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Updates in Surgery

Michele De Rosa, Fabio Rondelli, Marcello Boni, Fabio Ermili, Walter Bugiantella, Lorenzo Mariani, Graziano Ceccarelli, Antonio Giuliani
Total mesorectal excision (TME) represents the key principle in the surgical treatment of rectal cancer. Transanal mesorectal excision was introduced as a complement to conventional surgery to overcome its technical difficulties. The aim of this study was to evaluate the early surgical results following the introduction of this novel technique at our Unit. Between January and May 2016, 12 patients diagnosed with mid-low rectal adenocarcinoma were enrolled into this study and evaluated with regards demography, histopathology, peri-operative data and postoperative complications...
November 8, 2018: Updates in Surgery
Michele Grieco, Diletta Cassini, Domenico Spoletini, Enrica Soligo, Emanuela Grattarola, Gianandrea Baldazzi, Silvio Testa, Massimo Carlini
The objective is to investigate the short- and long-term outcomes of laparoscopic resections of splenic flexure colon cancers in three Italian high-volume centers. The laparoscopic resection of splenic flexure colon cancers is a challenging procedure and has not been completely standardized, mainly due to the technical difficulty, the arduous identification of major blood vessels, and the problems associated with anastomosis construction. In this retrospective cohort observational study, a consecutive series of patients treated in three Italian high-volume centers with elective laparoscopic resection of the splenic flexure for cancer is analyzed...
November 8, 2018: Updates in Surgery
Stefano Cianci, Carlo Ronsini, Giuseppe Vizzielli, Alessandro Tropea, Antonio Biondi, Giovanni Scambia, Anna Fagotti
Secondary and tertiary cytoreductive surgery was associated with improved overall survival in platinum-sensitive recurrent ovarian cancer (ROC). Hyperthermic intraoperative intra-peritoneal chemotherapy (HIPEC) is considered an attractive method in the treatment of ROC to deliver chemotherapy with enhanced effect directly at the tumor site. However, another deserving aspect is the feasibility and the oncologic role of HIPEC repetition. Twelve patients affected by secondary ovarian cancer recurrence previously submitted to cytoreduction followed by HIPEC were enrolled for the present study to receive tertiary cytoreduction followed by HIPEC repetition...
November 8, 2018: Updates in Surgery
Francesco Ferrara, Giuseppe Di Gioia, Daniele Gentile, Giulia Carrara, Davide Gobatti, Marco Stella
Splenic flexure (SFM) in rectal cancer surgery is a crucial step which may increase the difficulty of the operation. The aim of this retrospective single-center study is to demonstrate if the selective omission of SFM during anterior rectal resection can reduce the complexity of the operation, without affecting post-operative and oncologic outcomes. Data of 112 consecutive rectal resections for cancer from March 2010 to March 2017 were analyzed and divided into two groups: SFM and No-SFM. A sub-analysis was then performed for laparoscopy and traditional cases...
November 8, 2018: Updates in Surgery
Corrado Pedrazzani, Federica Secci, Eduardo Fernandes, Ivans Jelovskijs, Giulia Turri, Cristian Conti, Andrea Ruzzenente, Alfredo Guglielmi
Diverting loop ileostomy following low anterior resection (LAR) is known to decrease quality of life and prolongs the return back to patients' baseline activity. The aim of this retrospective study was to explore feasibility and safety of an early ileostomy reversal strategy in a cohort of patients undergoing minimally invasive LAR within an enhanced recovery after surgery (ERAS) program. Prospectively collected data from 15 patients who underwent minimally invasive LAR and diverting ileostomy at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust between September 2015 and December 2016 were retrospectively analyzed...
October 4, 2018: Updates in Surgery
Giovanni Vennarecci, Daniele Ferraro, Antonella Tudisco, Giovanni Battista Levi Sandri, Nicola Guglielmo, Giammauro Berardi, Isabella Sperduti, Giuseppe Maria Ettorre
The ALPPS is a technique that allows achieving hepatic resection by a rapid future liver remnant hypertrophy. The aim of this study was to report the experience of an Italian center with ALPPS in patients with liver tumors. A retrospective analysis of patients undergoing ALPPS between 2012 and 2017 was performed. Patients' characteristics and disease presentation, increase in future liver remnant (FLR) as well as intraoperative and postoperative short- and long-term outcomes were evaluated. A total of 24 patients underwent the ALPPS procedure: 17 procedures for hepatocarcinoma (HCC), 5 for colorectal liver metastases (CRLM), 1 for cholangiocarcinoma (CC) and 1 for Merkel Cell Carcinoma liver metastasis (MCCLM)...
September 25, 2018: Updates in Surgery
Micaela Piccoli, Ferdinando Agresta, Grazia Maria Attinà, Dalia Amabile, Domenico Marchi
To date, there is no shared consensus on a definition of a complex abdominal wall in elective surgery and in the emergency, on indications, technical details, complications, and follow-up. The purpose of the conference was to lay the foundations for a homogeneous approach to the complex abdominal wall with the primary intent being to attain the following objectives: (1) to develop evidence-based recommendations to define "complex abdominal wall"; (2) indications in emergency and in elective cases; (3) management of "complex abdominal wall"; (4) techniques for temporary abdominal closure...
September 25, 2018: Updates in Surgery
Marco G Patti, Francisco Schlottmann
The author name Marco G. Patti was incorrectly published.
September 21, 2018: Updates in Surgery
Hui Sun, Che-Wei Wu, Antonina Catalfamo, Valerio Fabiano, Gianlorenzo Dionigi
No abstract text is available yet for this article.
September 11, 2018: Updates in Surgery
Matteo Rottoli, Benedetta Casadei, Carlo Vallicelli, Giulia Vitali, Federico Ghignone, Marica Melina, Marta Tanzanu, Gilberto Poggioli
The aim of the study was to compare the perioperative outcomes of patients undergoing ileostomy closure after a three-stage ileal pouch-anal anastomosis to a control group of patients who had elective colorectal resections and stoma, and to analyse the differences based on the technique of closure. The cases were retrospectively compared for demographic characteristics and postoperative outcomes. Chi-square, Fisher's exact and Wilcoxon rank sum tests were used as appropriate. Between 2011 and 2016, 338 patients having their stoma reversed after three-stage IPAA were compared to 158 patients in the control group...
September 8, 2018: Updates in Surgery
Francesco Pennestrì, Pierpaolo Gallucci, Francesca Prioli, Piero Giustacchini, Luigi Ciccoritti, Luca Sessa, Rocco Bellantone, Marco Raffaelli
The use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch-jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass-RYGB, and One-Anastomosis gastric bypass-OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed...
September 6, 2018: Updates in Surgery
Stefano Guadagni, Marco Clementi, Maria Bencivenga, Shigeki Kusamura, Caterina Fiorentini, Francesco Masedu
Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy are candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients. From a cohort of 77 patients with unresectable recurrent rectal cancer in progression after standard treatments and submitted to HPP, 21 patients underwent repeat HPP using mitomycin C (MMC) at the dose of 25 mg/m2 ...
December 2018: Updates in Surgery
Antonio Brescia, Massimo Pezzatini, Gherardo Romeo, Matteo Cinquepalmi, Fioralba Pindozzi, Anna Dall'Oglio, Marcello Gasparrini, Fulger Lazar
ERAS protocol and indocyanine green fluorescence angiography (ICG-FA) represent the new surgical revolution minimizing complications and shortening recovery time in colorectal surgery. As of today, no studies have been published in the literature evaluating the impact of the ICG-FA in the ERAS protocol for the patients suitable for colorectal surgery. The aim of our study was to assess whether the systematic evaluation of intestinal perfusion by ICG-FA could improve patients outcomes when managed with ERAS perioperative protocol, thus reducing surgical complication rate...
December 2018: Updates in Surgery
Nicola de'Angelis, Niccoló Petrucciani, Giusy Giannandrea, Francesco Brunetti
Low-impact laparoscopic (LIL) cholecystectomy is an innovative surgical protocol that combines the use of mini-laparoscopic instruments (3-mm ports) under a low- and stable-pressure pneumoperitoneum (8 mmHg), with the aim of minimizing the surgical invasiveness and the risks related to CO2 insufflation on the peritoneal environment. In day-surgery settings, LIL may contribute to increase the surgical success due to several potential benefits in terms of postoperative pain intensity and time to full recovery...
August 29, 2018: Updates in Surgery
Areg Grigorian, Alessio Pigazzi, Ninh T Nguyen, Sebastian D Schubl, Victor Joe, Matthew Dolich, Michael Lekawa, Jeffry Nahmias
Laparoscopy accounts for > 70% of general surgical cases. Given the increased use of laparoscopy in emergent colorectal disease, we hypothesized that there would be an increased use of laparoscopic colectomy (LC) in trauma patients. In addition, we hypothesized increased length of stay (LOS) and mortality in trauma patients undergoing open colectomy (OC) vs. LC. This was a retrospective analysis using the National Trauma Data Bank (2008-2015). We included adult patients undergoing LC or OC. A multivariable logistic regression model was used for determining risk of LOS and mortality...
August 24, 2018: Updates in Surgery
Paolo Magistri, Tiziana Olivieri, Valentina Serra, Giuseppe Tarantino, Giacomo Assirati, Annarita Pecchi, Roberto Ballarin, Fabrizio Di Benedetto
Immune compromised as well as critically ill patients are at higher risk of surgical wound infection and dehiscence. Wound infections critically influence the outcomes after liver transplantation. In particular, it was shown that they significantly reduce the overall survival rate when compared to patients with uneventful wound healing, and their occurrence is associated with death or graft loss within 1-year post-transplantation. From January 2001 through December 2017, 763 patients underwent liver transplantation in our Institution, the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, "Policlinico" University Hospital, University of Modena and Reggio Emilia, Modena, Italy...
August 24, 2018: Updates in Surgery
Luigi Pugliese, Stefania Marconi, Erika Negrello, Valeria Mauri, Andrea Peri, Virginia Gallo, Ferdinando Auricchio, Andrea Pietrabissa
The use of 3D printing is gaining considerable success in many medical fields including surgery. Here, the technology was introduced for increasing the level of anatomical understanding thanks to the inherent characteristics of 3D printed models: these are highly accurate and customized reproductions, being obtained from own radiological imaging of patients, and are solid graspable objects allowing for free manipulation on part of the user. The resulting tactile feedbacks significantly help the comprehension of anatomical details, especially the spatial relations between structures...
September 2018: Updates in Surgery
Giuseppe Spinoglio, Emilio Bertani, Simona Borin, Alessandra Piccioli, Wanda Petz
Fluorescent imaging with indocyanine green (ICG) is an emerging technology that is gaining acceptance for being a valid tool in surgeons' decision making. ICG binds to plasma lipoproteins if injected intravenously and, when excited by near-infrared light, provides anatomic information about organs vascularization and tissues perfusion. If injected in tissues, it migrates in the lymphatic system, therefore enabling the identification of lymphatic draining pathways of different organs. In this paper we address specific applications of ICG fluorescence in robotic general surgery...
September 2018: Updates in Surgery
Marco G Patti, Francisco Schlottmann
No abstract text is available yet for this article.
September 2018: Updates in Surgery
Verónica Gorodner, Germán Viscido, Franco Signorini, Lucio Obeide, Federico Moser
Gastroesophageal reflux disease (GERD) is markedly increased among the obese population being recognized as one of the many obesity-related comorbidities. This concept should raise awareness, making physicians investigate more profoundly about this disease in this kind of patients. Currently, bariatric surgery is considered the gold standard treatment for morbid obesity. However, not all the operations are appropriate for the treatment of GERD and not all the patients are willing to receive bariatric surgery for the treatment of GERD...
September 2018: Updates in Surgery
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