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1. Retrospective analysis of transabdominal preperitoneal hernia repair in emergency cases: A cohort study.

Author

Brucchi F, Pelfini E, Masci E, Limongi C, Cassini D, and Faillace G

Subjects
Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Treatment Outcome, Aged, 80 and over, Operative Time, Emergencies, Recurrence, Follow-Up Studies, Peritoneum surgery, Herniorrhaphy methods, Herniorrhaphy adverse effects, Hernia, Inguinal surgery, Laparoscopy methods, Feasibility Studies
Abstract

Purpose: This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for inguinal hernias in emergency settings, providing insights from a long-term follow-up., Methods: We retrospectively analyzed all patients who underwent emergency TAPP repair in ASST Nord Milano from January 2005 to December 2023. A prospectively collected database of 54 consecutive TAPP hernia repairs was reviewed. The study evaluated the feasibility and safety of TAPP through operative time and the conversion rate. Effectiveness was gauged by recurrence and complication rates as well as acute and chronic pain using the Visual Analog Scale (VAS). Long-term follow-up included assessing recovery to normal activity., Results: Overall, data from 54 consecutive patients were analyzed. Median age was 72 (IQR = 11), with 21 men and 33 women (38.8% vs. 61.2%). The primary diagnosis was a primary hernia (61.1%), while a recurrent type was identified in 21 patients (38.9%). Femoral hernia was identified in 36 cases (48%). The median operative time was 100 min (IQR = 53 min) with 6 cases of conversion (11.1%). One recurrence (1.85%) was noted and the complication rate was 5.55 %. At a median follow-up of 38 months, there was a low grade of chronic pain (VAS 3) in a patient (1.85%) and one recurrence (1.85%)., Conclusion: TAPP is a safe, feasible, and effective option for emergency inguinal hernia repair, exhibiting low complication and recurrence rates on long-term follow-up when performed by surgeons with minimally invasive surgery experience and in selected patients., (© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Published
2024
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2. To close, not to close, or to act bigger? Managing the defect of large direct inguinal hernia to reduce the risk of recurrence during laparoscopic TAPP repair: a retrospective cohort study.

Author

Brucchi F, Ferraina F, Masci E, Ferrara D, Cassini D, and Faillace G

Subjects
Humans, Retrospective Studies, Male, Middle Aged, Female, Aged, Adult, Aged, 80 and over, Treatment Outcome, Cohort Studies, Follow-Up Studies, Propensity Score, Risk, Hernia, Inguinal surgery, Laparoscopy methods, Laparoscopy adverse effects, Surgical Mesh, Herniorrhaphy methods, Herniorrhaphy adverse effects, Recurrence
Abstract

Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41-84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair., (© 2024. The Author(s).)

Published
2024
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3. Quality of life and functional outcomes after laparoscopic total mesorectal excision (LaTME) and transanal total mesorectal excision (taTME) for rectal cancer. an updated meta-analysis.

Author

Lauricella S, Brucchi F, Carrano FM, Cassini D, Cirocchi R, and Sylla P

Subjects
Humans, Treatment Outcome, Rectum surgery, Rectum physiopathology, Male, Postoperative Complications etiology, Anal Canal surgery, Anal Canal physiopathology, Transanal Endoscopic Surgery, Female, Rectal Neoplasms surgery, Rectal Neoplasms physiopathology, Quality of Life, Laparoscopy
Abstract

Purpose: Concerns exist regarding the potential for transanal total mesorectal excision (TaTME) to yield poorer functional outcomes compared to laparoscopic TME (LaTME). The aim of this study is to assess the functional outcomes following taTME and LaTME, focusing on bowel, anorectal, and urogenital disorders and their impact on the patient's QoL., Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and A Measurement Tool to Assess systematic Reviews (AMSTAR) guidelines. A comprehensive search was conducted in Medline, Embase, Scopus, and Cochrane Library databases. The variables considered are: Low Anterior Resection Syndrome (LARS), International Prostate Symptom Score (IPSS) and Jorge-Wexner scales; European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C29 and QLQ-C30 scales., Results: Eleven studies involving 1020 patients (497-taTME group/ 523-LaTME group) were included. There was no significant difference between the treatments in terms of anorectal function: LARS (MD: 2.81, 95% CI: - 2.45-8.08, p = 0.3; I2 = 97%); Jorge-Wexner scale (MD: -1.3, 95% CI: -3.22-0.62, p = 0.19). EORTC QLQ C30/29 scores were similar between the groups. No significant differences were reported in terms of urogenital function: IPSS (MD: 0.0, 95% CI: - 1.49-1.49, p = 0.99; I 2  = 72%)., Conclusions: This review supports previous findings indicating that functional outcomes and QoL are similar for rectal cancer patients who underwent taTME or LaTME. Further research is needed to confirm these findings and understand the long-term impact of the functional sequelae of these surgical approaches., (© 2024. The Author(s).)

Published
2024
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4. A Randomized Phase III Trial of Complete Mesocolic Excision Compared with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial).

Author

Degiuli M, Aguilar AHR, Solej M, Azzolina D, Marchiori G, Corcione F, Bracale U, Peltrini R, Di Nuzzo MM, Baldazzi G, Cassini D, Sica GS, Pirozzi B, Muratore A, Calabrò M, Jovine E, Lombardi R, Anania G, Chiozza M, Petz W, Pizzini P, Persiani R, Biondi A, and Reddavid R

Subjects
Humans, Lymph Node Excision, Colectomy, Italy, Treatment Outcome, Randomized Controlled Trials as Topic, Surgical Oncology, Colonic Neoplasms pathology, Mesocolon surgery, Laparoscopy
Abstract

Background: Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials., Method: This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study. The secondary end points were safety (duration of operation, perioperative complications, hospital length of stay), oncologic outcomes (number of LNs retrieved, 3- and 5-year overall survival, 5-year DFS), and surgery quality (specimen length, area and integrity rate of mesentery, length of ileocolic and middle-colic vessels). The trial design required the LN yield to be higher in the CME group at interim analysis., Results: Interim data analysis is presented in this report. The study enrolled 258 patients in nine referral centers. The number of LNs retrieved was significantly higher after CME (25 vs. 20; p = 0.012). No differences were observed with respect to intra- or post-operative complications, postoperative mortality, or duration of surgery. The hospital stay was even shorter after CME (p = 0.039). Quality of surgery indicators were higher in the CME arm of the study. Survival data still were not available., Conclusions: Interim data show that CME for right colon cancer in referral centers is safe and feasible and does not increase perioperative complications. The study documented with evidence that quality of surgery and LN yield are higher after CME, and this is essential for continuation of patient recruitment and implementation of an optimal comparison. Trial registration The trial was registered at ClinicalTrials.gov with the code NCT04871399 and with the acronym CoME-In trial., (© 2023. The Author(s).)

Published
2024
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5. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN).

Author

Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D'Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, and Reddavid R

Subjects
Humans, Treatment Outcome, Retrospective Studies, Postoperative Complications surgery, Minimally Invasive Surgical Procedures, Colon, Transverse surgery, Laparoscopy methods, Surgical Oncology, Colonic Neoplasms surgery
Abstract

Background: Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes., Methods: This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate., Results: A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞)., Conclusions: Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection., (© 2022. The Author(s).)

Published
2023
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7. The role of emergency laparoscopic colectomy for complicated sigmoid diverticulits: A systematic review and meta-analysis.

Author

Cirocchi R, Fearnhead N, Vettoretto N, Cassini D, Popivanov G, Henry BM, Tomaszewski K, D'Andrea V, Davies J, and Di Saverio S

Subjects
Humans, Colectomy, Diverticulitis complications, Diverticulitis surgery, Laparoscopy, Sigmoid Diseases complications, Sigmoid Diseases surgery
Abstract

Background: Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting., Methods: A systematic literature search was performed for randomized controlled trials (RCTs) and non-RCTs published in PubMed, SCOPUS and Web of Science., Results: The search yielded four non-RCTs encompassing 436 patients undergoing either laparoscopic (181 patients, 41.51%) versus open sigmoid resection (255 patients, 58.49%). All studies reported ASA scores, but only four studies reported other severity scoring systems (Mannheim Peritonitis Index, P-POSSUM). Level of surgical expertise was reported in only one study. Laparoscopy improves slightly the rates of overall post-operative complications and post-operative hospital stay, respectively (RR 0.62, 95% CI 0.49 to 0.80 and MD -6.53, 95% CI -16.05 to 2.99). Laparoscopy did not seem to improve the other clinical outcomes: rate of Hartmann's vs anastomosis, operating time, reoperation rate and postoperative 30-day mortality., Conclusion: In this review four prospective studies were included, over 20 + year period, including overall 400 + patients. This meta-analysis revealed significant advantages associated with a laparoscopic over open approach to emergency sigmoidectomy in acute diverticulitis in terms of postoperative complication rates, although no differences were found in other outcomes. The lack of hemodynamic data and reasons for operative approach hamper interpretation of the data suggesting that patients undergoing open surgery were sicker and these results must be considered with extreme caution and this hypothesis requires confirmation by future prospective randomised controlled trials., (Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Published
2019
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8. Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis.

Author

Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, and Carlini M

Subjects
Aged, Aged, 80 and over, Anastomosis, Surgical methods, Colonic Neoplasms diagnosis, Female, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Neoplasm Staging, Operative Time, Postoperative Complications epidemiology, Retrospective Studies, Survival Rate trends, Treatment Outcome, Colectomy methods, Colon, Transverse surgery, Colonic Neoplasms surgery, Laparoscopy methods, Propensity Score
Abstract

Purpose: The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers., Materials and Methods: A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients' selection bias between the 2 surgical techniques. Data on patients' demographics, operative details, short-term and long-term outcomes were prospectively recorded., Results: In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen., Conclusions: The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.

Published
2019
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9. Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure.

Author

Cassini D, Depalma N, Grieco M, Cirocchi R, Manoochehri F, and Baldazzi G

Subjects
Adult, Aged, Aged, 80 and over, Elective Surgical Procedures methods, Female, Humans, Laparoscopy adverse effects, Length of Stay, Male, Middle Aged, Operative Time, Postoperative Complications epidemiology, Colon surgery, Diverticulitis surgery, Diverticulum, Colon surgery, Laparoscopy methods, Robotic Surgical Procedures adverse effects
Abstract

Background: Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis., Methods: Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon's compliance were evaluated., Results: One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon's compliance revealed a better performance in the robotic arm (p 0.059)., Conclusions: This preliminary study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon's compliance.

Published
2019
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10. Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects.

Author

Gregori M, Cassini D, Depalma N, Miccini M, Manoochehri F, and Baldazzi GA

Subjects
Acute Disease, Diverticulitis, Colonic complications, Humans, Peritonitis complications, Diverticulitis, Colonic surgery, Drainage methods, Laparoscopy methods, Peritonitis surgery, Sigmoid Diseases surgery, Therapeutic Irrigation methods
Abstract

The surgical treatment for patients with generalized peritonitis complicating sigmoid diverticulitis is currently debated; particularly in case of diffuse purulent contamination (Hinchey 3). Laparoscopic lavage and drainage (LLD) has been proposed by some authors as a safe and effective alternative to single- or multi-stage resective surgery. However, among all the different studies on LLD, there is no uniformity in terms of surgical technique adopted and data show significant differences in postoperative outcomes. Aim of this review was to analyze the differences and similarities among the authors in terms of application, surgical technique and outcomes of LLD in Hinchey 3 patients. A bibliographical research was performed by referring to PubMed and Cochrane. "Purulent peritonitis", "Hinchey 3 diverticulitis", "acute diverticulitis", "colonic perforation" and "complicated diverticulitis" were used as key words. Twenty-eight papers were selected, excluding meta-analysis, reviews and case reports with a very small number of patients. The aim of this review was to establish how LLD should be done, suggesting important technical tricks. We found agreement in terms of indications, preoperative management, ports' positioning, antibiotics, enteral feeding and drain management. On the contrast, different statements regarding indications, adhesiolysis and management of colonic hole and failure of laparoscopic lavage are reported. A widespread diffusion of LLD and standardization of its technique are impossible because of data heterogeneity and selection bias in the limited RCTs. It is necessary to wait for long terms results from randomized clinical trials (RCTs) in progress to establish the efficacy and safety of this technique. More importantly, an increased number of highly skilled and dedicated colorectal laparoscopic surgeons are required to standardized the procedure.

Published
2019
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11. Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases.

Author

Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, and Carlini M

Subjects
Adult, Aged, Aged, 80 and over, Anastomotic Leak epidemiology, Cohort Studies, Colonic Neoplasms mortality, Conversion to Open Surgery statistics & numerical data, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Survival Rate, Time Factors, Treatment Outcome, Young Adult, Colonic Neoplasms surgery, Digestive System Surgical Procedures methods, Laparoscopy methods
Abstract

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. The observational period was from January 2008 to August 2017. Patient demographics and clinical features, operative data, and short- and long-term outcomes were prospectively recorded in a specific database and were retrospectively analyzed. During the observation period, 117 patients were selected. Conversion to open surgery was necessary in 15 patients (12.8%). Of 102 complete laparoscopic procedures, multi-visceral resection was performed in 13 cases (12.7%). Postoperative surgical complications occurred in 13 patients (12.7%), with 3 cases of anastomotic leak (2.9%) and 3 cases of re-operation (2.9%). The postoperative mortality in this population was null. The 5-year overall survival rate was 84.3%, and the 5-year disease-free survival rate was 87.8%. Laparoscopic resection of the splenic flexure is feasible and safe in high-volume centers. Compared to the results of other laparoscopic colonic resections, the short- and long-term outcomes are similar, but the conversion rate is higher.

Published
2019
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12. Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients.

Author

Cassini D, Miccini M, Gregori M, Manoochehri F, and Baldazzi G

Subjects
Aged, Catheter Ablation adverse effects, Colorectal Neoplasms surgery, Female, Humans, Intraoperative Period, Male, Retrospective Studies, Catheter Ablation methods, Colectomy methods, Colorectal Neoplasms complications, Laparoscopy methods, Obesity complications
Abstract

Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m 2 ) ≥30 were defined as obese, and patients with a BMI (kg/m 2 ) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss results significantly lower in the Caiman group than in the historical one [52 ml vs 93 for RC (p 0.003); 65 vs 120 ml for LC (p 0.001); 93 vs 145 ml for AR (p 0.002) between group A and B, respectively]. No intraoperative complications were recorded in either group. The mean conversion rate was 4.4% (6 patients). There were no statistical differences in intensive care unit (ICU) stay, functional outcomes, mean hospital stay and overall morbidity rate between the two groups. There was no mortality in either group. The use of the Caiman EBVS instrument shows significant advantages with respect to a small number of intraoperative parameters. We can conclude that use of this radiofrequency device, in the laparoscopic approach, offers advantages in terms of lower intraoperative blood loss and shorter operative time in obese patients with colorectal cancer.

Published
2017
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13. Emergency Hartmann's Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis.

Author

Cassini D, Miccini M, Manoochehri F, Gregori M, and Baldazzi G

Subjects
Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Length of Stay, Male, Middle Aged, Postoperative Complications epidemiology, Recovery of Function, Reoperation, Treatment Outcome, Colectomy, Colon, Sigmoid surgery, Colostomy, Diverticulitis surgery, Laparoscopy, Peritonitis surgery
Abstract

Background: Hartmann's procedure (HP) followed by reversal restoration is the first choice for treatment of diffuse diverticular peritonitis. There is no unanimous consensus regarding the use of laparoscopy to treat the same condition., Methods: Data from 60 patients with diverticular diffuse peritonitis who underwent urgent HP followed by laparoscopic reversal were retrospectively analyzed. Patients were divided into 2 groups according to the open or laparoscopic HP (OHP, 24 patients; LHP, 36 patients). Outcomes were measured in terms of functional recovery, morbidity, mortality, and length of hospital stay., Results: HPs showed no differences among the groups in terms of operative time, blood loss, and length of intensive care unit stay. Overall morbidity was significantly lower in LHP than in OHP, corresponding to 33.3% and 66.7% respectively ( P = .018). The incidence of both surgical and medical complications was higher in OHP than in LHP (41.7% vs 22.2% [ P = .044] and 45.8% vs 24.3% [ P = .023], respectively). Mortality was 16.6% for each group. LHP showed a faster return to bowel movements and a shorter hospital stay than OHP. The secondary intestinal reversal was possible in 92% of cases, successfully completed laparoscopically in 91.3%. No patients of LHP group required a conversion to open intestinal reversal., Conclusion: LHP for treatment of diverticular diffuse peritonitis showed significantly lower morbidity, faster recovery, shorter hospital stay, and higher rates of successful laparoscopic reversal when compared with OHP.

Published
2017
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14. Robotic hybrid technique in rectal surgery for deep pelvic endometriosis.

Author

Cassini D, Cerullo G, Miccini M, Manoochehri F, Ercoli A, and Baldazzi G

Subjects
Adult, Blood Loss, Surgical statistics & numerical data, Female, Humans, Middle Aged, Operative Time, Postoperative Complications epidemiology, Treatment Outcome, Endometriosis surgery, Laparoscopy methods, Rectal Diseases surgery, Rectum surgery, Robotics
Abstract

Background: Deep pelvic endometriosis is a complex disorder that affects 6% to 12% of all women in childbearing age. The incidence of bowel endometriosis ranges between 5.3% and 12%, with rectum and sigma being the most frequently involved tracts, accounting for about 80% of cases. It has been reported that segmental colorectal resection is the best surgical option in terms of recurrence rate and improvement of symptoms. The aim of this study is to analyze indications, feasibility, limits, and short-term results of robotic (Da Vinci Surgical System)-assisted laparoscopic rectal sigmoidectomy for the treatment of deep pelvic endometriosis., Patients and Methods: Between January 2006 and December 2010, 19 women with bowel endometriosis underwent colorectal resection through the robotic-assisted laparoscopic approach. Intraoperative and postoperative data were collected. All procedures were performed in a single center and short-term complications were evaluated., Results: Nineteen robotic-assisted laparoscopic colorectal resections for infiltrating endometriosis were achieved. Additional procedures were performed in 7 patients (37%). No laparotomic conversion was performed. No intraoperative complications were observed. The mean operative time was 370 minutes (range = 250-720 minutes), and the estimated blood loss was 250 mL (range = 50-350 mL). The overall complication rate was 10% (2 rectovaginal fistulae)., Conclusions: Deep pelvic endometriosis is a benign condition but may have substantial impact on quality of life due to severe pelvic symptoms. We believe that robotic-assisted laparoscopic colorectal resection is a feasible and relatively safe procedure in the context of close collaboration between gynecologists and surgeons for treatment of deep pelvic endometriosis with intestinal involvement, with low rates of complications and significant improvement of intestinal symptoms.

Published
2014
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15. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, Gaetano, Podda, Mauro, Pisanu, Adolfo, Mortola, Lorenzo, Dalla Caneva, Patrizia, Massa, Giulia, Costa, Gianluca, Savastano, Riccardo, Cillara, Nicola, Collaborative Study Group endorsed by SICUT ACOI SICG SICE and Italian Chapter of WSES, 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, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, 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, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, 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, Zanoni, E., Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., 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., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., 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., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., 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., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, 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, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, 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, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, 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, Multivariate analysis, Sports medicine, Settore MED/18 - CHIRURGIA GENERALE, Critical Care and Intensive Care Medicine, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, NO, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, Internal medicine, medicine, Humans, Frail patient, Orthopedics and Sports Medicine, In patient, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, 030222 orthopedics, Creatinine, business.industry, Postoperative complication, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Appendicitis, chemistry, Emergency Medicine, Laparoscopy, Surgery, Acute appendiciti, Morbidity, Risk assessment, business
Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2019
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16. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Author

Bracale, U., Podda, Maria Vittoria, Castiglioni, S., Peltrini, R., Sartori, Alessandra, Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, Sergio, Rosa, Fausto, Altomare, D. F., Picciariello, A., Parisi, Carmelo Maria Antonio, Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, Andrea, Izzo, Filippo, Bertolino, F., Brunetti, Maria Mercede, Bianco, Flaviana, Cappiello, A., Boccia, L., Boffi, B., Perna, Francesco, Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, Giuseppe, Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, Matteo, Contine, A., Chiara, Osvaldo, Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, Maria Francesca, Danelli, P., Guerci, C., Scala, D., Marino, Giuseppe, De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Berta, G., Bono, D., Fabozzi, Simone Michele, Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, Anna Maria, Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, Maria, Ferrari, G., Magistro, C., Giuliani, Antonio, Di Natale, Maria Grazia, Brisinda, Giuseppe, Cavallaro, G., Sammarco, G., Gallo, Giuseppe, Goletti, O., Macchini, D., Greco, Viviana, Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, Roberto, La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, Emilio Fabrizio, Maggioni, D., Martino, G., Manca, Gavina, Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, Maria Chiara, Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, Maria Stella, Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, Martina, Muratore, A., Musella, Martina, Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, Alberto, Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Formisano, Capelli, P., Baldini, E., Festa, P., Mottola, Armando, Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, Roberto, Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, Gabriele, Fransvea, P., Testa, S., De Rosa, Maria Cristina, Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, Eliana, Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, Miriam, Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, Umberto, Podda, Mauro, Castiglioni, Simone, Peltrini, Roberto, Sartori, Alberto, Arezzo, Alberto, Corcione, Francesco, Agresta, Ferdinando, Rosati, Riccardo, Umberto, Bracale, Mauro, Podda, Simone, Castiglioni, Roberto, Peltrini, Alberto, Sartori, Alberto, Arezzo, Francesco, Corcione, Ferdinando, Agresta, CLOUD-19 Collaborative Group Adelmo Antonucci, Claudia, Zanframundo, Fabio, Cavallo, Giorgio, Mazzarolo, Antonio, Agrusa, Giuseppe Di Buono, Luca, Aldrighetti, Guido, Fiorentini, Alessandro, Lucianetti, Stefano, Magnone, Sergio, Alfieri, Fausto, Rosa, Altomare, Donato F., Arcangelo, Picciariello, Amilcare, Parisi, Antonio Di Cintio, Marco Francesco Amisano, Francesca, Cravero, Michele, Ammendola, Giorgio, Ammerata, Alessandro, Anastasi, Giuseppe, Canonico, Andra, Gattolin, Elisabetta, Travaglio, Andrea, Sartori, Massimiliano De Palma, Pierluigi, Angelini, Francesco, Galante, Angelo, Benevento, Stefano, Rausei, Angelo, Serao, Francesca, Abbatini, Mario, Annecchiarico, Antonio, Varricchio, Valerio, Annessi, David, Tumiati, Alfredo, Annicchiarico, Antonello, Mirabella, Marino, Marco V., Antonino, Spinelli, Antonio, Braun, Hong Tham Santi, Lucia, Romano, Michele, Antoniutti, Mariano Fortunato Armellino, Giulio, Argenio, Augusto, Verzelli, Andrea, Budassi, Gianluca, Baiocchi, Marie Sophie Alfano, Alessandro, Balani, Marco, Barone, Gianandrea, Baldazzi, Diletta, Cassini, Ruben Carlo Balzarotti Canger, Gianpietro, Zabbialini, Andrea, Belli, Francesco, Izzo, Franco, Bertolino, Marco, Brunetti, Francesco, Bianco, Antonio, Cappiello, Luigi, Boccia, Bernardo, Boffi, Federico, Perna, Stefano, Bonilauri, Giuseppe, Frazzetta, Pierpaolo, Bordoni, Francesco, Flere, Felice, Borghi, Giorgio, Giraudo, Vincenzo, Bottino, Alfonso, Canfora, Fabrizio Briganti Piccoli, Luca, Calligari, Bruno, Nipote, Aniello Gennaro Nasti, Andrea, Bufalari, Francesca, Bettarini, Massimo, Buononato, Marco, Greco, Pietro Giorgio Calò, Fabio, Meda, Eugenia, Cardamone, Pasquale, Castaldo, Massimo, Carlini, Domenico, Spoletini, Carlo De Nisco, Fabio, Pulighe, Feo, Carlo V., Nicolò, Fabbri, Carmine, Antropoli, Fabrizio, Foroni, Maurizio, Carnazza, Salvatore, Ragazzi, Elisa, Cassinotti, Luigi, Boni, Fausto, Catena, Mario, Giuffrida, Gennaro, Perrone, Christian, Ccotsoglou, Stefano, Granieri, Graziano, Ceccarelli, Walter, Bugiantella, Carla, Cedolini, Luca, Seriau, Maurizio, Cesari, Alessandro, Contine, Osvaldo, Chiara, Stefania, Cimbanassi, Eugenio, Cocozza, Mattia, Berselli, Corrado, Fantini, Renato, Costi, Lorenzo, Casali, Andrea, Morini, Francesco, Crafa, Serafino, Vanela, Giuseppe, Currò, Vincenzo, Orsini, Corrado Da Lio, Mario, Biral, Piergiorgio, Danelli, Claudio, Guerci, Dario, Scala, Graziella, Marino, Luciano De Carlis, Andrea, Lauterio, Donato De Giorgi, Gianluca, Sciannamea, Nicolo De Manzini, Pasquale, Losurdo, Maurizio De Palma, Nicola, Sangiuliano, Maurizio, Degiuli, Franco, Caterina, Paolo Del Rio, Elena, Bonati, Stefano Di Lernia, Marco Vittorio Rossi Ardizzone, Salomone Di Saverio, Caterina, Franchi, Beatrice Di Venere, Rosanna, Miglio, Diego, Cuccurullo, Carlo, Sagnelli, Docimo, Ludovico, Tolone, Salvatore, Mauro, Longoni, Giuseppe, Faillace, Fabio, Rondelli, Francesca Pennetti Pennella, Vincenzo, Colucci, Teresa, Carfora, Irnerio Angelo Muttillo, Biagio, Picardi, Rossi, Stefano, Roberto, Campagnacci, Angela, Maurizi, Fausto, Tricarico, Marco, Montagna, Elio, Amedeo, Scollica, Michela C., Enrico, Lauro, Ernesto, Laterza, Enrico, Molinari, Berta, G., Dario, Bono, Massimiliano, Fabozzi, Mafalda, Romano, Enzo, Facci, Dario, Parini, Roberto, Farfaglia, Valeria, Arizzi, Marco, Farsi, Egidio, Miranda, Fei, Landino, Giordano, Flavio, Felice, Pirozzi, Antonio, Sciuto, Alessandro, Ferrero, Marco, Palisi, Marco, Filauro, Andrea, Barberi, Antonio, Azzinnaro, Valentino, Fiscon, Silvia, Vigna, Michele, D’Ambra, Emanuele, Pontecorvi, Gabriele, Anania, Cristina, Bombardini, Galizia, Gennaro, Auricchio, Annamaria, Cardella, Francesca, Michele, Genna, Sergio, Gentilli, Nikaj, Herald, Giampaolo, Castagnoli, Alberto, Bartoli, Luca, Gianotti, Mattia, Garancini, Giovanni, Bellanova, Paola, Palazzo, Giovanni De Palma, Marco, Milone, Giovanni, Ferrari, Carmelo, Magistro, Antonio, Giuliani, Giuseppe Di Natale, Giuseppe, Brisinda, Giuseppe, Cavallaro, Giuseppe, Sammarco, Gaetano, Gallo, Orlando, Goletti, Daniele, Macchini, Vincenzo, Greco, Vincenzo, Amoroso, Gianluca, Guercioni, Michele, Benedetti, Guglielmo, Guzzo, Francesco, Pata, Ildo, Scandroglio, Francesco, Roscio, Elio, Jovine, Raffaele, Lombardi, Francesco La Rocca, Francesca Di Capua, Carmine, Lanci, Renzo, Leli, Andrea, Borasi, Pasquale, Lepiane, Andrea, Balla, Edoardo, Liberatore, Luca, Morelli, Gregorio Di Franco, Andrea, Lucchi, Laura, Vittori, Luigi, Bonavina, Emanuele, Asti, Dario, Maggioni, Gerosa, Martino, Giuseppe, Manca, Antonella, Delvecchio, Manfredo, Tedesco, Denise, Gambardella, Salvatore, Marafioti, Maria Luisa De Marco, Marco Azzola Guicciardi, Massimo, Motta, Marco, Calgaro, Vincenzo, Adamo, Mario, Guerrieri, Pietro, Coletta, Monica, Ortenzi, Gennaro, Martine, Giuliano, Lantone, Mario, Martinotti, Giuseppe, Fassardi, Maurizio, Castriconi, Simone, Squillante, Maurizio De Luca, Maurizio, Pavanello, Carlo Di Marco, Maurizio, Ronconi, Silvia, Casiraghi, Vincenzo, Mazzaferro, Carlo, Battiston, Michele, Perrotta, Carmine, Ripa, Micheletto, Giancarlo, Valerio, Panizzo, Paolo, Millo, Riccardo Brachet Contul, Valentina, Ferraro, Carlo, Molino, Enrico, Crolla, Gianluigi, Moretto, Matilde, Bacchion, Mario, Morino, Marco Ettore Allaix, Enrico, Motterlini, Michele, Petracca, Andrea, Muratore, Mario, Musella, Antonio, Vitiello, Bruno, Nardo, Veronica, Crocco, Giuseppe, Navarra, Salvatore, Lazzara, Giuseppe Giovanni Navarra, Manuela, Cuoghi, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Enrico, Opocher, Marco, Giovenzana, Paolo De Paolis, Mauro, Santarelli, Paolo, Delrio, Fabio, Carbone, Paolo Pietro Giampaolo Bianchi, Formisano, Patrizio, Capelli, Edoardo, Baldini, Patrizio, Festa, Arianna, Mottola, Giovanni, Merola, Nicola, Perrotta, Marta, Celiento, Eraldo, Personnettaz, Stefania, Muzio, Tommaso, Petitti, Antonietta, Melchiorre, Micaela, Piccoli, Francesca, Pecchini, Alice, Frontali, Anna, Maffioli, Pietro, Maida, Pasquale, Tammaro, Giusto, Pignata, Jacopo, Andreuccetti, Vincenzo, Pilone, Michele, Renzulli, Salvatore, Pintaldi, Andrea Pisani Ceretti, Nicolò Maria Mariani, Adolfo, Pisanu, Roberto, Polastri, Fabio, Maiello, Alberto, Porcu, Teresa, Perra, Felice, Mucilli, Mirko, Barone, Roberto, Troisi, Roberto, Montalti, Fabrizio, Scognamillo, Daniele, Delogu, Raffaele, Galleano, Michele, Malerba, Raffaele, Salfi, Marcello, Pisano, Raffaele, Sechi, Nicola, Cillara, Salvatore, Ramuscello, Eugenio De Leo, Enrico, Restini, Rocco, Tumolo, Pasquale, Cianci, Sabino, Capuzzolo, Maurizio, Rizzo, Alfonso, Recordare, Roberto, Santoro, Pietro Maria Amodio, Aldo, Rocca, Giuseppe, Cecere, Raffaele, Romito, Luca, Portigliotti, Riccardo, Rosati, Ugo, Elmore, Domenico, Russello, Saverio, Latteri, Salvatore Maria Costarella, Salvatore, Massa, Lorenzo, Capasso, Michele, Santangelo, Maurizio, Sodo, Giuliano, Sarro, Umberto, Rivolta, Stefano, Scabini, Davide, Pertile, Federico, Selvaggi, Selene, Rossi, Selvaggi, Francesco, Pellino, Gianluca, Gabriele, Sganga, Pietro, Fransvea, Silvio, Testa, Clemente De Rosa, Walter, Siquini, Cristian, Tranà, Mario, Solej, Stefano, Bolzon, Enrico, Guerra, Marco, Stella, Francesco, Ferrara, Francesco, Stipa, Enrico, Stringhi, Andrea, Celotti, Lucio, Taglietti, Roberto Del Giudice, Carlo Alessandro Talarico, Michele, Ruggiero, Giuseppe, Tirone, Uberto Fumagalli Romario, Wanda, Petz, Valerio, Caracino, Valentina, Rossetti, Luca Andrea Verza, Lorenzo, Vescovi, Michele, Marini, Nereo, Vettoretto, Emanuele, Botteri, Leonardo, Vincenti, Giusy, Giannandrea, Tiziana, Viora, Lorenzo, Maganuco, Paolo, Veronesi, Bruno, Zani, Giacomo, Zanu, Marco, Brizzolari, Federico, Zanzi, Anna, Guariniello, Marco Antonio Zappa, Elisa, Galfrascoli, Sandro, Zonta, Luigi, Oragano, Walter Zuliani &amp, Damiano, Chiari, de Manzini, Nicolo', Agresta, Ferdinando, Agrusa, Antonino, Di Buono, Giuseppe, Bracale, U., Podda, M., Castiglioni, S., Peltrini, R., Sartori, A., Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, S., Rosa, F., Altomare, D. F., Picciariello, A., Parisi, A., Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, A., Izzo, F., Bertolino, F., Brunetti, M., Bianco, F., Cappiello, A., Boccia, L., Boffi, B., Perna, F., Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, G., Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, M., Contine, A., Chiara, O., Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, M., Danelli, P., Guerci, C., Scala, D., Marino, G., De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Bono, D., Fabozzi, M., Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, A., Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, M., Ferrari, G., Magistro, C., Giuliani, A., Di Natale, G., Brisinda, G., Cavallaro, G., Sammarco, G., Gallo, G., Goletti, O., Macchini, D., Greco, V., Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, R., La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, E., Maggioni, D., Martino, G., Manca, G., Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, M., Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, S., Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, M., Muratore, A., Musella, M., Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, A., Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Capelli, P., Baldini, E., Festa, P., Mottola, A., Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, R., Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, G., Fransvea, P., Testa, S., De Rosa, C., Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, E., Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, M., Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, U, Podda, M, Castiglioni, S, Peltrini, R, Sartori, A, Arezzo, A, Corcione, F, Agresta, F, Antonucci, A, Zanframundo, C, Cavallo, F, Mazzarolo, G, Agrusa, A, Di Buono, G, Aldrighetti, L, Fiorentini, G, Lucianetti, A, Magnone, S, Alfieri, S, Rosa, F, Altomare, D, Picciariello, A, Parisi, A, Di Cintio, A, Amisano, M, Cravero, F, Ammendola, M, Ammerata, G, Anastasi, A, Canonico, G, Gattolin, A, Travaglio, E, De Palma, M, Angelini, P, Galante, F, Benevento, A, Rausei, S, Serao, A, Abbatini, F, Annecchiarico, M, Varricchio, A, Annessi, V, Tumiati, D, Annicchiarico, A, Mirabella, A, Marino, M, Spinelli, A, Braun, A, Santi, H, Romano, L, Antoniutti, M, Armellino, M, Argenio, G, Verzelli, A, Budassi, A, Baiocchi, G, Alfano, M, Balani, A, Barone, M, Baldazzi, G, Cassini, D, Canger, R, Zabbialini, G, Belli, A, Izzo, F, Bertolino, F, Brunetti, M, Bianco, F, Cappiello, A, Boccia, L, Boffi, B, Perna, F, Bonilauri, S, Frazzetta, G, Bordoni, P, Fleres, F, Borghi, F, Giraudo, G, Bottino, V, Canfora, A, Piccoli, F, Calligaris, L, Nipote, B, Nasti, A, Bufalari, A, Bettarini, F, Buononato, M, Greco, M, Calo, P, Medas, F, Cardamone, E, Castaldo, P, Carlini, M, Spoletini, D, De Nisco, C, Pulighe, F, Feo, C, Fabbri, N, Antropoli, C, Foroni, F, Carnazza, M, Ragazzi, S, Cassinotti, E, Boni, L, Catena, F, Giuffrida, M, Perrone, G, Ccotsoglou, C, Granieri, S, Ceccarelli, G, Bugiantella, W, Cedolini, C, Seriau, L, Cesari, M, Contine, A, Chiara, O, Cimbanassi, S, Cocozza, E, Berselli, M, Fantini, C, Costi, R, Casali, L, Morini, A, Crafa, F, Vanela, S, Curro, G, Orsini, V, Da Lio, C, Biral, M, Danelli, P, Guerci, C, Scala, D, Marino, G, De Carlis, L, Lauterio, A, De Giorgi, D, Sciannamea, G, De Manzini, N, Losurdo, P, Sangiuliano, N, Degiuli, M, Caterina, F, Del Rio, P, Bonati, E, Di Lernia, S, Ardizzone, M, Di Saverio, S, Franchi, C, Di Venere, B, Miglio, R, Cuccurullo, D, Sagnelli, C, Docimo, L, Tolone, S, Longoni, M, Faillace, G, Rondelli, F, Pennella, F, Colucci, V, Carfora, T, Muttillo, I, Picardi, B, Stefano, R, Campagnacci, R, Maurizi, A, Tricarico, F, Montagna, M, Amedeo, E, Scollica, M, Lauro, E, Laterza, E, Molinari, E, Berta, G, Bono, D, Fabozzi, M, Romano, M, Facci, E, Parini, D, Farfaglia, R, Arizzi, V, Farsi, M, Miranda, E, Fei, L, Flavio, G, Pirozzi, F, Sciuto, A, Ferrero, A, Palisi, M, Filauro, M, Barberis, A, Azzinnaro, A, Fiscon, V, Vigna, S, D'Ambra, M, Pontecorvi, E, Anania, G, Bombardini, C, Galizia, G, Auricchio, A, Cardella, F, Genna, M, Gentilli, S, Herald, N, Castagnoli, G, Bartoli, A, Gianotti, L, Garancini, M, Bellanova, G, Palazzo, P, De Palma, G, Milone, M, Ferrari, G, Magistro, C, Giuliani, A, Di Natale, G, Brisinda, G, Cavallaro, G, Sammarco, G, Gallo, G, Goletti, O, Macchini, D, Greco, V, Amoroso, V, Guercioni, G, Benedetti, M, Guzzo, G, Pata, F, Scandroglio, I, Roscio, F, Jovine, E, Lombardi, R, La Rocca, F, Di Capua, F, Lanci, C, Leli, R, Borasi, A, Lepiane, P, Balla, A, Liberatore, E, Morelli, L, Di Franco, G, Lucchi, A, Vittori, L, Bonavina, L, Asti, E, Maggioni, D, Martino, G, Manca, G, Delvecchio, A, Tedesco, M, Gambardella, D, Marafioti, S, De Marco, M, Guicciardi, M, Motta, M, Calgaro, M, Adamo, V, Guerrieri, M, Coletta, P, Ortenzi, M, Martines, G, Lantone, G, Martinotti, M, Fassardi, G, Castriconi, M, Squillante, S, De Luca, M, Pavanello, M, Di Marco, C, Ronconi, M, Casiraghi, S, Mazzaferro, V, Battiston, C, Perrotta, M, Ripa, C, Giancarlo, M, Panizzo, V, Millo, P, Contul, R, Ferraro, V, Molino, C, Crolla, E, Moretto, G, Bacchion, M, Morino, M, Allaix, M, Motterlini, E, Petracca, M, Muratore, A, Musella, M, Vitiello, A, Nardo, B, Crocco, V, Navarra, G, Lazzara, S, Cuoghi, M, Olmi, S, Oldani, A, Uccelli, M, Opocher, E, Giovenzana, M, De Paolis, P, Santarelli, M, Delrio, P, Carbone, F, Bianchi, P, Capelli, P, Baldini, E, Festa, P, Mottola, A, Merola, G, Perrotta, N, Celiento, M, Personnettaz, E, Muzio, S, Petitti, T, Melchiorre, A, Piccoli, M, Pecchini, F, Frontali, A, Maffioli, A, Maida, P, Tammaro, P, Pignata, G, Andreuccetti, J, Pilone, V, Renzulli, M, Pintaldi, S, Ceretti, A, Mariani, N, Pisanu, A, Polastri, R, Maiello, F, Porcu, A, Perra, T, Mucilli, F, Troisi, R, Montalti, R, Scognamillo, F, Delogu, D, Galleano, R, Malerba, M, Salfi, R, Pisano, M, Sechi, R, Cillara, N, Ramuscello, S, De Leo, E, Restini, E, Tumolo, R, Cianci, P, Capuzzolo, S, Rizzo, M, Recordare, A, Santoro, R, Amodio, P, Rocca, A, Cecere, G, Romito, R, Portigliotti, L, Rosati, R, Elmore, U, Russello, D, Latteri, S, Costarella, S, Massa, S, Capasso, L, Santangelo, M, Sodo, M, Sarro, G, Rivolta, U, Scabini, S, Pertile, D, Selvaggi, F, Rossi, S, Pellino, G, Sganga, G, Fransvea, P, Testa, S, De Rosa, C, Siquini, W, Trana, C, Solej, M, Bolzon, S, Guerra, E, Stella, M, Ferrara, F, Stipa, F, Stringhi, E, Celotti, A, Taglietti, L, Del Giudice, R, Talarico, C, Ruggiero, M, Tirone, G, Romario, U, Petz, W, Caracino, V, Rossetti, V, Verza, L, Vescovi, L, Marini, M, Vettoretto, N, Botteri, E, Vincenti, L, Giannandrea, G, Viora, T, Maganuco, L, Veronesi, P, Zani, B, Zanus, G, Brizzolari, M, Zanzi, F, Guariniello, A, Zappa, M, Galfrascoli, E, Zonta, S, Oragano, L, Zuliani, W, and Chiari, D

Subjects
Laparoscopic surgery, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, laparoscopy, COVID-19, Elective surgery, Emergency surgery, Survey, Oral Health, cross infection (MeSH), Surveys and Questionnaires, Epidemiology, Pandemic, Infection control, Practice Patterns, Physicians', emergency surgery, Laparoscopy, humans, medicine.diagnostic_test, General Commentary, laparoscopic surgery, infection control, Italy, physicians', Original Article, Elective Surgical Procedure, Human, heating ventilation air conditioning, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), fallow period, elective surgical procedures, pandemics, NO, aerosol generating procedures, elective surgery, survey, practice patterns, physicians', SARS-CoV-2, surveys and questionnaires, medicine, Infection Control, business.industry, General surgery, practice patterns, Surgery, business
Abstract

Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency ( Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.

Published
2021

17. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, Gianluca, Fransvea, Pietro, Podda, Mauro, Pisanu, Adolfo, Carrano, Francesco Maria, Iossa, Angelo, Balducci, Genoveffa, Agresta, Ferdinando Collaborative Study Group: 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, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, 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, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, 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, Zanoni, E., Costa G., Fransvea P., Podda M., Pisanu A., Carrano F.M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi 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., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva 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., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli 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., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, 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, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, 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, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, 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
Male, Settore MED/18 - CHIRURGIA GENERALE, Endoscopy, Gastrointestinal, Cohort Studies, 0302 clinical medicine, Postoperative Complications, Elderly, Abdomen, 80 and over, Medicine, Prospective Studies, Prospective cohort study, Laparoscopy, Abdomen, Acute, Aged, 80 and over, medicine.diagnostic_test, Mortality rate, Age Factors, Prognosis, Multicenter study, Italy, Acute abdomen, 030220 oncology & carcinogenesis, Emergency surgery, 030211 gastroenterology & hepatology, Female, medicine.symptom, Cohort study, Risk, Gastrointestinal, medicine.medical_specialty, Acute, Malignancy, NO, 03 medical and health sciences, Humans, Aged, business.industry, acute abdomen, elderly, emergency surgery, laparoscopy, multicenter study, Endoscopy, medicine.disease, Surgery, Emergencies, Morbidity, business, Procedures and Techniques Utilization, Abdominal surgery
Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Published
2020

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