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1. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Author

Costa, G, Fransvea, P, Lepre, L, Liotta, G, Mazzoni, G, Biloslavo, A, Bianchi, V, Occhionorelli, S, Costa, A, Sganga, G, Agresta, F, Alemanno, G, Antropoli, M, Apice, N, Argenio, G, Avenia, N, Azzinnaro, A, Barberis, A, Badessi, G, Baldazzi, G, Bergamini, C, Bianco, G, Bombardini, C, Borzellino, G, Brachini, G, Maurizio, B, Canini, T, Capolupo, G, Carannante, F, Caricato, M, Cassini, D, Castriconi, M, Catamero, A, Catarci, M, Ceccarelli, G, Ceresoli, M, Chiarugi, M, Cillara, N, Cirocchi, R, Cobuccio, L, Coccolini, F, Cocorullo, G, Cozza, V, Crucitti, A, Cucinotta, E, D'Alessio, R, de Manzoni Garberini, A, De Manzini, N, De Nisco, C, De Prizio, M, Finotti, E, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Giordano, A, Guerrieri, M, Iacopini, V, Kurihara, H, La Greca, A, Laracca, G, Laterza, E, Mariani, D, Marini, P, Marzaioli, R, Masciana, G, Mercantini, P, Miacci, V, Mingoli, A, Miranda, G, Paderno, N, Palini, G, Paradies, D, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Puccioni, C, Rocca, A, Rondelli, F, Ruscelli, P, Paolo, S, Scattizzi, M, Erao, A, Tartaglia, D, Tebala, G, Trana, C, Zago, M, Costa G., Fransvea P., Lepre L., Liotta G., Mazzoni G., Biloslavo A., Bianchi V., Occhionorelli S., Costa A., Sganga G., Agresta F., Alemanno G., Antropoli M., Apice N., Argenio G., Avenia N., Azzinnaro A., Barberis A., Badessi G., Baldazzi G., Bergamini C., Bianco G., Bombardini C., Borzellino G., Brachini G., Maurizio B. G., Canini T., Capolupo G. T., Carannante F., Caricato M., Cassini D., Castriconi M., Catamero A., Catarci M., Ceccarelli G., Ceresoli M., Chiarugi M., Cillara N., Cirocchi R., Cobuccio L., Coccolini F., Cocorullo G., Cozza V., Crucitti A., Cucinotta E., D'Alessio R., de Manzoni Garberini A., De Manzini N., De Nisco C., De Prizio M., Finotti E., Frezza B., Garbarino G. M., Garulli G., Genna M., Giannessi S., Giordano A., Guerrieri M., Iacopini V., Kurihara H., La Greca A., Laracca G. G., Laterza E., Mariani D., Marini P., Marzaioli R., Masciana G., Mercantini P., Miacci V., Mingoli A., Miranda G., Paderno N., Palini G. M., Paradies D., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Pignata G., Pinotti E., Pisanu A., Puccioni C., Rocca A., Rondelli F., Ruscelli P., Paolo S., Scattizzi M., erao A., Tartaglia D., Tebala G., Trana C., Zago M., Costa, G, Fransvea, P, Lepre, L, Liotta, G, Mazzoni, G, Biloslavo, A, Bianchi, V, Occhionorelli, S, Costa, A, Sganga, G, Agresta, F, Alemanno, G, Antropoli, M, Apice, N, Argenio, G, Avenia, N, Azzinnaro, A, Barberis, A, Badessi, G, Baldazzi, G, Bergamini, C, Bianco, G, Bombardini, C, Borzellino, G, Brachini, G, Maurizio, B, Canini, T, Capolupo, G, Carannante, F, Caricato, M, Cassini, D, Castriconi, M, Catamero, A, Catarci, M, Ceccarelli, G, Ceresoli, M, Chiarugi, M, Cillara, N, Cirocchi, R, Cobuccio, L, Coccolini, F, Cocorullo, G, Cozza, V, Crucitti, A, Cucinotta, E, D'Alessio, R, de Manzoni Garberini, A, De Manzini, N, De Nisco, C, De Prizio, M, Finotti, E, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Giordano, A, Guerrieri, M, Iacopini, V, Kurihara, H, La Greca, A, Laracca, G, Laterza, E, Mariani, D, Marini, P, Marzaioli, R, Masciana, G, Mercantini, P, Miacci, V, Mingoli, A, Miranda, G, Paderno, N, Palini, G, Paradies, D, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Puccioni, C, Rocca, A, Rondelli, F, Ruscelli, P, Paolo, S, Scattizzi, M, Erao, A, Tartaglia, D, Tebala, G, Trana, C, Zago, M, Costa G., Fransvea P., Lepre L., Liotta G., Mazzoni G., Biloslavo A., Bianchi V., Occhionorelli S., Costa A., Sganga G., Agresta F., Alemanno G., Antropoli M., Apice N., Argenio G., Avenia N., Azzinnaro A., Barberis A., Badessi G., Baldazzi G., Bergamini C., Bianco G., Bombardini C., Borzellino G., Brachini G., Maurizio B. G., Canini T., Capolupo G. T., Carannante F., Caricato M., Cassini D., Castriconi M., Catamero A., Catarci M., Ceccarelli G., Ceresoli M., Chiarugi M., Cillara N., Cirocchi R., Cobuccio L., Coccolini F., Cocorullo G., Cozza V., Crucitti A., Cucinotta E., D'Alessio R., de Manzoni Garberini A., De Manzini N., De Nisco C., De Prizio M., Finotti E., Frezza B., Garbarino G. M., Garulli G., Genna M., Giannessi S., Giordano A., Guerrieri M., Iacopini V., Kurihara H., La Greca A., Laracca G. G., Laterza E., Mariani D., Marini P., Marzaioli R., Masciana G., Mercantini P., Miacci V., Mingoli A., Miranda G., Paderno N., Palini G. M., Paradies D., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Pignata G., Pinotti E., Pisanu A., Puccioni C., Rocca A., Rondelli F., Ruscelli P., Paolo S., Scattizzi M., erao A., Tartaglia D., Tebala G., Trana C., and Zago M.

Abstract

Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide sig

Published
2023

2. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author

Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, Pp., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, Gm., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Costa, G., Crucitti, A., Dallacaneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, Gm., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Tranà, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., E. Zanoni., Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
medicine.medical_specialty, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, NO, Postoperative complications, Elderly, Laparotomy, medicine, Hernia, Incarcerated hernia, business.industry, Explorative laparotomy, Groin hernia · Incarcerated hernia · Elderly · Postoperative complications · Emergency surgery · Charlson’s comorbidity index, medicine.disease, Hernia repair, Comorbidity, Surgery, Groin hernia, Inguinal hernia, Charlson’s comorbidity index, Emergency surgery, business, Watchful waiting, Abdominal surgery
Abstract

Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation

Published
2022

3. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Author

Costa, Gianluca, Fransvea, Pietro, Lepre, Luca, Liotta, Gianluca, Mazzoni, Gianluca, Biloslavo, Alan, Bianchi, Valentina, Occhionorelli, Savino, Costa, Alessandro, Sganga, Gabriele, FACS on behalf of the IGo-GIPS study group (Agresta, F, Alemanno, G, Altieri, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Badessi, G, Baldazzi, G, Bergamini, C, Biloslavo, A, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Brisinda, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cascone, Ca, Cassini, D, Castriconi, M, Catarci, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cirocchi, R, Cobuccio, L, Coccolini, C, Cocorullo, G, Colangelo, E, Colozzi, S, Cortese, F, Costa, A, Costa, G, Cozza, V, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, De Manzini, N, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, De Stefano, M, Dibella, A, Di Cosimi, C, Di Grezia, M, Falcioni, T, Falco, N, Farina, C, Fico, V, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Iacopini, V, Iarussi, T, Kurihara, H, La Greca, A, Laracca, Gg, Laterza, E, La Vaccara, V, Leonardi, A, Lepre, L, Liotta, G, Luridiana, G, Magalini, S, Malagnino, A, Mar, G, Mariani, D, Marini, P, Marzaioli, R, Macianà, G, Mazzoni, G, Mecarelli, V, Mercantini, P, Mingoli, A, Mirco, P, Montuori, M, Nigro, C, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Pepe, G, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Puccioni, C, Rocca, A, Rondelli, F, Rossi, G, Sacchi, M, Sapienza, P, Sganga, G, Spagnoli, A, Spinoglio, G, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Tomassini, F, Tropeano, G, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
Surgical treatment, Laparoscopic approach, Perforated peptic ulcer
Published
2023

4. Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

Author

Fransvea, P., Costa, G., Lepre, L., Capolupo, G. T., Carannante, F., Puccioni, C., Costa, A., La Greca, A., Giovinazzo, F., Agresta F, Sganga on behalf of the IGo-GIPS study group (G., Alemanno, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bergamini, C, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Kurihara, H, Laracca, Gg, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Mariani, D, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Miranda, G, Montuori, M, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rocca, A, Rondelli, F, Rossi, G, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
acute care surgery, SIRS, elderly, frailty, metabolic syndrome
Abstract

Patients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures.We analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien-Dindo (C-D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition.Of the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs.Impact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.

Published
2022

5. Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study)

Author

Costa, Gianluca, Fransvea, Pietro, Puccioni, Caterina, Giovinazzo, Francesco, Carannante, Filippo, Bianco, Gianfranco, Catamero, Alberto, Masciana, Gianluca, Miacci, Valentina, Caricato, Marco, Capolupo, Gabriella Teresa, Sganga, Gabriele on behalf of the IGo-GIPS Study Group (Agresta, F, Alemanno, G, Altieri, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Badessi, G, Baldazzi, G, Bergamini, C, Biloslavo, A, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Brisinda, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cascone, Ca, Cassini, D, Castriconi, M, Catarci, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cirocchi, R, Cobuccio, L, Coccolini, C, Cocorullo, G, Colangelo, E, Colozzi, S, Cortese, F, Costa, A, Costa, G, Cozza, V, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, De Manzini, N, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, De Stefano, M, Dibella, A, Di Cosimi, C, Di Grezia, M, Falcioni, T, Falco, N, Farina, C, Fico, V, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Iacopini, V, Iarussi, T, Kurihara, H, La Greca, A, Laracca, Gg, Laterza, E, La Vaccara, V, Leonardi, A, Lepre, L, Liotta, G, Luridiana, G, Magalini, S, Malagnino, A, Mar, G, Mariani, D, Marini, P, Marzaioli, R, Macianà, G, Mazzoni, G, Mecarelli, V, Mercantini, P, Mingoli, A, Mirco, P, Montuori, M, Nigro, C, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Pepe, G, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Puccioni, C, Rocca, A, Rondelli, F, Rossi, G, Sacchi, M, Sapienza, P, Sganga, G, Spagnoli, A, Spinoglio, G, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Tomassini, F, Tropeano, G, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
acute care, gastrointestinal emergency, morbidity, mortality, surgery, Settore MED/18 - CHIRURGIA GENERALE
Abstract

Gastrointestinal emergencies (GE) are frequently encountered in emergency department (ED), and patients can present with wide-ranging symptoms. more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. In the light of this, these patients need a rapid decision-making process that allows a correct diagnosis and an adequate and timely treatment. The primary endpoint of this Italian nationwide study is to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18. Secondary endpoints will be to evaluate to analyze the prognostic role of existing risk-scores to define the most suitable scoring system for gastro-intestinal surgical emergency. The primary outcomes are 30-day overall postoperative morbidity and mortality rates. Secondary outcomes are 30-day postoperative morbidity and mortality rates, stratified for each procedure or cause of intervention, length of hospital stay, admission and length of stay in ICU, and place of discharge (home or rehabilitation or care facility). In conclusion, to improve the level of care that should be reserved for these patients, we aim to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18, to analyze the prognostic role of existing risk-scores and to define new tools suitable for EGS. This process could ameliorate outcomes and avoid futile treatments. These results may potentially influence the survival of many high-risk EGS procedure.

Published
2022

6. Ileostomy versus colostomy: impact on functional outcomes after total mesorectal excision for rectal cancer.

Author

Martellucci J, Balestri R, Brusciano L, Iacopini V, Puccini M, Docimo L, Cianchi F, Buccianti P, and Prosperi P

Subjects
Male, Humans, Female, Ileostomy adverse effects, Colostomy methods, Anastomotic Leak etiology, Anastomosis, Surgical adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Surgical Stomas pathology, Rectal Neoplasms pathology
Abstract

Aim: Even if a defunctioning stoma mitigates the serious consequences of anastomotic leakage after total mesorectal excision (TME) for rectal cancer, the presence of a temporary stoma or having a stoma for a prolonged period of time may also be a determining factor for further morbidities and poor bowel function. The aim of this study was to evaluate the impact of diverting stomas on clinical and functional outcomes after TME, comparing ileostomy or colostomy effects., Methods: All consecutive patients who underwent TME for rectal cancer between March 2017 and December 2020 in three Italian referral centres were enrolled in the present study. For every patient sex, age, stage of the tumour, neoadjuvant therapy, surgical technique, anastomotic technique, the presence of a diverting stoma, perioperative complications and functional postoperative status were recorded. Considering the diverting stoma, the kind of stoma, length of time before closure and stoma related complications were evaluated., Results: During the study period 416 consecutive patients (63% men) were included. Preoperative neoadjuvant therapy was performed in 79%. A minimally invasive approach was performed in >95% of patients. Temporary stoma was performed during the operation in 387 patients (93%) (ileostomy 71%, colostomy 21%). The stoma was closed in 84% of patients. The median time from surgery to stoma closure was 145 days. No difference was found between ileostomy and colostomy in overall morbidity after stoma creation and closure. Moreover, increased postoperative functional disturbance seemed to be significantly proportional to the attending time for closure for ileostomy., Conclusion: The presence of a defunctioning stoma seems to have a negative impact on functional bowel activity, especially for delayed closure for ileostomy. This should be considered when the kind of stoma (ileostomy vs. colostomy) is selected for each patient., (© 2023 Association of Coloproctology of Great Britain and Ireland.)

Published
2023
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7. The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU.

Author

Bergamini C, Alemanno G, Giordano A, Pantalone D, Fontani G, Di Bella AM, Iacopini V, Prosperi P, and Martellucci J

Subjects
Humans, Intensive Care Units, Ischemia, Retrospective Studies, Cardiac Surgical Procedures, Laparoscopy, Mesenteric Ischemia diagnostic imaging, Mesenteric Ischemia surgery
Abstract

Purpose: Acute mesenteric ischemia with non-occlusive mechanism (NOMI) is a possible complication after cardiac surgery in patients admitted to Intensive Care Unit (ICU). Since the diagnosis is often difficult with CT-scan, some authors have evaluated the role of bed-side diagnostic laparoscopy (DL). We aimed to contribute to this topic with a personal series., Methods: We retrospectively evaluated patients admitted to ICU after cardiac surgery since 2009 up to 2019, successively operated on for a suspected NOMI of recent onset with non-conclusive CT. They were divided into laparoscopic (Ls) and laparotomic (Lt) group, depending on whether or not they had a DL. They were compared for the CT false-positive (FP) and true-positive (TP) rate and the surgical outcome., Results: Seventy-three patients were enrolled. Lt included 30 patients (41%), Ls 43 (59%). The overall FP were 38 (52%), with a higher incidence in Ls. There was no difference in the mortality rate. The morbidity rate was higher in Lt, and especially in Lt-FP. The TP were 35 (47.9%). The mean operating time (OT) in the Lt-TP group was similar to the sum of the mean OT of the laparotomies plus that of the laparoscopies in the Ls-TP group. Conversely, when considering only laparotomic procedures, the Lt-TP had higher mean OT, such as an increased blood loss CONCLUSIONS: Post-cardiosurgical patients admitted to ICU have a relatively high rate of NOMI, in which CT-scan is often initially non-conclusive. Our data and those from the literature seem to show that in such cases bed-side DL may be an advantageous and safe procedure to avoid needless laparotomy and enables a more tailored open surgery., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2022
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