Lacavalla D, La Greca A, Larghi A, Mariani D, Mirco P, Occhionorelli S, Parini D, Polistina F, Rimbas M, Sapienza P, Tartaglia D, Tropeano G, Venezia P, Venezia DF, Zaghi C, Chiarugi M. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines. Updates Surg 2024; 76:331-343. [PMID: 38153659 DOI: 10.1007/s13304-023-01729-8] [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: 02/10/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds. The final version of the statements was discussed during the annual meeting in Rome (September 2022). The present paper presents the definitive conclusions of the discussion. Fifteen statements based on the literature evidence were provided. The statements gave precise indications regarding the decisional process and the management of patients who cannot temporarily or definitively undergo cholecystectomy for acute cholecystitis. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients should be multidisciplinary. The different gallbladder drainage methods must be tailored according to each patient and based on the expertise of the hospital. Percutaneous gallbladder drainage is recommended as the first choice as a bridge to surgery or in severely physiologically deranged patients. Endoscopic gallbladder drainage (cholecystoduodenostomy and cholecystogastrostomy) is suggested as a second-line alternative especially as a definitive procedure for those patients not amenable to surgical management. Trans-papillary gallbladder drainage is the last option to be reserved only to those unfit for other techniques. Delayed laparoscopic cholecystectomy in patients with percutaneous gallbladder drainage is suggested in all those patients recovering from the conditions that previously discouraged surgical intervention after at least 6 weeks from the gallbladder drainage.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy.
| | - Eugenio Cucinotta
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Mauro Zago
- General Surgery Department, Lecco Hospital, Lecco, Italy
| | - Gaia Altieri
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alan Biloslavo
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | - Roberto Caronna
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Ismail Cengeli
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Roberto Cirocchi
- General Surgery Department, Perugia University Hospital, Perugia, Italy
| | - Luigi Cobuccio
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Gianluca Costa
- General Surgery Department, Campus Biomedico University Hospital, Rome, Italy
| | - Valerio Cozza
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | | | | | - Valeria Fico
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Hayato Kuriara
- Emergency Surgery Department, Policlinico Hospital, Milan, Italy
| | - Domenico Lacavalla
- Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | - Antonio La Greca
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Larghi
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Italy
| | - Paolo Mirco
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Dario Parini
- General Surgery Department, Rovigo Hospital, Rovigo, Italy
| | | | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Paolo Sapienza
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Giuseppe Tropeano
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Venezia
- General Surgery Department, Bari University Hospital, Bari, Italy
| | | | - Claudia Zaghi
- General Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
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Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:1667-1684. [PMID: 38332174 PMCID: PMC10978699 DOI: 10.1007/s00464-023-10659-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been proposed as an alternative. The aim of this systematic review/meta-analysis was to evaluate safety and efficacy of SILA compared with conventional approach. METHODS Per PRISMA guidelines, we systematically reviewed randomised controlled trials (RCTs) comparing CLA vs SILA for acute appendicitis. The randomised Mantel-Haenszel method was used for the meta-analysis. Statistical data analysis was performed with the Review Manager software and the risk of bias was assessed with the Cochrane "Risk of Bias" assessment tool. RESULTS Twenty-one studies (RCTs) were selected (2646 patients). The operative time was significantly longer in the SILA group (MD = 7,32), confirmed in both paediatric (MD = 9,80), (Q = 1,47) and adult subgroups (MD = 5,92), (Q = 55,85). Overall postoperative morbidity was higher in patients who underwent SILA, but the result was not statistically significant. In SILA group were assessed shorter hospital stays, fewer wound infections and higher conversion rate, but the results were not statistically significant. Meta-analysis was not performed about cosmetics of skin scars and postoperative pain because different scales were used in each study. CONCLUSIONS This analysis show that SILA, although associated with fewer postoperative wound infection, has a significantly longer operative time. Furthermore, the risk of postoperative general complications is still present. Further studies will be required to analyse outcomes related to postoperative pain and the cosmetics of the surgical scar.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Maria Chiara Cianci
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Lavinia Amato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, S. Maria Hospital, Perugia, Italy
| | - Massimo Buononato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Ruggero Iandoli
- General Surgery P.O. Frangipane Ariano Irpino Asl AV, Ariano Irpino, Italy
| | | | | | - Riccardo Coletta
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
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Anania G, Campagnaro A, Chiozza M, Randolph J, Resta G, Marino S, Pedon S, Agrusa A, Cuccurullo D, Cirocchi R. A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on anatomical variants of the superior mesenteric artery: intraoperative analysis during laparoscopic right hemicolectomy-CoDIG 2 database (ColonDx Italian Group). Updates Surg 2024:10.1007/s13304-024-01787-6. [PMID: 38526696 DOI: 10.1007/s13304-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
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Affiliation(s)
- G Anania
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Campagnaro
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
| | - M Chiozza
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - G Resta
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Marino
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Pedon
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. Colli Monaldi Hospital, Napoli, NA, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, PG, Italy
- Division of Digestive and Emergency Surgery, Santa Maria Hospital, Via Tristano di Joannuccio 05100, Terni, TR, Italy
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Anania G, Chiozza M, Campagnaro A, Bagolini F, Resta G, Azzolina D, Silecchia G, Cirocchi R, Agrusa A, Cuccurullo D, Guerrieri M. Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?-CoDIG 2 (ColonDx Italian Group). Surg Endosc 2024; 38:1432-1441. [PMID: 38191814 PMCID: PMC10881627 DOI: 10.1007/s00464-023-10607-8] [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: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). METHODS CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. RESULTS A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). CONCLUSIONS This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.
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Affiliation(s)
- G Anania
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - M Chiozza
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy.
| | - A Campagnaro
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - F Bagolini
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - G Resta
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - D Azzolina
- Division of Scienze dell'Ambiente e della Prevenzione, University of Ferrara, Ferrara, FE, Italy
| | - G Silecchia
- Department of Scienze Medico Chirurgiche e Medicina Traslazionale, University of Roma S. Andrea University Hospital, Rome, RM, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, PG, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. dei Colli Monaldi Hospital, Naples, NA, Italy
| | - M Guerrieri
- Division of Clinica Chirurgica Generale e D'Urgenza, Università Politecnica delle Marche, Ancona, AN, Italy
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Tebala GD, Shabana A, Patel M, Samra B, Chetwynd A, Nixon M, Pradhan S, Elhag B, Mok G, Mighiu A, Antunes D, Slack Z, Cirocchi R, Bond-Smith G. Prognostic factors and predictive models in hot gallbladder surgery: A prospective observational study in a high-volume center. Ann Hepatobiliary Pancreat Surg 2024:ahbps.23-112. [PMID: 38212109 DOI: 10.14701/ahbps.23-112] [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: 09/27/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
Backgrounds/Aims The standard treatment for acute cholecystitis, biliary pancreatitis and intractable biliary colics ("hot gallbladder") is emergency laparoscopic cholecystectomy (LC). This paper aims to identify the prognostic factors and create statistical models to predict the outcomes of emergency LC for "hot gallbladder." Methods A prospective observational cohort study was conducted on 466 patients having an emergency LC in 17 months. Primary endpoint was "suboptimal treatment," defined as the use of escape strategies due to the impossibility to complete the LC. Secondary endpoints were postoperative morbidity and length of postoperative stay. Results About 10% of patients had a "suboptimal treatment" predicted by age and low albumin. Postop morbidity was 17.2%, predicted by age, admission day, and male sex. Postoperative length of stay was correlated to age, low albumin, and delayed surgery. Conclusions Several predictive prognostic factors were found to be related to poor emergency LC outcomes. These can be useful in the decision-making process and to inform patients of risks and benefits of an emergency vs. delayed LC for hot gallbladder.
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Affiliation(s)
- Giovanni Domenico Tebala
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Digestive and Emergency Surgery Unit, S.Maria Hospital, Terni, Italy
| | - Amanda Shabana
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mahul Patel
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Benjamin Samra
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Siddhee Pradhan
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bara'a Elhag
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriel Mok
- University of Oxford School of Medicine, Oxford, UK
| | | | - Diandra Antunes
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zoe Slack
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roberto Cirocchi
- Digestive and Emergency Surgery Unit, S.Maria Hospital, Terni, Italy
| | - Giles Bond-Smith
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Tebala GD, Desiderio J, Di Nardo D, Gemini A, Cirocchi R. The duodenal window approach to pancreatoduodenectomy. Ann Hepatobiliary Pancreat Surg 2024:ahbps.23-109. [PMID: 38193613 DOI: 10.14701/ahbps.23-109] [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: 09/21/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 01/10/2024] Open
Abstract
The pancreatoduodenectomy (PD) technique is yet to be standardized. One of the most difficult passages in PD is the mobilization of the second, third, and fourth parts of the duodenum. This maneuver is classically performed from the supramesocolic space after the division of the gastrocolic ligament, but traction on the transverse mesocolon and the superior mesenteric pedicle can cause bleeding from the venous and arterial branches of the pancreatic head and uncinate process. We hereby describe a technique to access and mobilize the distal duodenum and proximal jejunum (D2 to J1) through the duodenal window and the Treitz's foramen, performing an almost complete Kocher's maneuver before opening the gastrocolic ligament and mobilizing the hepatic flexure. The anatomical basis and the surgical technique of the duodenal-window-first PD are discussed. The duodenal-window-first approach is a standardizable step of PD that allows an easy and safe mobilization of D2 to J1. This technique has been applied to 15 cases of PD, both open and robotic, with no specific morbidity. Therefore, we propose the adoption of the duodenal-window-first technique as a routine standardized step of PD.
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Affiliation(s)
| | - Jacopo Desiderio
- Digestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Domenico Di Nardo
- Digestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Alessandro Gemini
- Digestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Roberto Cirocchi
- Digestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
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Brachini G, Cirillo B, Matteucci M, Cirocchi R, Tebala GD, Cavaliere D, Giacobbi L, Papa V, Solaini L, Avenia S, D’Andrea V, Davies J, Fedeli P, De Santis E. A Systematic Review of Varying Definitions and the Clinical Significance of Fredet's Fascia in the Era of Complete Mesocolic Excision. J Clin Med 2023; 12:6233. [PMID: 37834876 PMCID: PMC10573991 DOI: 10.3390/jcm12196233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Fredet's fascia represents a crucial landmark for vascular surgical anatomy, especially in minimally invasive complete mesocolic excision (CME) for right-sided colon adenocarcinoma. Fredet's fascia allows access to the gastrocolic trunk of Henle (GCTH), the most critical step in both open and minimally invasive right-sided CME techniques. Despite this, a recent workshop of expert surgeons on the standardization of the laparoscopic right hemicolectomy with CME did not recognize or include the term of Fredet's fascia or area. Hence, we undertook a systematic review of articles that include the terms "Fredet's fascia or area", or synonyms thereof, with special emphasis on the types of articles published, the nationality, and the relevance of this area to surgical treatments. METHODS We conducted a systematic review up to 15 July 2022 on PubMed, WOS, SCOPUS, and Google Scholar. RESULTS The results of the study revealed that the term "Fredet's fascia" is poorly used in the English language medical literature. In addition, the study found controversial and conflicting data among authors regarding the definition of "Fredet's fascia" and its topographical limits. CONCLUSIONS Knowledge of Fredet's fascia's surgical relevance is essential for colorectal surgeons to avoid accidental injuries to the superior mesenteric vascular pedicle during minimally invasive right hemicolectomies with CME. In order to avoid confusion and clarify this fascia for future use, we suggest moving beyond the use of the eponymous term by using a "descriptive term" instead, based on the fascia's anatomic structure. Fredet's fascia could, therefore, be more appropriately renamed "sub-mesocolic pre-duodenopancreatic fascia".
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Affiliation(s)
- Gioia Brachini
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Bruno Cirillo
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | | | - Davide Cavaliere
- General Surgical Department, Ospedale Degli Infermi Faenza, 48018 Faenza, Italy;
| | - Lorenza Giacobbi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | - Veronica Papa
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, 80132 Napoli, Italy;
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, 47121 Forlì, Italy;
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | - Vito D’Andrea
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University, Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
- University of Cambridge, Cambridge CB2 0QQ, UK
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Elena De Santis
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
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10
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Crippa J, Santambrogio G, Spinelli A, Montroni I, Cirocchi R, Fingerhut A, Mari GM. 'Reply to: Exploring the potential appropriateness of high ligation for a specific demographic'. Eur J Surg Oncol 2023; 49:106998. [PMID: 37543002 DOI: 10.1016/j.ejso.2023.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Jacopo Crippa
- Division of Colon & Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Antonino Spinelli
- Division of Colon & Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Isacco Montroni
- Colorectal Surgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Austria and Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, PR China
| | - Giulio M Mari
- Colorectal Surgery Unit, ASST Brianza, Desio Hospital, Desio, Italy
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Cirocchi R, Duro F, Avenia S, Capitoli M, Tebala GD, Allegritti M, Cirillo B, Brachini G, Sapienza P, Binda GA, Mingoli A, Fedeli P, Nascimbeni R. Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review. J Clin Med 2023; 12:5522. [PMID: 37685590 PMCID: PMC10488020 DOI: 10.3390/jcm12175522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND This systematic umbrella review aims to investigate and provide an analysis of guidelines regarding the treatment of diverticular abscesses. MATERIAL AND METHODS A systematic literature search was performed using the Cochrane Overviews of Reviews model and the 'Clinical Practice Guidelines'; at the end of initial search, only 12 guidelines were included in this analysis. The quality of the guidelines was assessed by adopting the "Appraisal of Guidelines for Research and Evaluation II" (AGREE II). The comparative analysis of these guidelines has highlighted the presence of some differences regarding the recommendations on the treatment of diverticular abscesses. In particular, there are some controversies about the diameter of abscess to be used in order to decide between medical treatment and percutaneous drainage. Different guidelines propose different abscess diameter cutoffs, such as 3 cm, 4-5 cm, or 4 cm, for distinguishing between small and large abscesses. CONCLUSIONS Currently, different scientific societies recommend that diverticular abscesses with diameters larger than 3 cm should be considered for percutaneous drainage whereas abscesses with diameters smaller than 3 cm could be appropriately treated by medical therapy with antibiotics; only a few guidelines suggest the use of percutaneous drainage for abscesses with a diameter greater than 4 cm. The differences among guidelines are the consequence of the different selection of scientific evidence. In conclusion, our evaluation has revealed the importance of seeking new scientific evidence with higher quality to either confirm, reinforce or potentially weaken the existing recommendations from different societies.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Francesca Duro
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Matteo Capitoli
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | | | | | - Bruno Cirillo
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | - Gioia Brachini
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | - Paolo Sapienza
- Department of Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy;
| | | | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | | | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
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12
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Cirocchi R, Cozza V, Sapienza P, Tebala G, Cianci MC, Burini G, Costa G, Coccolini F, Chiarugi M, Mingoli A. Percutaneous cholecystostomy as bridge to surgery vs surgery in unfit patients with acute calculous cholecystitis: A systematic review and meta-analysis. Surgeon 2023; 21:e201-e223. [PMID: 36577652 DOI: 10.1016/j.surge.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/17/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute cholecystitis is one of the most common causes of acute abdomen. Early laparoscopic cholecystectomy is the gold standard treatment, still burdened by a risk of intraoperative biliary duct injury. An alternative strategy to manage patients with severe acute cholecystitis is the percutaneous gallbladder drainage (PGBD). METHODS The Italian Society of Emergency Surgery and Trauma performed a systematic review and meta-analysis with the aim to clarify controversies about the preoperative use of PGBD. We extracted 32 studies: 9 Randomized Control Trial Studies (RCTs) and 23 no RCTs. RESULTS OF CRITICAL OUTCOMES The incidence of post-operative complications was lower in the PGBD associated at LC than in the LC alone (RCTs: RR 0.28, 95% CI 0.14 to 0.56, I2 = 63%). The incidence of the post-operative biliary leakage was higher in late PGBD' group (RCTs: RR 0.18, 95% CI 0.04 to 0.80). RESULTS OF OTHER OUTCOMES The incidence of intraabdominal abscess, blood loss, conversion to open, subtotal cholecystectomy, operative time and wound infection was lower in PGBD' group. The total hospital stay was the same. CONCLUSION A strong recommendation is performed to the use of the PGBD + LC than upfront LC to reduce biliary leakage (recommendation "strong positive") in high risk acute cholecystitis especially in patients with higher perioperative risks or longstanding acute cholecystitis. For post-operative complications a recommendation "positive weak" suggests that PGBD + LC could be used than upfront LC to reduce the rate of post-operative complications.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
| | - Paolo Sapienza
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
| | - Gianni Tebala
- Digestive and Emergency Surgery, AOSP of Terni, Italy.
| | - Maria Chiara Cianci
- Department of Pediatric Surgery Meyer Children's Hospital-University of Florence, Florence, Italy.
| | - Gloria Burini
- General and Emergency Surgical Clinic, Ospedali Riuniti di Ancona, Ancona, Italy.
| | - Gianluca Costa
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy.
| | - Federico Coccolini
- Operative Unit of Emergency Surgery, Az. Osp. Universitaria of Pisa, Pisa, Italy.
| | - Massimo Chiarugi
- Operative Unit of Emergency Surgery, Az. Osp. Universitaria of Pisa, Pisa, Italy.
| | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
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Brachini G, Matteucci M, Sapienza P, Cirocchi R, Favilli A, Avenia S, Cheruiyot I, Tebala G, Fedeli P, Davies J, Randolph J, Cirillo B. Systematic Review and Meta-Analysis of the Variants of the Obturatory Artery. J Clin Med 2023; 12:4932. [PMID: 37568334 PMCID: PMC10420221 DOI: 10.3390/jcm12154932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo's classification, is to analyze the origin of the obturator artery (OA) and its variants. METHODS Thirteen articles published between 1952 and 2020 were included. RESULTS The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8-83.1%) vs. 22.3% (95% CI 16.9-28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). CONCLUSIONS Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications.
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Affiliation(s)
- Gioia Brachini
- Department of Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.S.)
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Paolo Sapienza
- Department of Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.S.)
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (A.F.); (S.A.)
| | - Alessandro Favilli
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (A.F.); (S.A.)
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (A.F.); (S.A.)
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, P.O. Box 30197, Nairobi 00100, Kenya;
| | - Giovanni Tebala
- Department of Surgery, Azienda Ospedaliera Santa Maria di Terni, 05100 Terni, Italy;
| | - Piergiorgio Fedeli
- Department of Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB0QQ, UK;
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA 30341, USA;
| | - Bruno Cirillo
- Department of Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.S.)
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14
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Cirocchi R, Amato L, Ungania S, Buononato M, Tebala GD, Cirillo B, Avenia S, Cozza V, Costa G, Davies RJ, Sapienza P, Coccolini F, Mingoli A, Chiarugi M, Brachini G. Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4903. [PMID: 37568306 PMCID: PMC10419867 DOI: 10.3390/jcm12154903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC). MATERIAL AND METHODS A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases. RESULTS Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I2 = 99%; p = 0.36). A lower postoperative mortality was reported in patients who underwent EC (2.37%) with respect to the PTGBD group (13.78%) (RR 4.21; 95% CI [2.69 to 6.58]; p < 0.00001); furthermore, the risk of hospital readmission for biliary complications (RR 2.19 95% CI [1.72 to 2.79]; I2 = 48%; p < 0.00001) and hospital stay (MD 4.29 95% CI [2.40 to 6.19]; p < 0.00001) were lower in the EC group. CONCLUSIONS In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Lavinia Amato
- Department of General and Emergency Surgery, S. Maria della Stella Hospital, 05018 Orvieto, Italy
| | - Serena Ungania
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Massimo Buononato
- Department of General and Emergency Surgery, S. Maria della Stella Hospital, 05018 Orvieto, Italy
| | | | - Bruno Cirillo
- Emergency Department, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Valerio Cozza
- Department of Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Costa
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Richard Justin Davies
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Paolo Sapienza
- Emergency Department, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy
| | - Federico Coccolini
- Department of Emergency Surgery, Azienda Ospedaliero, Universitaria of Pisa, 56125 Pisa, Italy
| | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy
| | - Massimo Chiarugi
- Department of Emergency Surgery, Azienda Ospedaliero, Universitaria of Pisa, 56125 Pisa, Italy
| | - Gioia Brachini
- Emergency Department, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy
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15
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Cirocchi R, Marchetti F, Mari G, Bagolini F, Cavaliere D, Avenia S, Anania G, Tebala G, Donini A, Davies RJ, Fingerhut A. Inferior mesenteric artery ligation level in rectal cancer surgery: still no answer-a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:286. [PMID: 37493853 PMCID: PMC10371924 DOI: 10.1007/s00423-023-03022-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA) ligation on post-operative and oncological outcomes in rectal cancer surgery. METHODS We conducted a systematic review of the literature up to 06 September 2022. Included were RCTs that compared patients who underwent high (HL) vs. anterior (LL) IMA ligation for resection of rectal cancer. The literature search was performed on Medline/PubMed, Scopus, and the Web of Science without any language restrictions. The primary endpoint was overall anastomotic leakage (AL). Secondary endpoints were oncological outcomes, intraoperative complications, urogenital functional outcomes, and length of hospital stay. RESULTS Eleven RCTs (1331 patients) were included. The overall rate of AL was lower in the LL group, but the difference was not statistically significant (RR 1.43, 95% CI 0.95 to 2.96). The overall number of harvested lymph nodes was higher in the LL group, but the difference was not statistically significant (MD 0.93, 95% CI - 2.21 to 0.34). The number of lymph nodes harvested was assessed in 256 patients, and all had a laparoscopic procedure. The number of lymph nodes was higher when LL was associated with lymphadenectomy of the vascular root than when IMA was ligated at its origin, but there the difference was not statistically significant (MD - 0.37, 95% CI - 1.00 to 0.26). Overall survival at 5 years was slightly better in the LL group, but the difference was not statistically significant (RR 0.98, 95% CI 0.93 to 1.05). Disease-free survival at 5 years was higher in the LL group, but the difference was not statistically significant (RR 0.97, 95% CI 0.89 to 1.04). CONCLUSIONS There is no evidence to support HL or LL according to results in terms of AL or oncologic outcome. Moreover, there is not enough evidence to determine the impact of the level of IMA ligation on functional outcomes. The level of IMA ligation should be chosen case by case based on expected functional and oncological outcomes.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | | | - Giulio Mari
- Department of Colorectal Surgery ASST Brianza, Desio Hospital, Desio, Italy
| | | | - Davide Cavaliere
- Department of Colorectal Surgery and General Surgery, Ospedale Per Gli Infermi, Faenza, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Anania
- Department of Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, Hospital of Santa Maria of Terni, Terni, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Richard Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, China
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
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Cirocchi R, Cicoletti M, Arcangeli F, Tebala GD, Bruzzone P, Avenia S, Poli G, Trastulli S, Matteucci M. Preliminary Study of Axillary Lymphatic Drainage in Cutaneous Melanoma Patients: A Cross-Sectional Study. Medicina (Kaunas) 2023; 59:1357. [PMID: 37629647 PMCID: PMC10456326 DOI: 10.3390/medicina59081357] [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] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
Background: The axilla is a region of fundamental importance for the implications during oncological surgery, and there are many classifications of axillary lymph node subdivision: on the basis of studies on women with breast cancer, we used Clough's and Li's classification. However, currently we do not have a gold-standard classification regarding axillary lymphatic drainage in melanoma patients. Purpose: Our aim was to evaluate how these classifications could be adapted to sentinel lymph node evaluation in skin-melanoma patients and to look for a possible correlation between the most recent classifications of axillary lymph node location and Oeslner's classification, one of the most common anatomical classifications still widespread today. Methods: We analyzed data from 21 patients who underwent sentinel lymph node biopsy between January 2021 and January 2022. Results: Our study demonstrates that, to an extent, there is a possible difference in the use of the various classifications, hinting at possible limits of each. The data we obtained underline how cutaneous melanoma presents extremely heterogenous lymphatic drainage at the level of the axillary cavity. However, the limited data in our possession do not allow us to obtain, at the moment, results that are statistically significant, although we are continuing to enroll patients and collect data. Conclusions: Results of this study support the evidence that the common classifications used for breast cancer do not seem to be exhaustive. Therefore, a specific axillary lymph node classification is necessary in skin melanoma patients.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Michela Cicoletti
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Fabrizio Arcangeli
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Giovanni D. Tebala
- Department of Surgery, S. Maria Hospital, 06129 Perugia, Italy; (G.D.T.); (S.T.)
| | - Paolo Bruzzone
- Department of Surgery, Sapienza University, 00189 Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Giulia Poli
- Section of Pathology, Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy;
| | - Stefano Trastulli
- Department of Surgery, S. Maria Hospital, 06129 Perugia, Italy; (G.D.T.); (S.T.)
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Cirocchi R, Randolph J, Cheruiyot I, Davies RJ, Gioia S, Henry BM, Anania G, Donini A, Mingoli A, Sapienza P, Avenia S. Discontinuity of marginal artery at splenic flexure and rectosigmoid junction: A systematic review and meta-analysis. Colorectal Dis 2023. [PMID: 37317032 DOI: 10.1111/codi.16624] [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: 04/10/2022] [Revised: 02/08/2023] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Abstract
AIM The aim of this study was to provide comprehensive evidence-based assessment of the discontinuity of the marginal artery at the splenic flexure (SF) and the rectosigmoid junction (RSJ). METHOD A systematic review was conducted of literature published to 26 December 2022 in the electronic databases PubMed, SCOPUS and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using the Metafor package in R. The primary outcomes were the pooled PPEs of the marginal artery at the SF and the RSJ. The secondary outcome was the size of vascular anastomoses. RESULTS A total of 21 studies (n = 2,864 patients) were included. The marginal artery was present at the splenic flexure in 82% (95% CI: 62-95) of patients. Approximately 81% (95% CI: 63-94%) of patients had a large macroscopic anastomosis, while the remainder (19%) had small bridging ramifications forming the vessel. The marginal artery was present at the RSJ in 82% (95% CI: 70-91%) of patients. CONCLUSION The marginal artery may be absent at the SF and the RSJ in up to 18% of individuals, which may confer a higher risk of ischaemic colitis. As a result of high interstudy heterogeneity noted in our analysis, further well-powered studies to clarify the prevalence of the marginal artery at the SF and the RSJ, as well as its relationship with other complementary colonic collaterals (intermediate and central mesenteric), are warranted.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, USA
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
- International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Sara Gioia
- Section of Legal Medicine, Hospital of Terni, Terni, Italy
| | | | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
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Tebala GD, Di Cintio A, Ricci F, Avenia S, Cirocchi R, Desiderio J, Di Nardo D, Di Saverio S, Gemini A, Ranucci MC, Trastulli S, Cianchi F, Scatizzi M, Catena F. Primary Tumour Treatment in Stage 4 Colorectal Cancer with Unresectable Liver and Lung Metastases and No Peritoneal Carcinomatosis-Current Trends and Attitudes in the Absence of Clear Guidelines. J Clin Med 2023; 12:jcm12103499. [PMID: 37240604 DOI: 10.3390/jcm12103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/20/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resection of the primary tumour (RPT) despite the presence of untreatable metastases. METHODS An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an "elective resection score" and an "emergency resection score" were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload. RESULTS Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative. CONCLUSIONS In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.
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Affiliation(s)
| | - Antonio Di Cintio
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Francesco Ricci
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Stefano Avenia
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Roberto Cirocchi
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Jacopo Desiderio
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Domenico Di Nardo
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Salomone Di Saverio
- Department of General Surgery, "Madonna del Soccorso" Hospital, 63074 San Benedetto del Tronto, Italy
| | - Alessandro Gemini
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Maria Chiara Ranucci
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Stefano Trastulli
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Fabio Cianchi
- Department of Digestive Surgery, "Careggi" University Hospital, 50134 Firenze, Italy
| | - Marco Scatizzi
- Department of General Surgery, "S. Maria Annunziata e Serratori" Hospital, 50012 Firenze, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, "Maurizio Bufalini" Hospital, 47521 Cesena, Italy
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Bassotti G, Cirocchi R. Duodenojejunal Manometric Abnormalities in a Patient With Mesenterium Commune. J Neurogastroenterol Motil 2023; 29:262-263. [PMID: 37019870 PMCID: PMC10083107 DOI: 10.5056/jnm22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Digestive and Emergency Surgery Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Mari G, Santambrogio G, Crippa J, Cirocchi R, Origi M, Achilli P, Ferrari G, Megna S, Desio M, Cocozza E, Maggioni D, Montroni I, Spinelli A, Zuliani W, Costanzi A, Crestale S, Petri R, Bicelli N, Pedrazzani C, Boccolini A, Taffurelli G, Fingerhut A. 5 year oncological outcomes of the HIGHLOW randomized clinical trial. Eur J Surg Oncol 2023; 49:641-646. [PMID: 36335077 DOI: 10.1016/j.ejso.2022.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The oncological outcomes of low ligation (LL) compared to high ligation (HL) of the inferior mesenteric artery (IMA) during low-anterior rectal resection (LAR) with total mesorectal excision are still debated. The aim of this study is to report the 5 year oncologic outcomes of patients undergoing laparoscopic LAR with either HL vs. LL of the IMA MATERIALS AND METHODS: Between June 2014 and December 2016, patients who underwent elective laparoscopic LAR + TME in 6 Italian non-academic hospitals were randomized to HL or LL of IMA after meeting the inclusion criteria (HighLow trial; ClinicalTrials.gov Identifier NCT02153801). We analyzed the rate of local recurrence, distant metastasis, overall survival, disease-specific survival, and disease-free survival at 5 years of patients previously enrolled. RESULTS Five-year follow up data were available for 196 patients. Recurrence happened in 42 (21.4%) of patients. There was no statistically significant difference in the distant recurrence rate (15.8% HL vs. 18.9% LL; P = 0.970) and pelvic recurrence rate (4,9% HL vs 3,2% LL; P = 0.843). No statistically significant difference was found in 5-year OS (p = 0.545), DSS (p = 0.732) or DFS (p = 0.985) between HL and LL. Low vs medium and upper rectum site of tumor, conversion rate, Clavien-Dindo post-operative grade ≥3 complications and tumor stage were found statistically significantly associated to poor oncological outcomes in univariate analysis; in multivariate analysis, however, only conversion rate and stage 3 cancer were found to be independent risk factors for poor DFS at 5 years. CONCLUSION We confirmed the results found in the previous 3-year survival analysis, the level of inferior mesenteric artery ligation does not affect OS, DSS and DFS at 5-year follow-up.
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Affiliation(s)
- Giulio Mari
- Colorectal Surgery Unit ASST Brianza, DesioHospital, Desio, Italy.
| | | | - Jacopo Crippa
- Division of Colon& Rectal Surgery, IRCCSHumanitasResearchHospital, Rozzano, Milan, Italy
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Matteo Origi
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Pietro Achilli
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Giovanni Ferrari
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Stefano Megna
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Matteo Desio
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Eugenio Cocozza
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Dario Maggioni
- Colorectal Surgery Unit ASST Brianza, DesioHospital, Desio, Italy
| | - Isacco Montroni
- ColorectalSurgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS, Rozzano-Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milano, Italy
| | - Walter Zuliani
- Humanitas Mater Domini ClinicalInstitute, General Surgery, Castellanza, Varese, Italy
| | - Andrea Costanzi
- General Surgery Unit, San Leopoldo Mandic Hospital, Merate, ASST Lecco, Italy
| | - Sara Crestale
- General Surgery Unit, San Leopoldo Mandic Hospital, Merate, ASST Lecco, Italy
| | - Roberto Petri
- General Surgery Unit, University Hospital, Udine, Italy
| | | | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Andrea Boccolini
- Department of General and Emergency Surgery AOSP of Terni, Italy
| | | | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, MedicalUniversity of Graz, Austria and Department of General Surgery, RuijinHospital, ShanghaiJiaoTongUniversitySchool of Medicine, Shanghai Minimally Invasive SurgeryCenter, Shanghai, 200025, PR China
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21
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Tamburini N, Bombardini C, Chiappetta M, Maniscalco P, Valpiani G, Cesario A, Cirocchi R, Anania G, Stefanelli A, Cavallesco G, Margaritora S, Lococo F. Association of the Extent of Resection with Survival in Multiple Primary Lung Cancer: A Systematic Review. Thorac Cardiovasc Surg 2023; 71:145-158. [PMID: 35213931 DOI: 10.1055/s-0042-1742756] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The incidence of synchronous multiple primary lung cancer (SMPLC) has progressively increased, due to recent advances in imaging. To date, no guidelines defining recommendations for patients' selection and no standard treatment of cases with SMPLC have been defined.The primary aim of this systematic review was to assess survival among patients treated with lobectomy or sublobar resection MPLC. METHODS Comprehensive literature search of Medline, the Cochrane Library, reference lists, and ongoing studies was performed according to a prospectively registered design (PROSPERO: CRD42019115487). All studies published between 1998 and December 2020 that examined treatments with lobectomy compared to sublobar resection were included. Two double-blind investigators independently selected articles.Primary outcomes were to assess the 5-year overall survival (OS) rate among patients treated with lobectomy or sublobar resection and the impact of lymph node status on 5-year OS and 5-year disease-free survival in patients with MPLC. RESULTS The search yielded 424 articles; 4 observational studies met the inclusion criteria and collectively evaluated 298 patients with a mean age ranging from 61.5 to 67 years. A total of 112 patients were treated for bilateral synchronous tumors and 186 patients for unilateral multiple synchronous tumors. All included studies showed that the type of resection, lobectomy or limited resection, had no significant impact on survival. CONCLUSION Limited resection is a valuable treatment option for MPLC. However, the clinical level of evidence of the studies found is low and randomized studies are needed to clarify the extent of resection in MPLC.
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Affiliation(s)
- Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Cristina Bombardini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo Cesario
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Antonio Stefanelli
- Department of Radiation Oncology, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Cavallesco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Afzal B, Cirocchi R, Dawani A, Desiderio J, Di Cintio A, Di Nardo D, Farinacci F, Fung J, Gemini A, Guerci L, Kam SYM, Lakunina S, Madi L, Mazzetti S, Nadyrshine B, Shams O, Ranucci MC, Ricci F, Sharmin A, Trastulli S, Yasin T, Bond-Smith G, Tebala GD. Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables. World J Emerg Surg 2023; 18:10. [PMID: 36707812 PMCID: PMC9882741 DOI: 10.1186/s13017-023-00478-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process. METHODS Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created. RESULTS 18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed. CONCLUSION Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.
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Affiliation(s)
- Barza Afzal
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Roberto Cirocchi
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Aruna Dawani
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Jacopo Desiderio
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Antonio Di Cintio
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Domenico Di Nardo
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Federico Farinacci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - James Fung
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Alessandro Gemini
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Lorenzo Guerci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Sen Yin Melina Kam
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Svetlana Lakunina
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Lee Madi
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Stefano Mazzetti
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Bakhtiar Nadyrshine
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Ola Shams
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Maria Chiara Ranucci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Francesco Ricci
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Afroza Sharmin
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Stefano Trastulli
- grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
| | - Tanzela Yasin
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Giles Bond-Smith
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Giovanni D. Tebala
- grid.4991.50000 0004 1936 8948Surgical Emergency Unit, Oxford University Hospital NHS Foundation Trust, Oxford, UK ,grid.416377.00000 0004 1760 672XDigestive and Emergency Surgery Unit, S.Maria Hospital Trust, Terni, Italy
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Popivanov G, Kacarov A, Konaktchieva M, Cirocchi R, Paycheva T, Penkov M, Kjossev K, Mutafchiyski V. GASTRIC ULCER PENETRATING TO THE DUODENOJEJUNAL FLEXURE – MANAGEMENT AND PITFALLS. CASE REPORT AND REVIEW OF THE LITERATURE. JofIMAB 2022. [DOI: 10.5272/jimab.2022284.4738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: The penetration into adjacent organs is a classical complication of peptic ulcer despite being less frequent than the other complications. The current work presents a rare case of gastric ulcer penetrating the duodenojejunal flexure and discusses the diagnostic difficulties, pitfalls, and current treatment strategy. Case report: A 63-years-old woman was admitted complaining of intermittent black stools defecations, and a weight of 44 kg. The referral gastroscopy revealed a 10 cm ulcer on the posterior wall of the stomach. The histology demonstrated severe gastritis with atypical cells. The hemoglobin level was 88g/l. The patient was scheduled for elective resection for suspected gastric cancer. The intraoperative finding was completely different – there was an ulcer approximately 4-5 cm in diameter infiltrating the transverse mesocolon and duodenojejunal flexure. The case was considered T4 cancer and we decided against elective gastrectomy. The postoperative CT showed an ulcer penetrating the duodenojejunal flexure. The second gastroscopy found an ulcer with a size of 3-4 cm. The multiple biopsies showed exacerbated chronic peptic ulcer with H. pylori infection, which was treated with proton pump inhibitors and antibiotics. The follow-up gastroscopy four months later demonstrated shrinkage of the ulcer to 15 mm with complete epithelization. One year later she gained 23 kg and was free of complaints. Conclusion: Penetration and fistulization to the duodenojejunal flexure are uncommon but possible complications of peptic ulcer disease. They are not an absolute indication for surgery. Decision-making should take into account the clinical presentation, patient age, and comorbidity.
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Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M, Cirocchi R, Sorrenti S, D’Andrea V, Tonini V. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg 2022; 14:1060-1071. [PMID: 36185568 PMCID: PMC9521468 DOI: 10.4240/wjgs.v14.i9.1060] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) vs endostapler (ES) when it comes to stump closure.
AIM To compare safety and cost-effectiveness of EL vs ES.
METHODS From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021.
RESULTS The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA.
CONCLUSION Even when AA is complicated, the routine use of EL is safe in most patients.
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Affiliation(s)
- Noemi Zorzetti
- Department of General Surgery, Ospedale Civile A Costa, Porretta Terme 40046, Italy
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | | | - Samuele Vaccari
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
- Department of General Surgery, Ospedale di Bentivoglio, Bologna 40010, Italy
| | - Barbara Dalla Via
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
| | - Maurizio Cervellera
- Department of General Surgery, Ospedale Santissima Annunziata, Taranto 74121, Italy
| | - Roberto Cirocchi
- Department of General Surgery, Ospedale di Terni, Università di Perugia, Terni 05100, Italy
| | | | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Valeria Tonini
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
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Lauro A, Santoro A, Cirocchi R, Michelini M, Zorzetti N, Cianci MC, Bellini MI, Casadei C, Ripoli MC, Coletta R, Khouzam S, Marino IR, D'Andrea V, Morabito A. Serial transverse enteroplasty (STEP) in case of short bowel syndrome: did we achieve our goal? A systematic review. Updates Surg 2022; 74:1209-1223. [PMID: 35804224 DOI: 10.1007/s13304-022-01316-3] [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: 02/03/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
Surveys on Serial Transverse Enteroplasty (STEP) published in international literature (1 January 2003- 31 May 2021) were searched. Articles were included from 17 countries: 1/23 comparative and 22/23 cohort studies. STEP was performed on 308 patients: pediatrics, adults, and mixed ages. Pediatric group included 16 studies and the adult 6. Pre-STEP residual small bowell (SB) length for pediatrics and adults ranged from 18 to 26 cm and from 30 to 70 cm, respectively. Post-STEP increased SB length for pediatrics and adults ranged between 42 and 100% and 50% and 176%, respectively. For pediatrics, enteral autonomy was reached in 32.22% of cases, parenteral nutrition (PN) dependence was 36.11%, a repeated STEP procedure (Re-STEP) was needed in 17.22%, and a bowel transplant was performed in 6.11%. In adults, enteral autonomy was achieved in 52.38%, while PN dependence was 37.1%, and no Re-STEP or transplantation were required. For the mixed group, post-STEP bowel length increased from 2 to 50 cm, enteral autonomy was obtained in 43%, PN dependence was 57%, without reported Re-STEP or transplantation. Mortality rates were between 5.55% (pediatric) and 7.14% (adults). Preoperative length with preservation of ileocecal valve represented the main predictive factors to achieve enteral autonomy.
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Affiliation(s)
- A Lauro
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
| | - A Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - R Cirocchi
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - M Michelini
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - N Zorzetti
- Ospedale Civile "A. Costa", Porretta Terme, Bologna, Italy
| | - M C Cianci
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - M I Bellini
- Azienda Ospedaliera "San Camillo-Forlanini", Rome, Italy
| | - C Casadei
- IRCCS Azienda Ospedaliero, Universitaria Di Bologna, Bologna, Italy
| | - M C Ripoli
- Ospedale "Ceccarini", Riccione, Rimini, Italy
| | - R Coletta
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - S Khouzam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - A Morabito
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
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Palumbo P, Massimi F, Lucchese S, Grimaldi S, Vernaccini N, Cirocchi R, Sorrenti S, Usai S, Intini SG. Open Surgery for Sportsman’s Hernia a Retrospective Study. Front Surg 2022; 9:893390. [PMID: 35784930 PMCID: PMC9243487 DOI: 10.3389/fsurg.2022.893390] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Sportsman’s hernia is a painful syndrome in the inguinal area occurring in patients who play sports at an amatorial or professional level. Pain arises during sport, and sometimes persists after activity, representing an obstacle to sport resumption. A laparoscopic/endoscopic approach is proposed by many authors for treatment of the inguinal wall defect. Aim of this study is to assess the open technique in terms of safety and effectiveness, in order to obtain the benefit of an open treatment in an outpatient management. From October 2017 to July 2019, 34 patients underwent surgery for groin pain syndrome. All cases exhibited a bulging of the inguinal posterior wall. 14 patients were treated with Lichtenstein technique with transversalis fascia plication and placement of a polypropylene mesh fixed with fibrin glue. In 20 cases, a polypropylene mesh was placed in the preperitoneal space. The procedure was performed in day surgery facilities. Early or late postoperative complications did not occur in both groups. All patients returned to sport, in 32 cases with complete pain relief, whereas 2 patients experienced mild residual pain. The average value of return to sport was 34.11 ± 8.44 days. The average value of return to play was 53.82 ± 11.69 days. With regard to postoperative pain, no substantial differences between the two techniques were detected, and good results in terms of the resumption of sport were ensured in both groups. Surgical treatment for sportsman’s hernia should be considered only after the failure of conservative treatment. The open technique is safe and allows a rapid postoperative recovery.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- Correspondence: Piergaspare Palumbo
| | - Fanny Massimi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Lucchese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Serena Grimaldi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sofia Usai
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Gigola F, Cianci MC, Cirocchi R, Ranucci MC, Del Riccio M, Coletta R, Morabito A. Use of Teduglutide in Children With Intestinal Failure: A Systematic Review. Front Nutr 2022; 9:866518. [PMID: 35774551 PMCID: PMC9237607 DOI: 10.3389/fnut.2022.866518] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/11/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives Short-bowel syndrome (SBS) results from the loss of a significant portion of the small intestine leading to a state of malabsorption. After an intestinal loss, there is a process of adaptation involving the Glucagon-Like Peptide-2 (GLP-2), an enteroendocrine peptide also involved in nutrient absorption. Teduglutide is a recombinant analog of GLP-2 approved in 2016 to treat selected SBS pediatric patients who are dependent on parenteral support. The present systematic review aims to evaluate the efficacy of Teduglutide in pediatric patients with SBS in reducing the need for parenteral nutrition (PN). Materials and Methods We performed a literature search on MEDLINE and Embase to include articles up to November 2021. We included articles that involved using Teduglutide in the SBS pediatric population to define its efficacy in reducing the need for PN. The key words used were GLP-2, teduglutide, child. Results Fourteen studies completely fulfilled the inclusion criteria. Two hundred 23 patients were treated with Teduglutide, and the median duration of treatment was 45 weeks (IQR: 36–52.5 weeks). One-hundred and fifty-two patients were treated with 0.05 mg/Kg/d of subcutaneous Teduglutide, 38 received 0.025 mg/Kg/d and 8 received either 0.125 mg/Kg/d or 0.20 mg/Kg/d. A total of 36 patients achieved enteral autonomy (EA) after a median of 24 weeks of treatment (IQR: 24–48 weeks) and 149 patients showed a reduction in PN needs in terms of volume, calories, or hours per day. Eleven studies reported complications: gastrointestinal were the most common, with 89 cases reported in treated patients and 11 in non-treated patients. Conclusion Teduglutide appears safe and effective in reducing PN requirements and improving EA in the pediatric population. However, more studies are needed to understand its efficacy in the long term and after discontinuation and possible complications. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022301593].
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Affiliation(s)
- Francesca Gigola
- Department of Pediatric Surgery, Meyer Children’s Hospital Academic Centre, Florence, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Meyer Children’s Hospital Academic Centre, Florence, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maria Chiara Ranucci
- Department of Digestive and Emergency Surgery, Santa Maria di Terni Hospital, University of Perugia, Perugia, Italy
| | - Marco Del Riccio
- Postgraduate School of Hygiene and Preventive Medicine, Florence, Italy
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children’s Hospital Academic Centre, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
- *Correspondence: Riccardo Coletta,
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital Academic Centre, Florence, Italy
- Meyer Children’s Hospital, Department of Neurofarba, University of Florence, Florence, Italy
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Tebala GD, Milani MS, Cirocchi R, Bignell M, Bond-Smith G, Lewis C, Agnoletti V, Catarci M, Di Saverio S, Luridiana G, Catena F, Scatizzi M, Marini P. The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case-control analysis of a retrospective multicentre database. World J Emerg Surg 2022; 17:22. [PMID: 35488247 PMCID: PMC9051756 DOI: 10.1186/s13017-022-00425-z] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”.
Methods The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Italian Hospital Surgeons (ACOI) and the World Society of Emergency Surgery (WSES).
Results Three-quarters of patients have been admitted during workdays and only 25.7% during weekends. There was no difference in the distribution of gender, age, ASA class and diagnosis during weekends with respect to workdays. The first wave of the COVID pandemic caused a one-third reduction of emergency surgical admission both during workdays and weekends but did not change the relation between workdays and weekends. The treatment was more often surgical for patients admitted during weekends, with no difference between 2019 and 2020, and procedures were more often performed by open surgery. However, patients admitted during weekends had a threefold increased risk of laparoscopy-to-laparotomy conversion (1% vs. 3.4%). Hospital stay was longer in patients admitted during weekends, but those patients had a lower risk of readmission. There was no difference of the rate of rescue surgery between weekends and workdays. Subgroup analysis revealed that interventional procedures for hot gallbladder were less frequently performed on patients admitted during weekends. Conclusions Our analysis revealed that demographic and clinical profiles of patients admitted during weekends do not differ significantly from workdays, but the therapeutic strategy may be different probably due to lack of availability of services and skillsets during weekends. The first wave of the COVID-19 pandemic did not impact on this difference.
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Affiliation(s)
- Giovanni D Tebala
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. .,Digestive and Emergency Surgery Unit, Azienda Ospedaliera "S.Maria", "S.Maria" Hospital, Viale Tristano di Joannuccio, 05100, Terni, Italy.
| | - Marika S Milani
- Department of General Surgery, Causa Pia Luvini Hospital, Cittiglio, Italy
| | - Roberto Cirocchi
- Digestive and Emergency Surgery Unit, Azienda Ospedaliera "S.Maria", "S.Maria" Hospital, Viale Tristano di Joannuccio, 05100, Terni, Italy
| | - Mark Bignell
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Giles Bond-Smith
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Lewis
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vanni Agnoletti
- Department of Anaesthesia and Intensive Care, "M. Bufalini" Hospital, Cesena, Italy
| | - Marco Catarci
- Department of General Surgery, "S. Pertini" Hospital, Rome, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Madonna del Soccorso Hospital, S.Benedetto del Tronto, Italy
| | | | - Fausto Catena
- Department of General and Emergency Surgery, "M. Bufalini" Hospital, Cesena, Italy
| | - Marco Scatizzi
- Department of General Surgery, S.Maria Annunziata Hospital, Florence, Italy
| | - Pierluigi Marini
- Department of General and Emergency Surgery, S.Camillo-Forlanini Hospital, Rome, Italy
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29
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Meyer J, Cirocchi R, Di Saverio S, Ris F, Wheeler J, Davies RJ. Author Correction: Pre-operative iron increases haemoglobin concentration before abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2022; 12:6084. [PMID: 35414647 PMCID: PMC9005534 DOI: 10.1038/s41598-022-10305-w] [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: 11/09/2022] Open
Affiliation(s)
- Jeremy Meyer
- Colorectal Unit, Addenbrooke's Hospital, Cambridge NHS Foundation Trust, Cambridge, UK. .,Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland. .,Medical School, University of Geneva, Geneva, Switzerland.
| | | | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Medical School, University of Geneva, Geneva, Switzerland
| | - James Wheeler
- Colorectal Unit, Addenbrooke's Hospital, Cambridge NHS Foundation Trust, Cambridge, UK
| | - Richard Justin Davies
- Colorectal Unit, Addenbrooke's Hospital, Cambridge NHS Foundation Trust, Cambridge, UK
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30
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Cantisani V, De Silvestri A, Scotti V, Fresilli D, Tarsitano MG, Polti G, Guiban O, Polito E, Pacini P, Durante C, Grani G, Isidori AM, Giannetta E, Sorrenti S, Trimboli P, Catalano C, Cirocchi R, Lauro A, D'Andrea V. US-Elastography With Different Techniques for Thyroid Nodule Characterization: Systematic Review and Meta-analysis. Front Oncol 2022; 12:845549. [PMID: 35371974 PMCID: PMC8966910 DOI: 10.3389/fonc.2022.845549] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/29/2021] [Accepted: 02/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background Thyroid nodules are frequent in adult population and thyroid cancer incidence has increased dramatically over the past three decades. The aim of this systematic review and meta-analysis was to evaluate the US-Elastosonography (USE) diagnostic performance in assessing the thyroid nodules malignancy risk. Methods PubMed and Embase databases were searched from January 2011 to July 2021. We extracted data from selected studies and calculated the overall diagnostic accuracy of qualitative USE, semi-quantitative USE and quantitative USE. Summary receiver operating characteristic (ROC) curve was elaborated to show the results. All statistical tests were performed using Metadisc and Medcal software package. Results Finally 72 studies with 13,505 patients and 14,015 thyroid nodules (33% malignant) undergoing elastography were included. The pooled sensitivity, specificity and AUC were 84%, 81%, and 0.89 respectively for qualitative USE; 83%, 80%, and 0.93 for semi-quantitative USE and 78%, 81% and 0.87, for quantitative USE. The qualitative and semiquantitative USE present very similar diagnostic accuracy values and both better than the quantitative USE. Conclusions USE is a useful imaging tool for thyroid nodule characterization. In accordance with recent guidelines and meta-analyses, the USE could be used daily in thyroid nodule malignancy risk stratification. Systematic Review Registration PROSPERO: CRD42021279257.
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Affiliation(s)
- Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Annalisa De Silvestri
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Valeria Scotti
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Tarsitano
- Department of Clinical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
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Cirocchi R, Burini G, Avenia S, Tebala G, Palumbo P, Cianci MC, Morabito A, Bruzzone P. Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis. ANZ J Surg 2022; 92:2433-2441. [PMID: 35338686 DOI: 10.1111/ans.17594] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias. METHODS Preferred reporting items for systematic reviews and meta-analyses guidelines were employed. We analysed primary outcomes: pain, quality of life, pain during daily activities and visual analogue scale (VAS that measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence. RESULTS Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favourable in the post-repair group respect to the watchful waiting (WW) group (5.1% versus 2.2%). VAS, measured in one study, at 6 months was more favourable in the surgery group (37% versus 44%). After 12 months the outcome was better in the control group than in the repair group (28% versus 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis did not find significant statistical differences in the two groups examined for postoperative complications [RR = 0.95, 95% CI (0.50, 1.80), P = 0.88], as for hernia recurrence [RR = 1.01, 95% CI (0.50, 2.02), P = 0.98]. CONCLUSION WW seems to be an acceptable option for the patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent. The incidence of chronic pain after the repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Gloria Burini
- Deparment of General and Emergency Surgery, General and Emergency Surgical Clinic of Ancona, Ancona, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Giovanni Tebala
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | - Piergaspare Palumbo
- Department of Surgical Sciences, "Sapienza" University of Rome, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Paolo Bruzzone
- Department of General and Specialist Surgery "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy
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Fedeli P, Scendoni R, Cingolani M, Corrales Compagnucci M, Cirocchi R, Cannovo N. Informed Consent and Protection of Personal Data in Genetic Research on COVID-19. Healthcare (Basel) 2022; 10:healthcare10020349. [PMID: 35206963 PMCID: PMC8871888 DOI: 10.3390/healthcare10020349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
The particular characteristics of COVID-19 demand the careful biomedical study of samples from patients who have shown different symptomatology, in order to understand the genetic foundations of its phenotypic expression. Research on genetic material from COVID-19 patients is indispensable for understanding the biological bases for its varied clinical manifestations. The issue of “informed consent” constitutes the crux of the problem in regulating research biobanks, because it concerns the relationship between the person and the parts separated from the body. There are several consensus models that can be adopted, varying from quite restricted models of specific informed consent to forms that allow very broad authorization (open consent). Our current understanding of COVID-19 is incomplete. Thus, we cannot plan, with precision, the research to be conducted on biological samples that have been, or will be, collected from patients infected by the novel coronavirus. Therefore, we suggest utilizing the “participation pact” between researchers and donors, based on a new form of participation in research, which offers a choice based on the principles of solidarity and reciprocity, which represent the communication of “values”. In the last part of this paper, the general data protection regulation concerning the matter is discussed. The treatment of personal data must be performed with explicit goals, and donors must be provided with a clear, transparent explanation of the methods, goals and time of storage. The data must not be provided to unauthorized subjects. In conclusion, open informed consent forms will be necessary for research on individual patients and on populations.
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Affiliation(s)
| | - Roberto Scendoni
- Department of Law, University of Macerata, 62100 Macerata, Italy;
| | - Mariano Cingolani
- Department of Law, University of Macerata, 62100 Macerata, Italy;
- Correspondence:
| | - Marcelo Corrales Compagnucci
- Centre for Advanced Studies on Biomedical Innovation Law (CeBIL), Faculty of Law, University of Copenhagen, Karen Blixens Plads 16, DK-2300 Copenhagen, Denmark;
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, 06132 Perugia, Italy;
| | - Nunzia Cannovo
- Ethic Committee, University of Naples, 80138 Napoli, Italy;
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Cirocchi R, Mari G, Amato B, Tebala GD, Popivanov G, Avenia S, Nascimbeni R. The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature. J Clin Med 2022; 11:jcm11040917. [PMID: 35207190 PMCID: PMC8880703 DOI: 10.3390/jcm11040917] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review is to primarily evaluate sexual, urinary and defecatory function outcomes, as well as postoperative results, in patients who underwent surgery for diverticular disease, with or without inferior mesenteric artery (IMA) preservation. Materials and methods: The MEDLINE/PubMed, WOS and Scopus databases were interrogated. Comparative studies including patients who underwent sigmoidectomy for diverticular diseases were considered. Bowel function, genitourinary function, anastomotic leak, operation time, conversion to open surgery, anastomotic bleeding, bowel obstruction were the main items of interest. Results: Twelve studies were included in the review, three randomized and nine comparative studies. Bowel and genitourinary function are not differently affected by the level of vascular ligation. The site of ligation of IMA did not influence the rate of functional complications, anastomotic leak and bleeding. Of note, the preservation of IMA is associated with a higher conversion rate and longer operative time. Conclusions: Despite the heterogeneity of patient groups, and although the findings should be interpreted with caution, functional and clinical outcomes after sigmoidectomy for diverticular disease do not seem to be affected by the level of vascular ligation as long as the IMA is ligated far from its origin.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy; (R.C.); (S.A.)
| | - Giulio Mari
- General Surgery Department, ASST Monza, Desio Hospital, Lombardia, 20833 Desio, Italy
- Correspondence: ; Tel.: +39-0362383221
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy;
| | - Giovanni Domenico Tebala
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford OX3 7LE, UK;
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, “Sv. Georgi Sofiiski” 3 Str., 1606 Sofia, Bulgaria;
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy; (R.C.); (S.A.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25124 Brescia, Italy;
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Tebala GD, Milani MS, Bignell M, Bond-Smith G, Lewis C, Cirocchi R, Di Saverio S, Catena F, Scatizzi M, Marini P. Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients. World J Emerg Surg 2022; 17:8. [PMID: 35090519 PMCID: PMC8795350 DOI: 10.1186/s13017-022-00407-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/23/2021] [Accepted: 01/09/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methods Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Results Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Conclusions Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.
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Affiliation(s)
- Giovanni D Tebala
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. .,Consultant Emergency and Colorectal Surgeon, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Marika S Milani
- Department of General Surgery, Causa Pia Luvini Hospital, Cittiglio, Italy
| | - Mark Bignell
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Giles Bond-Smith
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Lewis
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Perugia, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, "M. Bufalini" Hospital, Cesena, Italy
| | - Marco Scatizzi
- Department of General Surgery, S. Maria Annunziata Hospital, Firenze, Italy
| | - Pierluigi Marini
- Department of General and Emergency Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
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Popivanov G, Cirocchi R, Penchev D, Kjossev K, Konaktchieva M, Mutafchiyski V. Successful Negative Pressure Therapy of Enteroatmospheric Fistula after Right Colectomy for Complicated Crohn’s Disease —A Proposal for a Three-Drain Wound-Separation Technique. Medicina (B Aires) 2022; 58:medicina58020199. [PMID: 35208523 PMCID: PMC8880797 DOI: 10.3390/medicina58020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs remain “a nightmare” for the patient, the surgeon, and the hospital. Here we describe a case of right colectomy for obstructing Crohn’s disease in a 26-year-old. On the 19th postoperative day, he developed a superficial EAF. Due to the frozen abdomen, neither resection of the anastomosis, nor implementation of the known techniques for treatment of EAFs were possible. This prompted us to modify the Pepe technique. The EAF was isolated from the upper and lower parts of the wound through deep-skin and subcutaneous sutures and the application of two small pieces of non-adherent plastic foil. The lower holes of a single drain, put through a piece of black foam, were placed over the fistula. The upper holes, which were enveloped with the foam, remained in contact with the wound. The drain was connected to a negative pressure of 125 mmHg. NPWT (negative pressure wound therapy) was also applied by two separate sponges and drains in the upper and lower part. The mainstay of EAF treatment is the isolation of the EAF from the abdominal cavity and subcutaneous tissue, supported by control of the sepsis and adequate nutrition. The proposed technique is applicable in cases with a single, superficial EAF on the background of the frozen abdomen with minimal lateral fascial retraction. As of today, due to the rarity of the condition and lack of randomized trials, EAFs still represents a unique challenge often requiring improvisation.
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Affiliation(s)
- Georgi Popivanov
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
- Correspondence: ; Tel.: +359-885-521-241; Fax: +359-2-95-26-536
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, 06123 Perugia, Italy;
| | - Dimitar Penchev
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
| | - Kirien Kjossev
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
| | - Marina Konaktchieva
- Department of Gastroenterology, Hepatology and Transplantology, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria;
| | - Ventsislav Mutafchiyski
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
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Amato B, Compagna R, De Vivo S, Rocca A, Carbone F, Gentile M, Cirocchi R, Squizzato F, Spertino A, Battocchio P. Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis. Antibiotics (Basel) 2022; 11:antibiotics11020134. [PMID: 35203737 PMCID: PMC8868080 DOI: 10.3390/antibiotics11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.
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Affiliation(s)
- Bruno Amato
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-3403604022
| | - Rita Compagna
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Salvatore De Vivo
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Aldo Rocca
- Deparment of Medicine and Health Sciences “V. Tiberio”, University of Campobasso, 86100 Campobasso, Italy;
| | - Francesca Carbone
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Maurizio Gentile
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy;
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, 05100 Terni, Italy;
| | - Francesco Squizzato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Andrea Spertino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Piero Battocchio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
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Konaktchieva M, Penchev D, Popivanov G, Vladova L, Cirocchi R, Penkov M, Karagyozov P, Mutafchiyski V. Intraductal Papillary Mucinous Neoplasm of the Pancreas: Need for a Tailored Approach to a Rare Entity. Folia Med (Plovdiv) 2021; 63:970-976. [DOI: 10.3897/folmed.63.e63071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features – presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100 000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up.
Herein we present two cases managed by diametrically different tactic according to the risk stratification – distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided.
The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions.
Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.
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Epifani AG, Cassini D, Cirocchi R, Accardo C, Di Candido F, Ardu M, Baldazzi G. Right sided diverticulitis in western countries: A review. World J Gastrointest Surg 2021; 13:1721-1735. [PMID: 35070076 PMCID: PMC8727183 DOI: 10.4240/wjgs.v13.i12.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/28/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.
AIM To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.
METHODS MEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021.
RESULTS A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.
CONCLUSION The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.
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Affiliation(s)
- Angelo Gabriele Epifani
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Diletta Cassini
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Perugia 06123, Italy
| | - Caterina Accardo
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Francesca Di Candido
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Massimiliano Ardu
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Gianandrea Baldazzi
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
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Cirocchi R, Metaj G, Cicoletti M, Arcangeli F, De Sol A, Poli G, Bruzzone P, Gioia S, Anagnostou C, Loreti F, Francesconi S, Ricci L, Laurenti ME, Capotorti A, Artico M, D’Andrea V, Henry BM, Fedeli P, Carlini L. Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma. J Clin Med 2021; 10:jcm10235544. [PMID: 34884243 PMCID: PMC8658642 DOI: 10.3390/jcm10235544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
| | - Giulio Metaj
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
- Correspondence:
| | - Michela Cicoletti
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Fabrizio Arcangeli
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Angelo De Sol
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
| | - Giulia Poli
- Section of Pathology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy;
| | - Paolo Bruzzone
- Department of General and Specialist Surgery “Paride Stefanini”, Sapienza University, 00100 Rome, Italy;
| | - Sara Gioia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, 05100 Terni, Italy;
| | - Christos Anagnostou
- Nuclear Medicine Service, “S. Maria” Hospital, 05100 Terni, Italy; (C.A.); (F.L.)
| | - Fabio Loreti
- Nuclear Medicine Service, “S. Maria” Hospital, 05100 Terni, Italy; (C.A.); (F.L.)
| | - Simona Francesconi
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Linda Ricci
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Maria Elena Laurenti
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Andrea Capotorti
- Department of Mathematics and Informatics, University of Perugia, 06121 Perugia, Italy;
| | - Marco Artico
- Department of Sensory Organs, “Sapienza” University of Rome, 00100 Rome, Italy;
| | - Vito D’Andrea
- Department of Surgical Science, “Sapienza” Università di Roma, 00100 Rome, Italy;
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Luigi Carlini
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
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Palumbo P, Massimi F, Biondi A, Cirocchi R, De Luca GM, Giraudo G, Intini SG, Monzani R, Sozio G, Usai S. Recommendations for outpatient activity in COVID-19 pandemic. Open Med (Wars) 2021; 16:1696-1704. [PMID: 34805532 PMCID: PMC8578809 DOI: 10.1515/med-2021-0378] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
The spread of the COVID-19 disease substantially influenced the International Healthcare system, and the national governments worldwide had before long to decide how to manage the available resources, giving priority to the treatment of the COVID-infected patients. Then, in many countries, it was decided to limit the elective procedures to surgical oncology and emergency procedures. In fact, most of the routine, middle-low complexity surgical interventions were reduced, and the day surgery (DS) activities were almost totally interrupted. As a result of this approach, the waiting list of these patients has significantly increased. In the current phase, with a significant decrease in the incidence of COVID-19 cases, the surgical daily activity can be safely and effectively restarted. Adjustments are mandatory to resume the DS activity. The whole separation of pathways with respect to the long-stay and emergency surgery, an accurate preoperative protocol of patient management, with a proper selection and screening of all-day cases, careful scheduling of surgical organization in the operating room, and planning of the postoperative pathway are the goals for a feasible, safe, and effective resumption of DS activity.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Fanny Massimi
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Biondi
- Department of General Surgery and Surgical Specialities, University of Catania, Catania, Italy
| | - Roberto Cirocchi
- Deparment of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Giorgio Giraudo
- Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Roberta Monzani
- Department of Anesthesia and Intensive Care, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giampaolo Sozio
- Department of General Surgery and Emergency, Alta Val D’Elsa Hospital, Poggibonsi (SI), Italy
| | - Sofia Usai
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Tebala GD, Slack Z, Fantini V, Masato S, Parla M, Cirocchi R, Di Saverio S. Professional responsibility between guidelines and customary practice. A conflict of interest? Med Hypotheses 2021; 158:110737. [PMID: 34801791 DOI: 10.1016/j.mehy.2021.110737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/09/2021] [Accepted: 11/12/2021] [Indexed: 12/07/2022]
Abstract
In Countries with Common Law, the principles of medical liability in case of malpractice claim are based on the Bolam/Bolitho tests, that is, the opinion of a panel of average professionals of the same specialty. On the contrary, in Countries whose legal system is based on the Corpus Iustinianeum the practice of a doctor is benchmarked against established guidelines. Occasionally, the opinion of an expert panel may not overlap the formal guidelines, in particular in cases like the surgical treatment of acute diverticulitis and that of acute cholecystitis where pre-existing old-fashioned ideas are so rooted into the behaviour of doctors that they are extremely difficult to eradicate despite the growing amount of evidence. This may lead to the paradox that a doctor who followed the guidelines might be considered imprudent or negligent as his or her choice did not overlap that of the "average" professional. This is a grey area that needs clarification. We propose that the "expert panel" nominated during a medical malpractice claim should not report their personal - although shared - opinion, but should unbiasedly report all the available acceptable options. Criminal and civil courts, along with other medical panels, must consider this bias when scrutinizing the practice of a professional.
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Affiliation(s)
- Giovanni D Tebala
- Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK.
| | - Zoe Slack
- Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | | | - Sarah Masato
- MM&Partners, Via Cesare Fracassini, 25, 00196 Rome, Italy
| | | | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza dell'Università, 06123 Perugia, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, via Ravasi, 2, 21100 Varese, Italy
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Cirocchi R, Panata L, Griffiths EA, Tebala GD, Lancia M, Fedeli P, Lauro A, Anania G, Avenia S, Di Saverio S, Burini G, De Sol A, Verdelli AM. Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements. J Clin Med 2021; 10:jcm10225238. [PMID: 34830520 PMCID: PMC8622805 DOI: 10.3390/jcm10225238] [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: 10/03/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background. To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. Methods. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. Results. The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a “poor” visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. Conclusions. During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (M.L.); (S.A.)
| | - Laura Panata
- Legal Medicine and Insurance Office, Santa Maria della Misericordia Hospital, 06129 Perugia, Italy; (L.P.); (A.M.V.)
| | - Ewen A. Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham B15 2GW, UK;
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Giovanni D. Tebala
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford OX3 9DU, UK;
| | - Massimo Lancia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (M.L.); (S.A.)
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Augusto Lauro
- Department of Surgical Sciences, Hospital “Policlinico Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy;
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (M.L.); (S.A.)
| | - Salomone Di Saverio
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, 63074 San Benedetto del Tronto, Italy;
| | - Gloria Burini
- Department of General and Emergency Surgery, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-3465700300
| | - Angelo De Sol
- Department of General Surgery, St. Maria Hospital, 05100 Terni, Italy;
| | - Anna Maria Verdelli
- Legal Medicine and Insurance Office, Santa Maria della Misericordia Hospital, 06129 Perugia, Italy; (L.P.); (A.M.V.)
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Cirocchi R, Randolph J, Davies RJ, Cheruiyot I, Gioia S, Henry BM, Carlini L, Donini A, Anania G. A systematic review and meta-analysis of variants of the branches of the superior mesenteric artery: the Achilles heel of right hemicolectomy with complete mesocolic excision? Colorectal Dis 2021; 23:2834-2845. [PMID: 34358401 DOI: 10.1111/codi.15861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/14/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
AIM Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation) is essential for adequate oncological resection during right hemicolectomy with complete mesocolic excision. This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon. METHODS A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, Scopus and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software. RESULTS A total of 41 studies (n = 4691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4%-99.8%), 72.6% (95% CI 61.3%-82.5%) and 96.9% (95% CI 94.2%-98.8%) respectively of patients. Supernumerary RCA and MCA were observed in 3.2% and 11.4% respectively of all cases. The RCA shared a common trunk with the ICA and MCA in 13.2% and 17.7% respectively of patients. A retro-superior mesenteric vein course of the ICA and RCA was observed in 55.1% and 11.4% respectively of all cases. CONCLUSION The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-superior mesenteric vein courses. These variations should be taken into consideration during right hemicolectomy with complete mesocolic excision to ensure adequate oncological resection while minimizing intra-operative complications.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Sara Gioia
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | | | - Luigi Carlini
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | - Annibale Donini
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-34-6570-0300
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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Burini G, Cianci MC, Coccetta M, Spizzirri A, Di Saverio S, Coletta R, Sapienza P, Mingoli A, Cirocchi R, Morabito A. Aspiration versus peritoneal lavage in appendicitis: a meta-analysis. World J Emerg Surg 2021; 16:44. [PMID: 34488825 PMCID: PMC8419906 DOI: 10.1186/s13017-021-00391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. METHODS According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. RESULTS Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75-2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73-3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04-2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64-2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14-11.12); no statistical significance was found for hospital stay (MD - 0.39, 95% CI - 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56-2.38; I2 = 71%). CONCLUSIONS This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.
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Affiliation(s)
- Gloria Burini
- General and Emergency Surgical Clinic of Ancona, Ancona, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | | | | | - Salomone Di Saverio
- Department of Colorectal Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children’s Hospital, School of Environment and Life Science, University of Salford, Salford, UK
| | - Paolo Sapienza
- Department of Surgery, University of Rome, Sapienza, Italy
| | - Andrea Mingoli
- Department of Surgery, University of Rome, Sapienza, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, Department of Neurofarba, University of Florence, Florence, Italy
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Trastulli S, Munzi G, Desiderio J, Cirocchi R, Rossi M, Parisi A. Indocyanine green fluorescence angiography versus standard intraoperative methods for prevention of anastomotic leak in colorectal surgery: meta-analysis. Br J Surg 2021; 108:359-372. [PMID: 33778848 DOI: 10.1093/bjs/znaa139] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/01/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Assessment of anastomotic blood perfusion with intraoperative indocyanine green fluorescence angiography (ICG-FA) may be effective in preventing anastomotic leak compared with standard intraoperative methods in colorectal surgery. METHODS MEDLINE, PubMed, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for RCTs and observational studies on intraoperative ICG-FA to May 2020. Odds ratios (ORs), risk differences and mean differences (MDs) were calculated with 95 per cent c.i. based on intention-to-treat analysis. The number needed to treat for an additional beneficial outcome was also estimated. RESULTS Twenty-five comparative studies included a total of 7735 patients. The use of intraoperative ICG fluorescence angiography was linked with a significant reduction in all grades anastomotic leak (OR 0.39 (95 per cent c.i. 0.31 to 0.49), P < 0.001; number needed to treat for an additional beneficial outcome (NNTB) 23) and length of hospital stay (MD -0.72 (95 per cent c.i. -1.22 to -0.21) days, P = 0.006). A significantly lower incidence of grade A (OR 0.33 (0.18 to 0.60), P < 0.001), grade B (OR 0.58 (0.35 to 0.97), P = 0.04) and grade C (OR 0.59 (0.38 to 0.92), P = 0.02) anastomotic leak was demonstrated in favour of ICG-FA. For low or ultra-low rectal resection, the odds of developing anastomotic leakage was 0.32 (0.23 to 0.45) (P < 0.001; NNTB 14). There were no differences in duration of surgery, and no adverse events related to ICG fluorescent injection. CONCLUSION The use of ICG-FA instead of standard intraoperative methods to assess anastomosis blood perfusion in colorectal surgery leads to a significant reduction in anastomotic leakage and in the need for surgical reintervention for anastomotic leak, especially in patients with low or ultra-low rectal resections.
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Affiliation(s)
- S Trastulli
- Department of Emergency and Digestive Surgery, St Mary's Hospital, Terni, Italy
| | - G Munzi
- Department of Surgical and Biomedical Sciences, University of Perugia, St Mary's Hospital, Terni, Italy.,Hepato-Bilio-Pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Italy
| | - J Desiderio
- Department of Emergency and Digestive Surgery, St Mary's Hospital, Terni, Italy
| | - R Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, St Mary's Hospital, Terni, Italy
| | - M Rossi
- Hepato-Bilio-Pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Italy
| | - A Parisi
- Department of Emergency and Digestive Surgery, St Mary's Hospital, Terni, Italy
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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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Cheruiyot I, Cirocchi R, Munguti J, Davies RJ, Randolph J, Ndung'u B, Henry BM. Surgical anatomy of the accessory middle colic artery: a meta-analysis with implications for splenic flexure cancer surgery. Colorectal Dis 2021; 23:1712-1720. [PMID: 33721386 DOI: 10.1111/codi.15630] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/09/2020] [Revised: 11/16/2020] [Accepted: 03/07/2021] [Indexed: 12/12/2022]
Abstract
AIM Surgical resection of splenic flexure cancers (SFCs) is technically demanding due to the complex regional anatomy, characterized by the presence of embryological adhesions, close proximity to the pancreas and spleen, and a highly heterogeneous arterial supply and lymphatic drainage. The accessory middle colic artery (AMCA) is increasingly being recognized as an important source of blood supply to the splenic flexure. The aim of this study is to determine the prevalence and anatomical features of the AMCA. METHOD A systematic search of the scientific literature was conducted on PubMed and Embase from inception to November 2020 to identify potentially eligible studies. Data were extracted and prevalence was pooled into a meta-analysis using MetaXL and Meta-Analyst software. RESULTS A total of 16 studies (n = 2203 patients) were included. The pooled prevalence (PP) of the AMCA was 25.4% (95% CI 18.1-33.4). Its prevalence was higher in patients without a left colic artery (LCA) (PP = 83.2%; 95% CI 70.4-93.1). The commonest origin for the AMCA was the superior mesenteric artery (PP = 87.9%; 95% CI 86.4-90.7). The AMCA shared a common trunk/gave rise to pancreatic branches in 23.1% of cases (95% CI 15.3-31.9). CONCLUSION The AMCA contributes to the vascularization of the splenic flexure in approximately 25% of individuals, and may be an important feeder artery to SFCs, especially in the absence of a LCA. Preoperative identification of this artery is important to ensure optimal surgery for SFC and minimize complications.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Jeremiah Munguti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Justus Randolph
- Georgia Baptist College of Nursing. Mercer University, Atlanta, GA, USA
| | - Bernard Ndung'u
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
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Meyer J, Cirocchi R, Di Saverio S, Ris F, Wheeler J, Davies RJ. Pre-operative iron allows correction of anaemia before abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Professional surgical societies recommend the identification and treatment of pre-operative anaemia in patients scheduled for abdominal surgery. However, the evidence supporting this recommendation has been of poor quality until the recent release of several randomized controlled trials (RCT) addressing the question. Our aim was to determine if pre-operative iron allows correction of haemoglobin concentration and decreased incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery.
Methods
MEDLINE, Embase and CENTRAL were searched for RCTs written in English and assessing the effect of pre-operative iron on the incidence of peri-operative allogeneic blood transfusion in patients undergoing major abdominal surgery. Pooled relative risk (RR), risk difference (RD) and mean difference (MD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I2 value.
Results
Four RCTs were retained for analysis out of 285 eligible articles. MD in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl (3 RCTs, 95% CI: 0.30 to 1.33, I2: 60%, p = 0.002). Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of RD (4 RCTs, RD: -0.13, 95% CI: -0.27 to 0.01, I2: 65%, p = 0.07) or RR (4 RCTs, RR: 0.57, 95% CI: 0.30 to 1.09, I2: 64%, p = 0.09).
Conclusion
Pre-operative iron significantly increases haemoglobin concentration by 0.81 g/dl before abdominal surgery but does not reduce the need for peri-operative blood transfusion. Important heterogeneity exists between existing RCTs in terms of populations and interventions. Future trials should target patients suffering from iron-deficiency anaemia and assess the effect of intervention on anaemia-related complications.
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Affiliation(s)
- J Meyer
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Cirocchi
- Department of General Surgery and Surgical Oncology, Hospital of Terni, Terni, Italy
| | - S Di Saverio
- General Surgery, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - F Ris
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - J Wheeler
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
| | - R J Davies
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
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Vettoretto N, Foglia E, Ferrario L, Gerardi C, Molteni B, Nocco U, Lettieri E, Molfino S, Baiocchi GL, Elmore U, Rosati R, Currò G, Cassinotti E, Boni L, Cirocchi R, Marano A, Petz WL, Arezzo A, Bonino MA, Davini F, Biondi A, Anania G, Agresta F, Silecchia G. Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary. Surg Endosc 2021; 34:3270-3284. [PMID: 32274626 DOI: 10.1007/s00464-020-07542-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery. METHODS A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model. RESULTS From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature. CONCLUSION The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.
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Affiliation(s)
- N Vettoretto
- Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy.
| | - E Foglia
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - L Ferrario
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - C Gerardi
- Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - B Molteni
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Nocco
- Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - E Lettieri
- School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy
| | - S Molfino
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - G L Baiocchi
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - G Currò
- Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy
| | - E Cassinotti
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - L Boni
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - A Marano
- Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - W L Petz
- Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - M A Bonino
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Davini
- Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Biondi
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Anania
- Chirurgia Generale, University of Ferrara, Ferrara, Italy
| | - F Agresta
- Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy
| | - G Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
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