1
|
Tagliatesta L, Arcari M, Porcheddu L, Lorenzoni M, Siboni S. Prosthesis Complications in Elderly Patients: A Case of a Swallowed Overdenture. Compend Contin Educ Dent 2024; 45:93-95. [PMID: 38289627] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Swallowed or aspirated dentures may result in serious systemic complications and require multidisciplinary attention or intervention. With an increasing number of edentulous elderly patients, such situations are not uncommon occurrences in everyday dentistry. In fact, dentures are the most ingested foreign body in the elderly patient population, and this is a particular risk if the dentures are lacking in stability. The present case report discusses the swallowing of an overdenture by a 95-year-old patient, who underwent endoscopic removal of the foreign body. The aim of this article is to highlight the risks of prosthetic restoration in older patients and the importance of thorough, scrupulous follow-up.
Collapse
Affiliation(s)
- Luigi Tagliatesta
- Specialist in Oral Surgery, Department of Biomedical, Surgical and Dental Sciences, Head of Pediatric Oral Surgery Unit, Santi Paolo and Carlo Hospital, University of Milan, Milan, Italy
| | - Matteo Arcari
- Resident in Oral Surgery, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Surgery, Santi Paolo and Carlo Hospital, University of Milan, Milan, Italy
| | - Laura Porcheddu
- Dentistry Student, Department of Biomedical, Surgical and Dental Sciences, Unit ofPediatric Oral Surgery, Santi Paolo and Carlo Hospital, University of Milan, Milan, Italy
| | - Marco Lorenzoni
- Resident in Oral Surgery, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Surgery, Santi Paolo and Carlo Hospital, University of Milan, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, Division of General and Foregut Surgery, University of Milan, San Donato Milanese (MI), Italy
| |
Collapse
|
2
|
Froiio C, Tareq A, Riggio V, Siboni S, Bonavina L. Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review. Eur Surg 2023. [DOI: 10.1007/s10353-022-00789-1] [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: 01/11/2023]
Abstract
Summary
Background
The burden of gastroesophageal reflux disease (GERD) is high, with up to 30% of the Western population reporting reflux-related symptoms with or without hiatal hernia. Magnetic sphincter augmentation (MSA) is a standardized laparoscopic procedure for patients who are dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The MSA device is manufactured in different sizes and is designed to augment the physiologic barrier to reflux by magnetic force.
Methods
An extensive scoping review was performed to provide a map of current evidence with respect to MSA, to identify gaps in knowledge, and to make recommendations for future research. All the authors contributed to the literature search in PubMed and Web of Science and contributed to summarizing the evidence.
Results
Magnetic sphincter augmentation, especially in combination with crural repair, is effective in reducing GERD symptoms, proton pump inhibitor use, and esophageal acid exposure, and in improving patients’ quality of life. Safety issues such as device erosion or migration have been rare and not associated with mortality. The MSA device can be removed laparoscopically if necessary, thereby preserving the option of fundoplication or other therapies in the future. Contraindication to scanning in high-power Tesla magnetic resonance systems remains a potential limitation of the MSA procedure. High-resolution manometry and functional lumen imaging probes appear to be promising tools to predict procedural outcomes by improving reflux control and reducing the incidence of dysphagia.
Conclusion
A consensus on acquisition and interpretation of high-resolution manometry and impedance planimetry data is needed to gain better understanding of physiology, to improve patient selection, and to pave the way for a personalized surgical approach in antireflux surgery.
Collapse
|
3
|
Abstract
With the advent of high-resolution esophageal manometry, it is recognized that the antireflux barrier receives a contribution from both the lower esophageal sphincter (intrinsic sphincter) and the muscle of the crural diaphragm (extrinsic sphincter). Further, an increased intra-abdominal pressure is a major force responsible for an adaptive response of a competent sphincter or the disruption of the esophagogastric junction resulting in gastroesophageal reflux, especially in the presence of a hiatal hernia. This review describes how the pressure dynamics in the lower esophageal sphincter were discovered and measured over time and how this has influenced the development of antireflux surgery.
Collapse
Affiliation(s)
- Stefano Siboni
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese
| | | | - Ciara Egan
- Humanitas University, Humanitas Research Hospital, Rozzano, Milan
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology, and Gastroenterology, University Hospital of Padova, Padova, Italy
| | | | - Tom R. DeMeester
- Emeritus, Keck School of Medicine, University of Southern California, Montague, MI
| |
Collapse
|
4
|
Siboni S, Kristo I, Rogers BD, De Bortoli N, Hobson A, Louie B, Lee YY, Tee V, Tolone S, Marabotto E, Visaggi P, Haworth J, Ivy M, Greenan G, Facchini C, Masuda T, Yano F, Perry K, Balasubramanian G, Theodorou D, Triantafyllou T, Cusmai L, Boveri S, Schoppmann SF, Gyawali CP, Bonavina L. Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD: The "Straight Leg-Raise" International Study. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00970-3. [PMID: 36270615 DOI: 10.1016/j.cgh.2022.10.008] [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: 07/28/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The straight leg raise (SLR) maneuver during high-resolution manometry (HRM) can assess esophagogastric junction (EGJ) barrier function by measuring changes in intraesophageal pressure (IEP) when intra-abdominal pressure is increased. We aimed to determine whether increased esophageal pressure during SLR predicts pathologic esophageal acid exposure time (AET). METHODS Adult patients with persistent gastroesophageal reflux disease (GERD) symptoms undergoing HRM and pH-impedance or wireless pH study off proton pump inhibitor were prospectively studied between July 2021 and March 2022. After the HRM Chicago 4.0 protocol, patients were requested to elevate 1 leg at 45º for 5 seconds while supine. The SLR maneuver was considered effective when intra-abdominal pressure increased by 50%. IEPs were recorded 5 cm above the lower esophageal sphincter at baseline and during SLR. GERD was defined as AET greater than 6%. RESULTS The SLR was effective in 295 patients (81%), 115 (39%) of whom had an AET greater than 6%. Hiatal hernia (EGJ type 2 or 3) was seen in 135 (46%) patients. Compared with patients with an AET less than 6%, peak IEP during SLR was significantly higher in the GERD group (29.7 vs 13.9 mm Hg; P < .001). Using receiver operating characteristic analysis, an increase of 11 mm Hg of peak IEP from baseline during SLR was the optimal cut-off value to predict an AET greater than 6% (area under the receiver operating characteristic curve, 0.84; sensitivity, 79%; and specificity, 85%), regardless of the presence of hiatal hernia. On multivariable analysis, an IEP pressure increase during the SLR maneuver, EGJ contractile integral, EGJ subtype 2, and EGJ subtype 3, were found to be significant predictors of AET greater than 6% CONCLUSIONS: The SLR maneuver can predict abnormal an AET, thereby increasing the diagnostic value of HRM when GERD is suspected. CLINICALTRIALS gov ID: NCT04813029.
Collapse
Affiliation(s)
- Stefano Siboni
- Division of Foregut Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milan, Milan, Italy
| | - Ivan Kristo
- Upper GI Service, Medizinische Universität, Wien, Austria
| | - Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri; Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
| | | | | | - Brian Louie
- Division of Thoracic Surgery, Swedish Medical Center, Digestive Health Institute, Seattle, Washington
| | - Yeong Yeh Lee
- School of Medical Sciences, GI Function and Motility Unit, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Vincent Tee
- School of Medical Sciences, GI Function and Motility Unit, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Salvatore Tolone
- Division of General, Mini-Invasive and Bariatric Surgery, University of Naples, Naples, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino, Genoa, Italy
| | | | | | - Megan Ivy
- Division of Thoracic Surgery, Swedish Medical Center, Digestive Health Institute, Seattle, Washington
| | - Garrett Greenan
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Chiara Facchini
- Gastroenterology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino, Genoa, Italy
| | - Takahiro Masuda
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Fumiaki Yano
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kyle Perry
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, Ohio
| | | | - Dimitrios Theodorou
- Foregut Surgery Unit, University of Athens School of Medicine, Athens, Greece
| | - Tania Triantafyllou
- Foregut Surgery Unit, University of Athens School of Medicine, Athens, Greece
| | - Lorenzo Cusmai
- Division of Foregut Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milan, Milan, Italy
| | - Sara Boveri
- Laboratory of Biostatistics and Data Management, Scientific Directorate, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Luigi Bonavina
- Division of Foregut Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milan, Milan, Italy.
| |
Collapse
|
5
|
Sozzi M, Siboni S, Bonavina L. Sleeping on the Right Side After Esophagectomy. Clin Gastroenterol Hepatol 2022; 21:1377-1378. [PMID: 35552013 DOI: 10.1016/j.cgh.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Marco Sozzi
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| |
Collapse
|
6
|
Siboni S, D'Aiello AF, Chessa M, Bonavina L. Tailored endoscopic treatment of tracheo-oesophageal fistula using preoperative holographic assessment and a cardiac septal occluder. BMJ Case Rep 2022; 15:e248981. [PMID: 35272993 PMCID: PMC8915373 DOI: 10.1136/bcr-2022-248981] [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] [Accepted: 02/10/2022] [Indexed: 11/03/2022] Open
Abstract
Devices originally designed for closure of cardiac septal defects have also been proposed for the treatment of acquired tracheo-oesophageal fistula (TOF). Choosing the right occluder device to match TOF size and shape is essential for a tailored treatment. We report the successful endoscopic closure of a post-radiotherapy TOF using preprocedural CT scan with holographic three-dimensional reconstruction and an Amplatzer atrial septal device. Complete TOF sealing was achieved with resolution of respiratory symptoms, and the patient was maintaining his ability to eat at 4-month follow-up.
Collapse
Affiliation(s)
- Stefano Siboni
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Massimo Chessa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
7
|
Milito P, Siboni S, Lovece A, Andreatta E, Asti E, Bonavina L. Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia. J Gastrointest Surg 2022; 26:64-69. [PMID: 34341888 PMCID: PMC8760227 DOI: 10.1007/s11605-021-05098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE Symptom recurrence after initial surgical management of esophageal achalasia occurs in 10-25% of patients. The aim of this study was to analyze safety and efficacy of revisional therapy after failed Heller myotomy (HM). METHODS A retrospective review of a prospective database was performed searching for patients with recurrent symptoms after primary surgical therapy for achalasia. Patients with previously failed HM were considered for the final analysis. The Foregut questionnaire, and the Atkinson and Eckardt scales were used to assess severity of symptoms. Objective investigations routinely included upper gastrointestinal endoscopy and barium swallow study. Redo treatments consisted of endoscopic pneumatic dilation (PD), laparoscopic HM, hybrid Ivor Lewis esophagectomy, or stapled cardioplasty. A yearly clinical and endoscopic follow-up was scheduled in all patients. RESULTS Over a 20-year period, 26 patients with a median age of 66 years (IQR 19.5) underwent revisional therapy after failed HM for achalasia at a tertiary-care university hospital. The median time after index procedure was 10 years (IQR 21). Revisional therapy consisted of endoscopic pneumatic dilation (n=13), laparoscopic HM and fundoplication (n=10), esophagectomy (n=2), and stapled cardioplasty and fundoplication (n=1). Nine (34.6%) of these patients required further endoscopic or surgical treatments. There was no mortality, and the overall complication rate was 7.7%. At a median follow-up of 42 months (range 10-149), a significant decrease of dysphagia, regurgitation, chest pain, respiratory symptoms, and median Eckardt score (p<0.05) was noted. CONCLUSION In specialized and multidisciplinary centers, revisional therapy for achalasia is feasible, safe, and effective.
Collapse
Affiliation(s)
- Pamela Milito
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Andrea Lovece
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Erika Andreatta
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy ,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| |
Collapse
|
8
|
Abstract
Diagnosis of esophageal disorders is well ahead of available treatment options. With HRM, for example, one can identify numerous conditions and their variants, which may lose meaning if the clinical and therapeutic implications of these subclassifications are limited. We report an exemplary case of a patient with hiatal hernia complaining of reflux, dysphagia, and chest pain refractory to medical treatment. Jackhammer esophagus was diagnosed and a hybrid approach consisting of POEM and concomitant crural repair and Dor fundoplication is proposed.
Collapse
Affiliation(s)
- Pamela Milito
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy ,Department of General and Foregut Surgery, I.R.C.C.S. Policlinico San Donato, University of Milan, Piazza Malan 1, San Donato Milanese, 20097 Milan, Italy
| |
Collapse
|
9
|
Ferrari D, Siboni S, Riva CG, Guerrazzi G, Lovece A, Bonavina L. Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease. Front Med (Lausanne) 2021; 8:645592. [PMID: 34796181 PMCID: PMC8592890 DOI: 10.3389/fmed.2021.645592] [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: 12/23/2020] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease. Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure <5 mmHg, distal esophageal amplitude <30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score >50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group. Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score. Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.
Collapse
Affiliation(s)
- Davide Ferrari
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| | - Carlo Galdino Riva
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| | - Guglielmo Guerrazzi
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrea Lovece
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Siboni S, Ferrari D, Riva CG, Sozzi M, Lazzari V, Milani V, Bonavina L. Reference high-resolution manometry values after magnetic sphincter augmentation. Neurogastroenterol Motil 2021; 33:e14139. [PMID: 33772949 PMCID: PMC8596403 DOI: 10.1111/nmo.14139] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 12/06/2022]
Abstract
BACKGROUND Magnetic sphincter augmentation (MSA) is an innovative antireflux procedure that can improve lower esophageal sphincter (LES) competency and reduce symptoms of gastroesophageal reflux disease (GERD). Some patients report postoperative dysphagia. To date, no studies have described reference high-resolution manometry (HRM) values after MSA implantation. METHODS High-resolution manometry was performed in patients free of dysphagia after MSA with or without concurrent crura repair. Reference values for all parameters of the Chicago Classification were defined as those between the 5th and 95th percentiles. The contribution of concurrent crura repair to LES competency and to reference values was also analyzed. KEY RESULTS Eighty-four patients met the study inclusion criteria. The upper limit of normality for integrated relaxation pressure (IRP) and intrabolus pressure (IBP) was 20.2 mmHg and 30.3 mmHg, respectively. Both variables were higher after MSA compared to normative Chicago Classification v3.0 values. The Distal Contractile Integral upper limit was in the range of normality. Patients undergoing crura repair had a significantly higher IRP (p = 0.0378) and lower GERDQ-A scores (p = 0.0374) and Reflux Symptom Index (p = 0.0030) compared to those who underwent MSA device implantation alone. CONCLUSION & INFERENCES This study provides HRM reference values for patients undergoing successful MSA implantation. Crural repair appears to be a key component of LES augmentation and is associated with improved clinical outcomes.
Collapse
Affiliation(s)
- Stefano Siboni
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | - Davide Ferrari
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | - Carlo Galdino Riva
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | - Marco Sozzi
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | - Veronica Lazzari
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | | | - Luigi Bonavina
- Division of General and Foregut SurgeryDepartment of Biomedical Sciences for HealthIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| |
Collapse
|
11
|
Cusmai L, Siboni S, Bonavina L. Impacted Gallstone in the Duodenum: What to Do? J Clin Gastroenterol 2021; 55:821. [PMID: 34091517 DOI: 10.1097/mcg.0000000000001576] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Lorenzo Cusmai
- IRCCS Policlinico San Donato Division of General and Foregut Surgery, University of Milan, Milan, Italy
| | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking. METHODS A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database. RESULTS Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy. CONCLUSION Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.
Collapse
Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, 20133, Milan, Italy.,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Daniele Bernardi
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Veronica Lazzari
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, 20133, Milan, Italy. .,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy.
| |
Collapse
|
13
|
Haltmeier T, Inaba K, Durso J, Khan M, Siboni S, Cheng V, Schnüriger B, Benjamin E, Demetriades D. Transthyretin at Admission and Over Time as a Marker for Clinical Outcomes in Critically Ill Trauma Patients: A Prospective Single-Center Study. World J Surg 2020; 44:115-123. [PMID: 31637508 PMCID: PMC7222866 DOI: 10.1007/s00268-019-05140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Transthyretin (TTR) has been described as a predictor for outcomes in medical and surgical patients. However, the association of TTR on admission and over time on outcomes has not yet been prospectively assessed in trauma patients. Methods This is a prospective observational study including trauma patients admitted to the intensive care unit (ICU) of a large Level I trauma center 05/2014–05/2015. TTR levels at ICU admission and all subsequent values over time were recorded. Patients were observed for 28 days or until hospital discharge. The association of outcomes and TTR levels at admission and over time was assessed using multivariable regression and generalized estimating equation (GEE) analysis, respectively. Results A total of 237 patients with TTR obtained at admission were included, 69 of whom had repeated TTR measurements. Median age was 40.0 years and median ISS 16.0; 83.1% were male. Below-normal TTR levels at admission (41.8%) were independently associated with higher in-hospital mortality (p = 0.042), more infectious complications (p = 0.032), longer total hospital length of stay (LOS) (p = 0.013), and ICU LOS (p = 0.041). Higher TTR levels over time were independently associated with lower in-hospital mortality (p = 0.015), fewer infections complications (p = 0.028), shorter total hospital and ICU LOS (both p < 0.001), and fewer ventilator days (0.004). Conclusions In critically ill trauma patients, below-normal TTR levels at admission were independently associated with worse outcomes and higher TTR levels over time with better outcomes, including lower in-hospital mortality, less infectious complications, shorter total hospital and ICU LOS, and fewer ventilator days. Based on these results, TTR may be considered as a prognostic marker in this patient population.
Collapse
Affiliation(s)
- Tobias Haltmeier
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA.,Division of Acute Care Surgery, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kenji Inaba
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA.
| | - Joseph Durso
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| | - Moazzam Khan
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| | - Stefano Siboni
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| | - Vincent Cheng
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| | - Beat Schnüriger
- Division of Acute Care Surgery, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Elizabeth Benjamin
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| | - Demetrios Demetriades
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, 1200 N. State St, Inpatient Tower (C) - Rm C5L100, Los Angeles, CA, 90033, USA
| |
Collapse
|
14
|
Zanghì S, Siboni S, Asti E, Bonavina L. Endoscopic stapling versus laser for Zenker diverticulum: a retrospective cohort study. Eur Arch Otorhinolaryngol 2020; 278:2625-2630. [PMID: 32895798 DOI: 10.1007/s00405-020-06346-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Despite the evolution of the endoscopic techniques for the treatment of symptomatic Zenker diverticulum, comparative studies are lacking. Aim of this observational study was to compare safety, efficacy, and outcomes of endoscopic stapling (ES) versus Laser (EL). METHODS A prospectively collected database of patients who underwent treatment for Zenker diverticulum at a single institution was reviewed. Consecutive patients treated by ES or EL were included in the study. Demographic data, presenting symptoms, diverticulum characteristics, and intra- and postoperative data were analyzed. The Functional Outcome Swallowing Scale (FOSS) and MD Anderson Dysphagia Inventory (MDADI) questionnaires were administered to assess severity of dysphagia and quality of life before and after treatment. RESULTS Between March 2017 and September 2018, 36 patients underwent ES or EL. In the TL group (n = 19), the diverticulum size was smaller compared to the EL group (n = 17) (p = 0.002). Two perforations occurred in the EL group, one treated conservatively and the other requiring drainage of a mediastinal abscess. At a median follow-up of 16 months, symptoms improved in both groups but the number of patients with a postoperative FOSS score ≥ 2 significantly decreased only after EL (p < 0.001). The scores of all items of the MDADI questionnaire significantly increased in both groups, but the average delta values were greater in the EL patients (p < 0.001). CONCLUSIONS Both TL and ES are effective treatment options for Zenker diverticulum. Postoperative quality of life was significantly higher in patients undergoing EL compared to ES.
Collapse
Affiliation(s)
- Simone Zanghì
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy.
| |
Collapse
|
15
|
Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep 2020; 10:13753. [PMID: 32792508 PMCID: PMC7426413 DOI: 10.1038/s41598-020-70742-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
The magnetic sphincter augmentation (MSA) device has been proven safe and effective in controlling typical reflux symptoms and esophageal acid exposure for up to 6-year follow-up. Longer term outcomes have not been reported yet. A prospectively maintained database was reviewed to assess long-term safety and efficacy of the laparoscopic MSA procedure at a single referral center. Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), use of proton-pump inhibitors (PPI), and esophageal acid exposure were compared to baseline. Favorable outcomes were defined as ≥ 50% improvement of GERD-HRQL total score and PPI discontinuation. Between March 2007 and March 2020, 335 patients met the study inclusion criteria, and 124 of them were followed from 6 to 12 years after surgery (median 9 years, IQR 2). Mean total GERD-HRQL score significantly improved from 19.9 to 4.01 (p < 0.001), and PPI were discontinued by 79% of patients. The mean total percent time with pH < 4 decreased from 9.6% at baseline to 4.1% (p < 0.001), with 89% of patients achieving pH normalization. Independent predictors of a favorable outcome were age at intervention < 40 years (OR 4.17) and GERD-HRQL score > 15 (OR 4.09). We confirm long-term safety and efficacy of MSA in terms of symptom improvement, decreased drug dependency, and reduced esophageal acid exposure.
Collapse
Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza E. Malan, 1, 20097, San Donato Milanese, MI, Italy
| | - Veronica Lazzari
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza E. Malan, 1, 20097, San Donato Milanese, MI, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza E. Malan, 1, 20097, San Donato Milanese, MI, Italy
| | - Daniele Bernardi
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza E. Malan, 1, 20097, San Donato Milanese, MI, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. .,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza E. Malan, 1, 20097, San Donato Milanese, MI, Italy.
| |
Collapse
|
16
|
Bernardi D, Ferrari D, Siboni S, Porta M, Bruni B, Bonavina L. Minimally invasive approach to esophageal lipoma. J Surg Case Rep 2020; 2020:rjaa123. [PMID: 32760482 PMCID: PMC7394138 DOI: 10.1093/jscr/rjaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/10/2020] [Indexed: 12/25/2022] Open
Abstract
Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.
Collapse
Affiliation(s)
- Daniele Bernardi
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Davide Ferrari
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Stefano Siboni
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Matteo Porta
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Barbara Bruni
- Pathology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Bonavina
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| |
Collapse
|
17
|
Riva CG, Siboni S, Ferrari D, Sozzi M, Capuzzo M, Asti E, Ogliari C, Bonavina L. Effect of Body Position on High-resolution Esophageal Manometry Variables and Final Manometric Diagnosis. J Neurogastroenterol Motil 2020; 26:335-343. [PMID: 32606256 PMCID: PMC7329148 DOI: 10.5056/jnm20010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022] Open
Abstract
Background/Aims According to the Chicago classification version 3.0, high-resolution manometry (HRM) should be performed in the supine position. However, with the patient in the upright/sitting position, the test could more closely simulate real-life behavior and may be better tolerated. We performed a systematic review of the literature to search whether the manometric variables and the final diagnosis are affected by positional changes. Methods A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies published in English that compared HRM results in different body positions were included. Moreover, the change in diagnosis of esophageal motility disorders according to the shift of body position was investigated. Results Seventeen studies including 1714 patients and healthy volunteers met the inclusion criteria. Six studies showed a significant increase in lower esophageal sphincter basal pressure in the supine position. Integrated relaxation pressure was significantly higher in the supine position in 10 of 13 studies. Distal contractile index was higher in the supine position in 9 out of 10 studies. One hundred and fifty-one patients (16.4%) out of 922 with normal HRM in the supine position were diagnosed with ineffective esophageal motility (IEM) when the test was performed in the upright position (P < 0.001). Conclusions Performing HRM in the upright position affects some variables and may change the final manometric diagnosis. Further studies to determine the normal values in the sitting position are needed.
Collapse
Affiliation(s)
- Carlo G Riva
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Davide Ferrari
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Marco Sozzi
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Matteo Capuzzo
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Cristina Ogliari
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato Milanese, Milano, Italy
| |
Collapse
|
18
|
Siboni S, Sozzi M, Capuzzo M, Buogo A, Riva CG, Ferrari D, Bonavina L. Combined pharmacologic antireflux therapy after esophagectomy: effect on symptoms and endoscopic findings at 1-year follow-up. Eur Surg 2020. [DOI: 10.1007/s10353-020-00635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Rebuffi L, Mukherjee B, Siboni S, Young AP, Williams BP, Tsung CK, Scardi P. Surface softening in palladium nanoparticles: effects of a capping agent on vibrational properties. Nanoscale 2020; 12:5876-5887. [PMID: 32104854 DOI: 10.1039/d0nr00182a] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The presence of a capping agent (CTAB) on Pd nanoparticles produces a strong static disorder in the surface region. This results in a surface softening, which contributes to an overall increase in the Debye-Waller coefficient measured by X-ray powder diffraction. Molecular dynamics and density functional theory simulations show that the adsorption-induced surface disorder is strong enough to overcome the effects of nanoparticle size and shape.
Collapse
Affiliation(s)
- Luca Rebuffi
- Advanced Photon Source, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, IL 60439, USA
| | - Binayak Mukherjee
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.
| | - Stefano Siboni
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.
| | - Allison P Young
- Boston College, Merkert Chemistry Center, Department of Chemistry, 2609 Beacon St., Chestnut Hill, Massachusetts 02467, USA
| | - Benjamin P Williams
- Boston College, Merkert Chemistry Center, Department of Chemistry, 2609 Beacon St., Chestnut Hill, Massachusetts 02467, USA
| | - Chia-Kuang Tsung
- Boston College, Merkert Chemistry Center, Department of Chemistry, 2609 Beacon St., Chestnut Hill, Massachusetts 02467, USA
| | - Paolo Scardi
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.
| |
Collapse
|
20
|
Abstract
Background Persistent or de novo gastroesophageal reflux disease (GERD) may be a significant clinical issue after gastric/bariatric surgical procedures. We investigated the effect of magnetic sphincter augmentation (MSA) in the treatment of GERD after previous gastric/bariatric surgery. Database We conducted a systematic review according to the Preferred Reporting Items For Systematic Reviews and Meta-analyses statement. We searched multiple databases (PubMed, Cochrane, Embase, Scopus) up to May 2019. We also queried the prospectively collected database of patients who underwent MSA at our tertiary-care hospital and compared postsurgical to naïve patients operated during the same time period. Results Seven studies (3 case series and 4 case reports), for a total of 35 patients, met the inclusion criteria in the systematic review. The most common index operation was a bariatric procedure, either sleeve gastrectomy or Roux-en-Y gastric bypass. After MSA implant, the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) score significantly improved compared to baseline (P = .005). Two patients (5.7%) required laparoscopic device removal. In the local institutional cohort series of 67 patients treated by MSA, the prevalence of preoperative grade B esophagitis, operative time, size of MSA, and length of stay were greater in patients with prior gastric surgery compared to naïve patients. Conclusions MSA is a safe, simple, and standardized antireflux procedure. It is also feasible in patients with refractory GERD following gastric/bariatric surgery. Further prospective and comparative studies are needed to validate the preliminary clinical experience in this subset of patients.
Collapse
Affiliation(s)
- Carlo Galdino Riva
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Veronica Lazzari
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Krizia Aquilino
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| |
Collapse
|
21
|
Riva CG, Siboni S, Sozzi M, Lazzari V, Asti E, Bonavina L. High-resolution manometry findings after Linx procedure for gastro-esophageal reflux disease. Neurogastroenterol Motil 2020; 32:e13750. [PMID: 31633258 DOI: 10.1111/nmo.13750] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Magnetic sphincter augmentation with the Linx® system is a novel laparoscopic procedure for the treatment of gastro-esophageal reflux disease (GERD). Only few data are available regarding the impact of Linx on high-resolution manometry (HRM) variables. METHODS The prospectively collected database of patients who underwent Linx procedure at a single institution was queried. All patients who completed pre- and postoperative HRM, GERD health-related quality of life (GERD-HRQL) questionnaire, and functional outcome swallowing scale (FOSS) questionnaire were included in the study. KEY RESULTS Forty-five out of 304 patients were included. At a median follow-up of 12 months (IQR 10) after surgery, a statistically significant increase of lower esophageal sphincter (LES) total length (P = .002), intra-abdominal length (P = .001), integrated relaxation pressure (IRP), intrabolus pressure (IBP), and esophagogastric contractile integral (EGJ-CI) was noted (P < .001). Distal esophageal amplitude (P = .004), mean distal contractile integral (DCI) (P < .001), post multiple repeated swallows DCI (P = .001), and the percent of normal peristalsis increased (P = .040). All patients were relieved of reflux symptoms. Ineffective esophageal motility reversed to normal in 36% of patients after surgery. The only factor significantly associated with postoperative dysphagia was preoperative dysphagia (P = .006). Postoperatively, a significant correlation between IRP and DCI (r = 0.361 and P = .019) and between IBP and DCI (r = 0.443 and P = .003) was found. CONCLUSIONS AND INFERENCES The Linx procedure had a remarkable effect on esophageal motility in the short-term follow-up. It appears that the overall postoperative increase of IRP and IBP may justify the higher DCI values. Preoperative dysphagia was the only factor associated with postoperative dysphagia.
Collapse
Affiliation(s)
- Carlo Galdino Riva
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Sozzi
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Veronica Lazzari
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
22
|
Milito P, Asti E, Aiolfi A, Zanghi S, Siboni S, Bonavina L. Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction. J Gastrointest Surg 2020; 24:499-504. [PMID: 30941689 DOI: 10.1007/s11605-019-04210-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Minimally invasive enucleation is the treatment of choice in symptomatic patients with esophageal leiomyoma. Comprehensive long-term follow-up data are lacking. Aim of this study was to review the clinical outcomes of three procedures for enucleation of leiomyoma of the esophagus and esophagogastric junction. METHODS A single institution retrospective review was performed using a prospectively collected research database and individual medical records. Demographics, presenting symptoms, use of proton-pump inhibitors (PPI), tumor location and size, treatment modalities, and subjective and objective clinical outcomes were recorded. Barium swallow and upper gastrointestinal endoscopy were routinely performed during the follow-up. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Short-Form 36 questionnaires were used to compare quality of life before and after treatment. RESULTS Between 2002 and 2017, 35 patients underwent minimally invasive leiomyoma enucleation through thoracoscopy (n = 15), laparoscopy (n = 15), and endoscopy (n = 5). The overall morbidity rate was 14.3% and there was no mortality. All patients had a minimum of 1-year follow-up. The median follow-up was 49 (IQR 54) months, and there were no recurrences of leiomyoma. At the latest follow-up, the SF-36 scores were unchanged compared to baseline. However, there was a higher incidence of reflux symptoms (p < 0.050) and PPI use (p < 0.050) after endoscopic treatment. CONCLUSIONS Minimally invasive enucleation is safe and effective and can be performed by a variety of approaches according to leiomyoma location and morphology. Overall, health-related quality of life outcomes of each procedure appear satisfactory, but PPI dependence was greater in the endoscopic group.
Collapse
Affiliation(s)
- Pamela Milito
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Simone Zanghi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. .,Divisione Universitaria di Chirurgia, IRCSS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milan, Italy.
| |
Collapse
|
23
|
Asti E, Siboni S, Sironi A, Barbieri L, Bonavina L. Minimally invasive surgery for submucosal benign esophageal tumors: indications, preoperative investigations, patient selection, and clinical outcomes. Ann Laparosc Endosc Surg 2019. [DOI: 10.21037/ales.2019.06.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
24
|
Abstract
An intriguing simple toy, commonly known as the Notched Stick, is discussed as an example of a “vibrot”, a device designed and built to yield conversion of mechanical vibrations into a rotational motion. The toy, that can be briefly described as a propeller fixed on a stick by means of a nail and free to rotate around it, is investigated from both an experimental and a numerical point of view, under various conditions and settings, to investigate the basic working principles of the device. The conversion efficiency from vibration to rotational motion turns out to be very small, or even not detectable at all, whenever the propeller is tightly connected to the stick nail and perfectly axisymmetrical with respect to the nail axis; the small effects possibly observed can be ascribed to friction forces. In contrast, the device succeeds in converting vibrations into rotations when the propeller center of mass is not aligned with the nail axis, a condition occurring when either the nail-propeller coupling is not tight or the propeller is not completely axisymmetrical relative to the nail axis. The propeller rotation may be induced by a process of parametric resonance for purely vertical oscillations of the nail, by ordinary resonance if the nail only oscillates horizontally or, finally, by a combination of both processes when nail oscillations take place in an intermediate direction. Parametric resonance explains the onset of rotations also when the weight of the propeller is negligible. In contrast with what is commonly claimed in the literature, the possible elliptical motion of the nail, due to a composition of two harmonic motions of the same frequency imposed along orthogonal directions, seems unnecessary to determine the propeller rotation.
Collapse
Affiliation(s)
- Marica Broseghini
- Department of Civil, Environmental and Mechanical Engineering (DICAM), University of Trento, Trento, Italy
| | - Clara Ceccolini
- Department of Civil, Environmental and Mechanical Engineering (DICAM), University of Trento, Trento, Italy
| | - Claudio Della Volpe
- Department of Civil, Environmental and Mechanical Engineering (DICAM), University of Trento, Trento, Italy
- * E-mail:
| | - Stefano Siboni
- Department of Civil, Environmental and Mechanical Engineering (DICAM), University of Trento, Trento, Italy
| |
Collapse
|
25
|
Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. [PMID: 31164915 PMCID: PMC6544956 DOI: 10.1186/s13017-019-0245-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
Collapse
Affiliation(s)
- Mircea Chirica
- 1Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Stefano Siboni
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Alberto Aiolfi
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Carlo Galdino Riva
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Emanuele Asti
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Davide Ferrari
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Ari Leppäniemi
- Department of Emergency Surgery, University Hospital Meilahti Abdominal Center, Helsinki, Finland
| | - Richard P G Ten Broek
- 5Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre Yves Brichon
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Yoram Kluger
- 7Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gustavo Pereira Fraga
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Gil Frey
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Nelson Adami Andreollo
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Federico Coccolini
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | | | | | - Osvaldo Chiara
- 12General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Salomone Di Saverio
- 13Cambridge Colorectal Unit, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | | | - Dieter Weber
- 15Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | - Walter Biffl
- 16Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Helene Corte
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Imtaz Wani
- 18Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Pierre Cattan
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Fausto Catena
- 20Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Luigi Bonavina
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| |
Collapse
|
26
|
Aiolfi A, Asti E, Siboni S, Bernardi D, Rausa E, Bonitta G, Bonavina L. Impact of spleen-preserving total gastrectomy on postoperative infectious complications and 5-year overall survival: systematic review and meta-analysis of contemporary randomized clinical trials. ACTA ACUST UNITED AC 2019; 26:e202-e209. [PMID: 31043828 DOI: 10.3747/co.26.4391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The role of splenectomy in proximal gastric cancer is still debated. The objective of the present meta-analysis was to provide more-robust evidence about the effect of spleen-preserving total gastrectomy on postoperative infectious complications, overall morbidity, and 5-year overall survival (os). Methods PubMed, embase, and the Web of Science were consulted. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I 2 index and Cochran Q-test. Results Three randomized controlled trials published between 2000 and 2018 were included. Overall, 451 patients (50.1%) underwent open total gastrectomy with spleen preservation and 448 (49.9%) underwent open total gastrectomy with splenectomy. The patients ranged in age from 24 to 78 years. No differences were found in the number of harvested lymph nodes (p = 0.317), the reoperation rate (p = 0.871), or hospital length of stay (p = 0.347). The estimated pooled risk ratios for infectious complications, overall morbidity, and mortality were 1.53 [95% confidence interval (ci): 1.09 to 2.14; p = 0.016], 1.51 (95% ci: 1.11 to 2.05; p = 0.008), and 1.23 (95% ci: 0.40 to 3.71; p = 0.719) respectively. The estimated pooled hazard ratio for 5-year os was 1.06 (95% ci: 0.78 to 1.45; p = 0.707). Conclusions Spleen-preserving total gastrectomy should be considered in patients with curable gastric cancer because it is significantly associated with decreased postoperative infectious complications and overall morbidity, with no difference in the 5-year os. Those observations appear worthwhile for establishing better evidence-based treatment for gastric cancer.
Collapse
Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - E Asti
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - S Siboni
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - D Bernardi
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - E Rausa
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| | - L Bonavina
- Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
| |
Collapse
|
27
|
Siboni S, Sozzi M, Bonavina L. What Is the Value of Preoperative Esophageal Manometry in Patients with Giant Paraesophageal Hernia? J Am Coll Surg 2019; 228:211-212. [DOI: 10.1016/j.jamcollsurg.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
|
28
|
Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, Toti F, Bonavina L. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis. World J Emerg Surg 2018; 13:42. [PMID: 30214470 PMCID: PMC6134522 DOI: 10.1186/s13017-018-0203-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023] Open
Abstract
Background Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. Methods PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms "Rigid endoscopy AND Flexible endoscopy AND foreign bod*". Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2 index and Cochrane Q test. Results Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48-2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96-8.61; p = 0.06), 1.09 (95% CI 0.38-3.18; p = 0.87), and 1.50 (95% CI 0.53-4.25; p = 0.44), respectively. There was no mortality. Conclusions FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated.
Collapse
Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Galdino Riva
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Toti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| |
Collapse
|
29
|
Riva CG, Toti FAT, Siboni S, Bonavina L. Unusual foreign body impacted in the upper oesophagus: original technique for transoral extraction. BMJ Case Rep 2018; 2018:bcr-2018-225241. [PMID: 29950367 DOI: 10.1136/bcr-2018-225241] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Foreign body ingestion is a common event; in the adult population, most ingestions occur in patients with mental disability, psychiatric disorders, alcohol intoxication or in prisoners seeking secondary gain. Removal through flexible endoscopy is generally the first-line approach but rescue oesophagotomy may be necessary for foreign bodies impacted in the upper oesophagus. A 27-year-old man was admitted in the emergency room after intentional ingestion of a wooden spherical object with a central hole. A total body CT scan showed that the object was completely obstructing the upper oesophageal lumen but there were no signs of perforation. In the operating room, a Weerda diverticuloscope and a 5 mm 0° telescope were used to visualise the foreign body under general anaesthesia. A standard endoscopic biopsy forceps was passed through the hole of the sphere and was retracted with the jaws open allowing transoral extraction without complications.
Collapse
Affiliation(s)
- Carlo Galdino Riva
- Department of Surgery, IRCCS Policlinico San Donato, Università degli Studi di Milano, Milano, Italy
| | | | - Stefano Siboni
- Department of Surgery, IRCCS Policlinico San Donato, Università degli Studi di Milano, Milano, Italy
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
30
|
Siboni S, Asti E, Milito P, Bonitta G, Sironi A, Aiolfi A, Bonavina L. Impact of Laparoscopic Repair of Large Hiatus Hernia on Quality of Life: Observational Cohort Study. Dig Surg 2018; 36:402-408. [PMID: 29925065 DOI: 10.1159/000490359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 12/10/2022]
Abstract
BACKGROUND Laparoscopic surgery has proven safe and effective in the treatment of large hiatus hernia. Differences may exist between objectively assessed surgical outcomes, symptomatic scores, and patient-reported outcomes. METHODS An observational, single-arm cohort study was conducted in patients undergoing primary laparoscopic repair with crura mesh augmentation and Toupet fundoplication for large (> 50% of intrathoracic stomach) type III-IV hiatus hernia. Data were extracted from hospital charts and a prospectively updated research database. The main study outcome was quality of life assessed by the Gastroesophageal reflux disease Health-Related Quality of Life (GERD-HRQL) score and the Short-form 36 (SF-36). RESULTS Between 2013 and 2016, 37 out of 49 operated patients completed the comprehensive quality-of-life evaluation at the 2-year follow-up. The GERD-HRQL score significantly decreased compared to baseline (p < 0.001). All items of the SF-36 significantly improved compared to baseline (p < 0.05). Both Physical and Mental Component Summary scores were significantly higher than preoperative scores, with a medium Cohen's effect size (-0.77 and 0.56, respectively). At the 2-year follow-up, symptoms had disappeared in the majority of patients. The use of proton-pump inhibitors significantly decreased compared to baseline (13.5 vs. 86.4%, p < 0.001). Also, the use of antidepressants and benzodiazepines significantly decreased after surgery (8.1 vs. 32.4%, p < 0.001). The overall alimentary satisfaction score was > 8 in 92% of patients. There were no safety issues related to the use of the absorbable synthetic mesh. The incidence of anatomical hernia recurrence was 5.4%, but no patient with recurrent hernia required surgical revision. CONCLUSIONS Laparoscopic repair of large hiatus hernia with mesh and partial fundoplication is associated with symptomatic relief, no side-effects, and a significant improvement in disease-specific and generic quality of life at 2-year follow-up.
Collapse
Affiliation(s)
- Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Pamela Milito
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Andrea Sironi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy,
| |
Collapse
|
31
|
Siboni S, Aiolfi A, Ceriani C, Tontini GE, Bonavina L. Cricopharyngeal myotomy with thulium laser through flexible endoscopy: proof-of-concept study. Endosc Int Open 2018; 6:E470-E473. [PMID: 29616239 PMCID: PMC5880037 DOI: 10.1055/a-0581-8789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/27/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic treatment of Zenker's diverticulum has proven feasible, but electrocautery and CO 2 laser technology carry the risk of collateral thermal injury. Thulium laser septum incision may overcome this limitation. We describe for the first time the use of thulium laser through flexible endoscopy in a small cohort of patients with Zenker diverticulum. PATIENTS AND METHODS Thulium laser septum division was performed via flexible endoscopy under general anesthesia in consecutive symptomatic patients with primary or recurrent Zenker diverticulum. Primary study outcomes were feasibility and safety of the procedure. A 1.9-μm laser fiber was used with an emission power of 10 - 16 W. RESULTS Five patients were treated between May and June 2017. Two patients presented with recurrent symptomatic diverticulum after previous transoral septum stapling. Complete division of the septum was achieved in all patients. There was no bleeding nor need of adjunctive electrocautery devices to complete the procedure. The postoperative course was uneventful in all patients; the chest film and gastrographin swallow study on postoperative Day 1 were negative for pneumomediastinum, leaks or residual pouch. All patients were discharged within 48 hours on a soft diet. At the 1- and 3-month follow-up visits, all patients were satisfied with the procedure and reported improved swallowing and absence of regurgitation and cough. CONCLUSIONS Division of Zenker's septum with thulium laser is feasible and safe through flexible endoscopy. Longer-term follow-up is required to establish efficacy and effectiveness of this novel procedure.
Collapse
Affiliation(s)
- Stefano Siboni
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Alberto Aiolfi
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Chiara Ceriani
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Gian Eugenio Tontini
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Luigi Bonavina
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy,Corresponding author Prof. Luigi Bonavina Divisione Universitaria di Chirurgia GeneraleIRCCS Policlinico San DonatoPiazza Malan 2San Donato Milanese (Milano) 20097Milan, Italy+02-52774840
| |
Collapse
|
32
|
Abstract
Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms “achalasia,” “end-stage achalasia,” “esophagectomy,” and “esophageal resection.” Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.
Collapse
Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| |
Collapse
|
33
|
Aiolfi A, Asti E, Bonitta G, Siboni S, Bonavina L. Esophageal Resection for End-Stage Achalasia. Am Surg 2018; 84:506-511. [PMID: 29712597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy," and "esophageal resection." Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.
Collapse
|
34
|
Aiolfi A, Asti E, Bernardi D, Bonitta G, Rausa E, Siboni S, Bonavina L. Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: Systematic review and meta-analysis. Int J Surg 2018; 52:82-88. [PMID: 29471155 DOI: 10.1016/j.ijsu.2018.02.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic Nissen and Toupet fundoplication (LF) are currently considered gold-standard surgical treatment for Gastroesophageal Reflux Disease (GERD). Magnetic Sphincter Augmentation (MSA) is an innovative surgical procedure that has been showed to be effective to control GERD symptoms and to reduce esophageal acid exposure. The aim of this systematic review and meta-analysis was to compare early outcomes of LF and MSA. MATERIALS AND METHODS PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms "Gastroesophageal reflux or heartburn", "LINX or magnetic sphincter augmentation" and "fundoplication". Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2-index and Cochrane Q-test. Meta-regression was used to address the effect of potential confounders. RESULTS Seven observational cohort studies, published between 2014 and 2017, matched the inclusion criteria. Overall, 1211 patients, 686 MSA and 525 LF, were included. Postoperative morbidity ranged from 0 to 3% in the MSA group and from 0 to 7% in the LF group, and there was no mortality. Dysphagia requiring endoscopic dilatation occurred in 9.3% and 6.6% of patients respectively (OR = 1.56, 95% CI = 0.61-3.95, p = 0.119). The pooled OR of gas/bloat symptoms, ability to vomit, and ability to belch were 0.39 (95% CI 0.25-0.61; p < 0.001), 10.10 (95% CI 5.33-19.15; p < 0.001), and 5.53 (95% CI 3.73-8.19; p < 0.001), respectively. The postoperative GERD-HRQL was similar (p = 0.101). The pooled OR of PPI suspension, endoscopic dilation, and reoperation were similar in the two patients groups (p = 0.548, p = 0.119, p = 0.183, respectively). CONCLUSION Both anti-reflux procedures are safe and effective up to 1-year follow-up. PPI suspension rate, dysphagia requiring endoscopic dilatation, and disease-related quality of life are similar in the two patient groups. MSA is associated with less gas/bloat symptoms and increased ability to vomit and belch.
Collapse
Affiliation(s)
- Alberto Aiolfi
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Emanuele Asti
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Daniele Bernardi
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Gianluca Bonitta
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Emanuele Rausa
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Stefano Siboni
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| | - Luigi Bonavina
- University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Italy.
| |
Collapse
|
35
|
Siboni S, Aiolfi A, Toti F, Bonavina L. Is magnetic sphincter augmentation a reasonable surgical option for gastroesophageal reflux disease? ACTA ACUST UNITED AC 2018. [DOI: 10.21037/aoe.2018.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
36
|
Zanghì S, Siboni S, Asti E, Festa A, Bonavina L. Metastasis to the esophagus from primary adenocarcinoma of the lung. Eur Surg 2017. [DOI: 10.1007/s10353-017-0501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
37
|
Ali JT, Rice RD, David EA, Spicer JD, Dubose JJ, Bonavina L, Siboni S, O'Callaghan TA, Luo-Owen X, Harrison S, Ball CG, Bini J, Vercruysse GA, Skarupa D, Miller CC, Estrera AL, Khalil KG. Perforated esophageal intervention focus (PERF) study: a multi-center examination of contemporary treatment. Dis Esophagus 2017; 30:1-8. [PMID: 28881905 DOI: 10.1093/dote/dox093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/07/2017] [Accepted: 06/29/2017] [Indexed: 12/11/2022]
Abstract
The treatment of esophageal perforation (EP) remains a significant clinical challenge. While a number of investigators have previously documented efficient approaches, these were mostly single-center experiences reported prior to the introduction of newer technologies: specifically endoluminal stents. This study was designed to document contemporary practice in the diagnosis and management of EP at multiple institutions around the world and includes early clinical outcomes. A five-year (2009-2013) multicenter retrospective review of management and outcomes for patients with thoracic or abdominal esophageal perforation was conducted. Demographics, etiology, diagnostic modalities, treatments, subsequent early outcomes as well as morbidity and mortality were captured and analyzed. During the study period, 199 patients from 10 centers in the United States, Canada, and Europe were identified. Mechanisms of perforation included Boerhaave syndrome (60, 30.1%), iatrogenic injury (65, 32.6%), and penetrating trauma (25, 12.6%). Perforation was isolated to the thoracic segment alone in 124 (62.3%), with 62 (31.2%) involving the thoracoabdominal esophagus. Mean perforation length was 2.5 cm. Observation was selected as initial management in 65 (32.7%), with only two failures. Direct operative intervention was initial management in 65 patients (32.6%), while 29 (14.6%) underwent esophageal stent coverage. Compared to operative intervention, esophageal stent patients were significantly more likely to be older (61.3 vs. 48.3 years old, P < 0.001) and have sustained iatrogenic mechanisms of esophageal perforation (48.3% vs.15.4%). Secondary intervention requirement for patients with perforation was 33.7% overall (66). Complications included sepsis (56, 28.1%), pneumonia (34, 17.1%) and multi-organ failure (23, 11.6%). Overall mortality was 15.1% (30). In contemporary practice, diagnostic and management approaches to esophageal perforation vary widely. Despite the introduction of endoluminal strategies, it continues to carry a high risk of mortality, morbidity, and need for secondary intervention. A concerted multi-institutional, prospectively collected database is ideal for further investigation.
Collapse
Affiliation(s)
- J T Ali
- The University of Texas at Austin, Austin, Texas
| | - R D Rice
- San Antonio Military Medical Center, San Antonio
| | - E A David
- Department of Surgery, University of California at Davis, Sacramento
| | | | | | - L Bonavina
- Department of Surgery, University of Milan, Milan, Italy
| | - S Siboni
- Department of Surgery, University of Southern California, Los Angeles County, Los Angeles
| | - T A O'Callaghan
- Division of Trauma Services, Loma Linda University, Loma Linda, California
| | - X Luo-Owen
- Division of Trauma Services, Loma Linda University, Loma Linda, California
| | - S Harrison
- Department of Cardiothoracic Surgery, University of Mississippi, Jackson, Mississippi
| | - C G Ball
- Department of Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta, Canada
| | - J Bini
- Miami Valley Hospital, Department of Surgery, Dayton, Ohio
| | - G A Vercruysse
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - D Skarupa
- Department of Surgery, University of Florida-Jacksonville, Jacksonville, Florida, USA
| | - C C Miller
- Houston Medical Center, University of Texas, Houston, Texas
| | - A L Estrera
- Houston Medical Center, University of Texas, Houston, Texas
| | - K G Khalil
- Houston Medical Center, University of Texas, Houston, Texas
| |
Collapse
|
38
|
Siboni S, Asti E, Sozzi M, Bonitta G, Melloni M, Bonavina L. Respiratory Symptoms and Complications of Zenker Diverticulum: Effect of Trans-Oral Septum Stapling. J Gastrointest Surg 2017; 21:1391-1395. [PMID: 28470561 DOI: 10.1007/s11605-017-3435-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients. METHODS Consecutive adult patients who underwent trans-oral septum stapling for Zenker diverticulum were included in a retrospective, observational cohort study. Pre- and postoperative symptoms, including chronic cough and aspiration pneumonia, were evaluated using a dedicated foregut questionnaire and were recorded on a prospectively maintained database. The operation was performed under general anesthesia. A barium swallow study and an upper gastrointestinal endoscopy were performed 6 months after the operation, and the foregut questionnaire was administered yearly. RESULTS A total of 139 patients were finally included in the study. The median age was 72 years. In 62 (44.6%, CI 36.2-53.3) patients, there was a history of chronic cough and/or aspiration pneumonia. Chronic cough was associated with pneumonia (p < 0.001), while pneumonia was associated with severe regurgitation (p < 0.042) and weight loss (p = 0.001). The overall postoperative morbidity rate was 2.2% and there was no mortality. The median postoperative hospital stay was 2 days (range 0-22). The median follow-up was 38 months (range 2-105). At 3 years, a statistically significant reduction in the rate of chronic cough (36.8 vs. 7.9%, p < 0.001), recurrent episodes of pneumonia (6.6 vs. 0.0%, p = 0.031), dysphagia (78.9 vs. 6.6%, p < 0.001), and regurgitation (67.1 vs. 6.6%, p < 0.001) was recorded. The probability of remaining symptom-free at 90 months of follow-up was 0.818 (CI: 0.745-0.899). CONCLUSIONS Trans-oral septum stapling is safe and can effectively reduce the burden of respiratory symptoms and complications associated with Zenker diverticulum.
Collapse
Affiliation(s)
- Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Marco Sozzi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Matteo Melloni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
| |
Collapse
|
39
|
Lazzari V, Siboni S, Asti E, Bonavina L. Transanal removal of a broken drinking glass self-inserted and retained in the rectum. BMJ Case Rep 2017; 2017:bcr-2017-220268. [PMID: 28576915 DOI: 10.1136/bcr-2017-220268] [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] [Indexed: 11/04/2022] Open
Abstract
Retained rectal foreign bodies are increasingly reported in current clinical practice, and there is no clear consensus in the literature as to whether transanal extraction should be performed in the emergency or in the operating room. A 47-year-old presented to the hospital for a retained drinking glass in the rectum that was broken after an attempt at self-extraction. Physical examination showed no evidence of abdominal guarding nor bleeding from the rectum; abdominal and pelvic X-rays confirmed the presence of a broken glass, 8×6 cm in size and no signs of perforation. Initial anoscopy performed in the emergency room confirmed the partial fracture of the glass. The patient was transferred to the operating room and transanal extraction was carried out under general anaesthesia without complications.
Collapse
Affiliation(s)
| | - Stefano Siboni
- Universita degli Studi di Milano, Surgery, Milano, Italy.,IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy
| | - Emanuele Asti
- IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy.,Universita degli Studi di Milano, Biomedical Sciences for Health, Milano, Italy
| | - Luigi Bonavina
- Universita degli Studi di Milano, Biomedical Sciences for Health, Milano, Italy.,IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy
| |
Collapse
|
40
|
Sozzi M, Siboni S, Asti E, Bonitta G, Bonavina L. Short-Term Outcomes of Minimally Invasive Esophagectomy for Carcinoma In Patients with Liver Cirrhosis. J Laparoendosc Adv Surg Tech A 2017; 27:592-596. [DOI: 10.1089/lap.2017.0115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Marco Sozzi
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Stefano Siboni
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Emanuele Asti
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
| |
Collapse
|
41
|
Milito P, Siboni S, Asti E, Bonavina L. The seatbelt sign: early recognition may be life-saving. BMJ Case Rep 2017; 2017:bcr-2017-219814. [PMID: 28433971 DOI: 10.1136/bcr-2017-219814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pamela Milito
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Stefano Siboni
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Emanuele Asti
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
42
|
Matsushima K, Inaba K, Jhaveri V, Cheng V, Herr K, Siboni S, Strumwasser A, Demetriades D. Loss of muscle mass: a significant predictor of postoperative complications in acute diverticulitis. J Surg Res 2016; 211:39-44. [PMID: 28501129 DOI: 10.1016/j.jss.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe muscle mass depletion, sarcopenia, has been shown to be associated with poor operative outcomes. However, its impact on emergency abdominal operations remains unclear. The purpose of this study was to examine the association between low muscle mass (LMM) and outcomes after emergency operations for acute diverticulitis. PATIENTS AND METHODS Patients ≥18 y requiring an emergency operation for acute diverticulitis between January 2007 and September 2014 were included. On preoperative computed tomography, the cross-sectional area (CSA) and transverse diameter (TVD) of the right and left psoas muscle were measured at the level of the third lumbar vertebral body. Sensitivity analysis was performed to determine appropriate CSA and TVD cutoff values defining low skeletal muscle mass. Clinical outcomes of patients with low muscle mass (LMM group) were compared with the non-LMM group. RESULTS A total of 89 patients met our inclusion criteria. Median CSA and TVD were 794 mm2 and 24 mm, respectively. There was a strong correlation between the CSA and TVD (R2 = 0.84). In univariable analysis, significantly higher rates of postoperative major complications (63% versus 37%, P = 0.027) and surgical site infection (47% versus 19%, P = 0.008) were identified in the LMM group. After adjusting for clinically important covariates in a logistic regression model, patients with LMM were significantly associated with higher odds of major complications and surgical site infection. CONCLUSIONS Preoperative assessment of the psoas muscle CSA and TVD on computed tomography can be a practical method for identifying patients at risk for postoperative complications.
Collapse
Affiliation(s)
- Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Vidhi Jhaveri
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Keith Herr
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Stefano Siboni
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Aaron Strumwasser
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| |
Collapse
|
43
|
Cho J, Benjamin ER, Siboni S, Inaba K, Demetriades D. Combined Head and Abdominal Blunt Trauma: What Takes Priority? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
44
|
Gutierrez A, Inaba K, Siboni S, Effron Z, Haltmeier T, Jaffray P, Reddy S, Lofthus A, Benjamin E, Dubose J, Demetriades D. The utility of chest X-ray as a screening tool for blunt thoracic aortic injury. Injury 2016; 47:32-6. [PMID: 26296454 DOI: 10.1016/j.injury.2015.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/29/2015] [Accepted: 08/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The early and accurate identification of patients with blunt thoracic aortic injury (BTAI) remains a challenge. Traditionally, a portable AP chest X-ray (CXR) is utilized as the initial screening modality for BTAI, however, there is controversy surrounding its sensitivity. The purpose of this study was to assess the sensitivity of CXR as a screening modality for BTAI. METHODS After IRB approval, all adult (≥18 yo) blunt trauma patients admitted to LAC+USC (01/2011-12/2013) who underwent CXR and chest CT were retrospectively reviewed. Final radiology attending CXR readings were reviewed for mediastinal abnormalities (widened mediastinum, mediastinal to chest width ratio greater than 0.25, irregular aortic arch, blurred aortic contour, opacification of the aortopulmonary window, and apical pleural haematoma) suggestive of aortic injury. Chest CT final attending radiologist readings were utilized as the gold standard for diagnosis of BTAI. The primary outcome analyzed was CXR sensitivity. RESULTS A total of 3728 patients were included in the study. The majority of patients were male (72.6%); mean age was 43 (SD 20). Median ISS was 9 (IQR 4-17) and median GCS was 15 (IQR 14-15). The most common mechanism of injury was MVC (48.0%), followed by fall (20.6%), and AVP (16.9%). The total number of CXRs demonstrating a mediastinal abnormality was 200 (5.4%). Widened mediastinum was present on 191 (5.1%) of CXRs, blurred aortic contour on 10 (0.3%), and irregular aortic arch on 4 (0.1%). An acute aortic injury confirmed by chest CT was present in 17 (0.5%) patients. Only 7 of these with CT-confirmed BTAI had a mediastinal abnormality identified on CXR, for a sensitivity of 41% (95% CI: 19-67%). CONCLUSION The results from this study suggest that CXR alone is not a reliable screening modality for BTAI. A combination of screening CXR and careful consideration of other factors, such as mechanism of injury, will be required to effectively discriminate between those who should and should not undergo chest CT.
Collapse
Affiliation(s)
- Adam Gutierrez
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA.
| | - Stefano Siboni
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Zachary Effron
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Tobias Haltmeier
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Paul Jaffray
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Sravanthi Reddy
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Alexander Lofthus
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Elizabeth Benjamin
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Joseph Dubose
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA 90033, USA
| |
Collapse
|
45
|
|
46
|
|
47
|
Benjamin ER, Siboni S, Haltmeier T, Lofthus A, Inaba K, Demetriades D. Negative Finding From Computed Tomography of the Abdomen After Blunt Trauma. JAMA Surg 2015; 150:1194-5. [DOI: 10.1001/jamasurg.2015.1649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth R. Benjamin
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Stefano Siboni
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Tobias Haltmeier
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Alexander Lofthus
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Kenji Inaba
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Demetrios Demetriades
- Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| |
Collapse
|
48
|
Abstract
Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and non-duodenal intra-abdominal Organ Injury Scale ≥ 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS ( P = 0.004) and similar mortality ( P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE.
Collapse
Affiliation(s)
- Stefano Siboni
- From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California
| | - Elizabeth Benjamin
- From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California
| | - Tobias Haltmeier
- From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California
| |
Collapse
|
49
|
Haltmeier T, Benjamin ER, Siboni S, Dilektasli E, Inaba K, Demetriades D. Prehospital Intubation for Isolated Severe Blunt Traumatic Brain Injury: Worse Outcomes and Higher Mortality. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Matsushima K, Inaba K, Jhaveri V, Cheng V, Strumwasser AM, Magee GA, Siboni S, Benjamin ER, Tham T, Demetriades D. Loss of Muscle Mass: A Significant Predictor of Postoperative Complications in Patients with Acute Diverticulitis. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|