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1. Effect of Rehabilitation Treatments on Disability in Persons With Disorders of Consciousness: A Propensity Score Study

Author

Sattin D., Leonardi M., Nelli B., Bramanti P., Marino S., Ferro S., Basaglia N., Guido D., Dolce G., Lucca L. F, Cortese M. D., Ermio C., Dattilo T. L., Capomolla S., Di Iasi G., Estraneo A., De Tanti A., Maradini N., Piperno R., Ferri A., Basaglia N, Bergonzoni A., Chiavaroli F., Di Marco F., Carli S., Biasutti E., Marin D., Formisano R., Rizza F., Pisarri F. M., Vichi R., D'Urso A., Grillo G., Leto A., Guerrasio M., Taliento C., Napolitano F., Castelli E., Lispi M. L., Diverio M., Barbieri C., Bini P. P., Angelino G., Dada O., Orlandi A., Pistarini C., Pisoni C., Manera M., Compostini A., Aiachini B., Pessina A., Musio A., Colombetti E., Taraschi S., Aluas M., Croci M., Negri M., Zucchella M. A., Guizzetti G. B., Salamone E., De Valle G., Caroppi S. M., Ramorino E., Salina D., Spannocchi G., Strazzer S., Villa F., Guarnerio C., Chiambretto P., Dartizio R., Feller S., Franzoni L., Giunco F., Massironi L., Azimonti R., Marcolli S. S., Meinecke C., Buse G., Marchesi V, Molteni F., Gramigna C., Lanfranchi M., Pisani L., Sozzi M., Borri G., Cannata A. P., Grillo A., Roca S., Locati D., Arenare F., Magnoni A., Perin C., Sussele M., Quintana T. Y., Camici M. E., Magistrelli F., Samueli T., San Felici L., Manganelli F., Vignati M., Bellanova L., Cattaneo N., Ferraro F., Olgiati E., Brizioli E., Vallasciani M., Gironelli L., Calderisi E., Novelli A., Scaramuzzo R., Perino C., Forno R., Zamponi E., Corna S., Ferrario S., Lamberti G., Rosso S., Colonna F., Navarro J., Trabacca A., Gennaro L., Bertolini A., Addante L., Amenduni M. T., Fiore P., Amoruso M. T., Colella D., Angelillo M. T., Melis G., Desogus G., Baglieri A., Galardi G., Sant'Angelo A., Posteraro F., Forte F., Logi F., Potenza F., Lino M., Zaccara G., Ragazzoni A., Chiaramonti R., March A., Grober G., Kaczor M., Zelger P, Mazzini N., Monti A., Zampolini M., Scarponi F., Avesani R., Salvi L., Tonin P., Cosentino E., Furlanetto N., Bordin M., Martinuzzi A., Buffoni M., Boldrini P., Semerjian M., Sattin, D, Leonardi, M, Nelli, B, Bramanti, P, Marino, S, Ferro, S, Basaglia, N, Guido, D, Dolce, G, Lucca, L, Cortese, M, Ermio, C, Dattilo, T, Capomolla, S, Di Iasi, G, Estraneo, A, De Tanti, A, Maradini, N, Piperno, R, Ferri, A, Bergonzoni, A, Chiavaroli, F, Di Marco, F, Carli, S, Biasutti, E, Marin, D, Formisano, R, Rizza, F, Pisarri, F, Vichi, R, D'Urso, A, Grillo, G, Leto, A, Guerrasio, M, Taliento, C, Napolitano, F, Castelli, E, Lispi, M, Diverio, M, Barbieri, C, Bini, P, Angelino, G, Dada, O, Orlandi, A, Pistarini, C, Pisoni, C, Manera, M, Compostini, A, Aiachini, B, Pessina, A, Musio, A, Colombetti, E, Taraschi, S, Aluas, M, Croci, M, Negri, M, Zucchella, M, Guizzetti, G, Salamone, E, De Valle, G, Caroppi, S, Ramorino, E, Salina, D, Spannocchi, G, Strazzer, S, Villa, F, Guarnerio, C, Chiambretto, P, Dartizio, R, Feller, S, Franzoni, L, Giunco, F, Massironi, L, Azimonti, R, Marcolli, S, Meinecke, C, Buse, G, Marchesi, V, Molteni, F, Gramigna, C, Lanfranchi, M, Pisani, L, Sozzi, M, Borri, G, Cannata, A, Grillo, A, Roca, S, Locati, D, Arenare, F, Magnoni, A, Perin, C, Sussele, M, Quintana, T, Camici, M, Magistrelli, F, Samueli, T, San Felici, L, Manganelli, F, Vignati, M, Bellanova, L, Cattaneo, N, Ferraro, F, Olgiati, E, Brizioli, E, Vallasciani, M, Gironelli, L, Calderisi, E, Novelli, A, Scaramuzzo, R, Perino, C, Forno, R, Zamponi, E, Corna, S, Ferrario, S, Lamberti, G, Rosso, S, Colonna, F, Navarro, J, Trabacca, A, Gennaro, L, Bertolini, A, Addante, L, Amenduni, M, Fiore, P, Amoruso, M, Colella, D, Angelillo, M, Melis, G, Desogus, G, Baglieri, A, Galardi, G, Sant'Angelo, A, Posteraro, F, Forte, F, Logi, F, Potenza, F, Lino, M, Zaccara, G, Ragazzoni, A, Chiaramonti, R, March, A, Grober, G, Kaczor, M, Zelger, P, Mazzini, N, Monti, A, Zampolini, M, Scarponi, F, Avesani, R, Salvi, L, Tonin, P, Cosentino, E, Furlanetto, N, Bordin, M, Martinuzzi, A, Buffoni, M, Boldrini, P, and Semerjian, M

Subjects
Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Propensity score, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Disorders of consciousness, Severity of Illness Index, Disability Evaluation, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Severity of illness, medicine, Humans, Longitudinal Studies, Aged, Vegetative state, Rehabilitation, business.industry, Minimally conscious state, Recovery of Function, Disability Rating Scale, Middle Aged, medicine.disease, Treatment Outcome, Italy, Propensity score matching, Physical therapy, Consciousness Disorders, Female, Observational study, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

To evaluate the effects of rehabilitation (physical and cognitive) treatments on the diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number of potential confounders measured at baseline, in a large cohort of patients with disorders of consciousness across time.An observational, longitudinal (2 evaluations), multicenter project was made in 90 Italian centers.Patients (N=364) with a diagnosis of disorders of consciousness.Primary outcome was the severity of diagnosis, expressed on an ordinal scale (OtherMCSVSdeath). In the Other group were included patients who emerged from an MCS and recovered consciousness. The secondary outcome was the DRS score (range of 0-30 with 30 being the worst value). The DRS is a tool used to define the level of residual disability, commonly used to classify the level of functional impairment in patients with acquired brain injury. Both outcomes were measured for each wave.A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic data were included in the propensity score (PS) analysis. Results showed that the rehabilitation treatments (physical and cognitive) reduced the clinical worsening over time in both severity diagnosis and DRS (around 6.5 points) in patients with disorders of consciousness across different propensity score strategies (ie, PS matching, PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem to be limited to patients with a median value of DRS=23.Our propensity score analysis suggests that rehabilitation treatment protocols seem effective and should be applied to a broader spectrum of patients with disorders of consciousness.

Published
2020

2. Clinical features and follow-up in patients with 22q11.2 deletion syndrome

Author

Cancrini, C, Puliafito, P, Digilio, M, Soresina, A, Martino, S, Rondelli, R, Consolini, R, Ruga, E, Cardinale, F, Finocchi, A, Romiti, Ml, Martire, B, Bacchetta, R, Albano, V, Carotti, A, Specchia, F, Montin, D, Cirillo, E, Cocchi, G, Trizzino, A, Bossi, G, Milanesi, O, Azzari, C, Corsello, G, Pignata, C, Aiuti, A, Pietrogrande, M, Marino, B, Ugazio, A, Plebani, A, Rossi, P, Pierani, P, Gabrielli, A, Danieli, M, De Mattia, D, Sisto, C, Dammacco, F, Ranieri, G, Pession, A, Ricci, G, Minelli, P, Lougaris, V, Badolato, R, Cattaneo, R, Airò, P, Mura, R, Cossu, F, Del Giacco, S, Manconi, P, Consarino, C, Dello Russo, A, Miniero, R, Anastasio, E, Marino, S, Russo, G, Paganelli, R, Sperlì, D, Carpino, L, Aricò, M, Gambineri, E, Lippi, F, Canessa, C, Maggi, E, Romagnani, S, Matucci, A, Vultaggio, A, Gattorno, M, Castagnola, E, Nigro, G, Presta, G, Civino, A, Buzi, F, Gambaretto, G, Fasoli, S, Salpietro, C, Gallizzi, R, Dellepiane, R, Panisi, C, Fabio, G, Carrabba, M, Roncarolo, M, Biondi, A, Vallinoto, C, Poggi, V, Menna, G, Di Nardo, R, Sottile, R, Marone, G, Spadaro, G, Carli, M, Basso, G, Putti, C, Semenzato, G, Agostini, C, D'Angelo, P, Izzi, G, Bertolini, P, Zecca, M, Marseglia, G, Maccario, R, Felici, L, Favre, C, Vecchi, V, Sacchini, P, Rinaldi, G, Livadiotti, S, Simonetti, A, Stabile, A, Duse, M, Iacobini, M, Quinti, I, Fiorilli, M, Moschese, V, Cecere, F, D'Ambrosio, A, De Zan, G, Strafella, S, Tamaro, P, Rabusin, M, Tommasini, A, Tovo, P, De Carli, M, De Carli, S, Nespoli, L, Marinoni, M, Porcellini, A, Lunardi, C, Patuzzo, G, Boner, A, Degani, D, Cancrini, C, Puliafito, P, Digilio, Mc, Soresina, A, Martino, S, Rondelli, R, Consolini, R, Ruga, Em, Cardinale, F, Finocchi, A, Romiti, Ml, Martire, B, Bacchetta, R, Albano, V, Carotti, A, Specchia, F, Montin, D, Cirillo, E, Cocchi, G, Trizzino, A, Bossi, G, Milanesi, O, Azzari, C, Corsello, G, Pignata, C, Aiuti, Alessandro, Pietrogrande, Mc, Marino, B, Ugazio, Ag, Plebani, A, Rossi, P., Cancrini, Caterina, Puliafito, Pamela, Digilio, Maria Cristina, Soresina, Annarosa, Martino, Silvana, Rondelli, Roberto, Consolini, Rita, Ruga, Ezia Maria, Cardinale, Fabio, Finocchi, Andrea, Romiti, Maria Luisa, Martire, Baldassarre, Bacchetta, Rosa, Albano, Veronica, Carotti, Adriano, Specchia, Fernando, Montin, Davide, Cirillo, Emilia, Cocchi, Guido, Trizzino, Antonino, Bossi, Grazia, Milanesi, Ornella, Azzari, Chiara, Corsello, Giovanni, Pignata, Claudio, Pietrogrande, Maria Cristina, Marino, Bruno, Ugazio, Alberto Giovanni, Plebani, Alessandro, Rossi, Paolo, Aiuti, A, Rossi, P, Pierani, P, Gabrielli, A, Danieli, Mg, De Mattia, D, Sisto, C, Dammacco, F, Ranieri, G, Pession, A, Ricci, G, Minelli, P, Lougaris, V, Badolato, R, Cattaneo, R, Airò, P, Mura, Rm, Cossu, F, Del Giacco, S, Manconi, Pe, Consarino, C, Dello Russo, Am, Miniero, R, Anastasio, E, Marino, S, Russo, G, Paganelli, R, Sperlì, D, Carpino, L, Aricò, M, Gambineri, E, Lippi, F, Canessa, C, Maggi, E, Romagnani, S, Matucci, A, Vultaggio, A, Gattorno, M, Castagnola, E, Nigro, G, Presta, G, Civino, A, Buzi, F, Gambaretto, G, Fasoli, S, Salpietro, C, Gallizzi, R, Dellepiane, Rm, Panisi, C, Fabio, G, Carrabba, M, Pietrogrande, M, Roncarolo, Mg, Biondi, A, Vallinoto, C, Poggi, V, Menna, G, Di Nardo, R, Sottile, R, Marone, G, Spadaro, G, Carli, M, Basso, G, Putti, C, Semenzato, G, Agostini, C, D'Angelo, P, Izzi, G, Bertolini, P, Zecca, M, Marseglia, G, Maccario, R, Felici, L, Favre, C, Vecchi, V, Sacchini, P, Rinaldi, G, Livadiotti, S, Simonetti, A, Stabile, A, Duse, M, Iacobini, M, Quinti, I, Fiorilli, M, Moschese, V, Cecere, F, D'Ambrosio, A, De Zan, G, Strafella, S, Tamaro, Paolo, Rabusin, M, Tommasini, A, Tovo, P, De Carli, M, De Carli, S, Nespoli, L, Marinoni, M, Porcellini, A, Lunardi, C, Patuzzo, G, Boner, A, Degani, D., Cancrini, C., Pulisfito, P., Digilio, M. C., Soresina, A., Martino, S., Rondelli, R., Consolini, R., Ruga, E. M., C. a. r. d. i. n. a. l. e., F., Finocchi, A., Romiti, M. L., Martire, B., Bacchetta, R., Albano, V., Carotti, A., Specchia, F., Montin, D., Cocchi, G., Trizzino, A., Bossi, G., Milanesi, O., Azzari, C., Corsello, G., Aiuti, A., Pietrogrande, M. C., Marino, B., Ugazio, A. G., Plebani, A., Digilio, MC, Ruga, EM, Romiti, ML, trizzino, A, Aiuti, Pietrogrande, MC, and Ugazio, AG

Subjects
Male, Pediatrics, 22q11.2 deletion, Delayed Diagnosis, Time Factors, Chromosomes, Human, Pair 22, Developmental Disabilities, digeorge syndrome, Sex Factor, Severity of Illness Index, Retrospective Studie, DiGeorge syndrome, Early Diagnosi, Age Factor, Prospective Studies, Neonatal hypocalcemia, Prospective cohort study, Child, medicine.diagnostic_test, Delayed Diagnosi, Primary immune disorders, Age Factors, del 22q, MIM, Abnormalities, Multiple, Adolescent, Adult, Child, Preschool, DiGeorge Syndrome, Early Diagnosis, Female, Follow-Up Studies, Genetic Testing, Humans, Infant, Infant, Newborn, Monitoring, Physiologic, Retrospective Studies, Risk Assessment, Sex Factors, Young Adult, Disease Progression, Cohort, Abnormalities, Multiple, Pediatrics, Perinatology and Child Health, Human, medicine.medical_specialty, Time Factor, Monitoring, Developmental Disabilitie, Italian Association of Pediatric Haematology and Oncology, Context (language use), Chromosomes, Follow-Up Studie, Severity of illness, medicine, 22q11DS, 22q11.2 deletion syndrome, AIEOP, Mendelian Inheritance in Man, Preschool, Physiologic, Genetic testing, Settore MED/38 - Pediatria Generale e Specialistica, business.industry, Retrospective cohort study, medicine.disease, Newborn, Prospective Studie, Pair 22, business
Abstract

Objective To investigate the clinical manifestations at diagnosis and during follow-up in patients with 22q11.2 deletion syndrome to better define the natural history of the disease. Study design A retrospective and prospective multicenter study was conducted with 228 patients in the context of the Italian Network for Primary Immunodeficiencies. Clinical diagnosis was confirmed by cytogenetic or molecular analysis. Results The cohort consisted of 112 males and 116 females; median age at diagnosis was 4 months (range 0 to 36 years 10 months). The diagnosis was made before 2 years of age in 71% of patients, predominantly related to the presence of heart anomalies and neonatal hypocalcemia. In patients diagnosed after 2 years of age, clinical features such as speech and language impairment, developmental delay, minor cardiac defects, recurrent infections, and facial features were the main elements leading to diagnosis. During follow-up (available for 172 patients), the frequency of autoimmune manifestations ( P = .015) and speech disorders ( P = .002) increased. After a median follow-up of 43 months, the survival probability was 0.92 at 15 years from diagnosis. Conclusions Our data show a delay in the diagnosis of 22q11.2 deletion syndrome with noncardiac symptoms. This study provides guidelines for pediatricians and specialists for early identification of cases that can be confirmed by genetic testing, which would permit the provision of appropriate clinical management.

Published
2014

3. Right Atrial Myxoma with Pulmonary Embolism

Author

De Carli S, Ciani R, Leonardo A. Sechi, Ettore Bartoli, Barillari G, and Dolcetti G

Subjects
Adult, Male, medicine.medical_specialty, Heart disease, Right atrial, Heart Neoplasms, Recurrence, Internal medicine, medicine, Humans, Pharmacology (medical), Heart Atria, cardiovascular diseases, Vascular disease, business.industry, Respiratory disease, Myxoma, medicine.disease, Pulmonary embolism, cardiovascular system, Cardiology, Right Atrial Myxoma, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business, Complication, Echocardiography, Transesophageal
Abstract

Right atrial myxomas are rare tumors that often go undiagnosed. Pulmonary embolism originating from the tumor mass is a potentially fatal complication. We report the case of a young man in whom a right atrial myxoma with recurrent episodes of pulmonary embolism was diagnosed 1 month after the beginning of symptoms by two-dimensional transthoracic and transesophageal echocardiography. Early diagnosis of cardiac myxomas is important since surgical treatment is usually resolutive with low recurrence rates and good long-term survival.

Published
1994

4. COVID-19 and Obesity: Is Bariatric Surgery Protective? Retrospective Analysis on 2145 Patients Undergone Bariatric-Metabolic Surgery from High Volume Center in Italy (Lombardy)

Author

Alberto Oldani, Matteo Uccelli, Francesca Ciccarese, Simone Targa, Giancarlo Cesana, Andrea D'Alessio, Stefano Maria De Carli, Roberta Villa, Adelinda Angela Giulia Zanoni, Stefano Olmi, Ayman Ismail, Lorenzo G. Mantovani, Riccardo Giorgi, Giovanni Cesana, Uccelli, M., Cesana, G. C., De Carli, S. M., Ciccarese, F., Oldani, A., Zanoni, A. A. G., Giorgi, R., Villa, R., Ismail, A., Targa, S., D'Alessio, A., Cesana, G., Mantovani, L., Olmi, S., Uccelli, M, Cesana, G, De Carli, S, Ciccarese, F, Oldani, A, Zanoni, A, Giorgi, R, Villa, R, Ismail, A, Targa, S, D'Alessio, A, Mantovani, L, and Olmi, S

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Coronavirus disease 2019 (COVID-19), Original Contributions, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Bariatric surgery, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, medicine, Humans, Obesity, Risk factor, Young adult, Laparoscopy, Aged, Retrospective Studies, Nutrition and Dietetics, medicine.diagnostic_test, SARS-CoV-2, business.industry, Incidence (epidemiology), COVID-19, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, Hospitalization, Obesity surgery, Pneumonia, Italy, Female, 030211 gastroenterology & hepatology, Metabolic surgery, business
Abstract

Introduction On February 20, 2020, a severe case of pneumonia due to SARS-CoV-2 was diagnosed in northern Italy (Lombardy). Some studies have identified obesity as a risk factor for severe disease in patients with COVID-19. The purpose of this study was to investigate the incidence of SARS-CoV-2 infection and its severity in patients who have undergone bariatric surgery. Material and Methods During the lockdown period (until May 2020), we contacted operated patients by phone and social networks (e.g., Facebook) to maintain constant contact with them; in addition, we gave the patients a dedicated phone number at which to call us for emergencies. We produced telemedicine and educational videos for obese and bariatric patients, and we submitted a questionnaire to patients who had undergone bariatric surgery in the past. Results A total of 2145 patients (313 male; 1832 female) replied to the questionnaire. Mean presurgical BMI: 44.5 ± 6.8 kg/m2. Mean age: 44.0 ± 10.0 year. Mean BMI after surgery: 29.3 ± 5.5 kg/m2 (p

Published
2021

5. Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair

Author

Roberta Villa, Matteo Uccelli, Giovanni Cesana, Adelinda Angela Giulia Zanoni, Riccardo Giorgi, Stefano Olmi, Stefano Maria De Carli, Ayman Ismail, Alberto Oldani, Francesca Ciccarese, Olmi, S., Uccelli, M., Cesana, G. C., Ciccarese, F., Oldani, A., Giorgi, R., De Carli, S. M., Villa, R., Zanoni, A. A. G., and Ismail, A.

Subjects
Sleeve gastrectomy, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Abdominal Hernia, 030209 endocrinology & metabolism, Asymptomatic, Group B, Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, Weight loss, Laparoscopic ventral hernia repair, medicine, Humans, Herniorrhaphy, Retrospective Studies, Bariatric surgery, Nutrition and Dietetics, business.industry, Composite mesh, Surgical Mesh, Hernia, Ventral, Obesity, Morbid, Surgery, medicine.anatomical_structure, Concomitant, Laparoscopy, 030211 gastroenterology & hepatology, IPOM, medicine.symptom, business
Abstract

Purpose: To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh. Materials and Methods: This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B). Results: Group A (30 patients) had a mean BMI of 37.8 ± 5.7kg/m2 (range: 34.0–74.2kg/m2); group B (170 patients) had a mean BMI of 24.6 ± 4.5kg/m2 (range 19.0–29.8kg/m2) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6min (range 30–120); group B 38.9 ± 21.5min (range 25–110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7days (range 1–5) versus group B, 2.8 ± 1.9days (range 1–4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23). Conclusion: The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2–W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable.

Published
2020

6. Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic One Anastomosis Gastric Bypass with Braun Anastomosis: What's Better?

Author

Francesca Ciccarese, Giovanni Cesana, Alberto Oldani, Roberta Villa, Stefano Olmi, Riccardo Giorgi, Stefano Maria De Carli, Matteo Uccelli, Adelinda Angela Giulia Zanoni, Giulia David, Olmi, S., Oldani, A., Cesana, G., Ciccarese, F., Uccelli, M., De Carli, S. M., Villa, R., David, G., Giorgi, R., and Zanoni, A. A. G.

Subjects
Adult, Male, medicine.medical_specialty, bariatric surgery, Gastric Bypass, Context (language use), Anastomosis, Braun anastomosis, Bile reflux, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Gastrectomy, Weight Loss, medicine, Esophagitis, Humans, Retrospective Studies, business.industry, Reflux, GERD, Perioperative, Middle Aged, Esophageal cancer, medicine.disease, digestive system diseases, Obesity, Morbid, Surgery, Jejunum, 030220 oncology & carcinogenesis, Gastroesophageal Reflux, Female, Laparoscopy, 030211 gastroenterology & hepatology, business
Abstract

Background and Aims: Although laparoscopic one anastomosis gastric bypass (LOAGB) is a promising bariatric procedure, a large number of surgeons have strong objections mainly because of risk of bile reflux, marginal ulceration, malnutrition, and long-term risk of gastric and esophageal cancer. Lateral enteroenterostomy placed distally to a gastrojejunal anastomosis shows efficacy in preventing bile reflux after gastric resection and gastrojejunal anastomosis, but at present its efficacy in a bariatric surgery context has not been evaluated. Patients and Methods: From January 2013 to December 2018, 100 patients have been admitted to our department to be treated by performing LOAGB. Patients have been divided into two groups on the basis of the indications to this surgical procedure; Group A: presence of de novo gastroesophageal reflux disease (GERD) or severe esophagitis after laparoscopic sleeve gastrectomy, with or without weight regain; Group B: LOAGB as primary procedure. Another group of 30 patients (Group C) underwent LOAGB with Braun anastomosis as primary bariatric surgical procedure for morbid obesity. We have conducted a retrospective analysis of the surgical outcomes in terms of perioperative mortality, short-, mid-, and long-term postoperative complications and weight loss. Results: Group A: 50 patients; incidence of postoperative GERD, esophagitis, or esophageal ulcers was 26% (13 cases). All these patients have been successfully treated by performing Braun anastomosis. Group B: 20 patients; incidence of de novo reflux was 25% (5 cases); Braun anastomosis was performed with complete resolution of signs and symptoms in all cases. Group C: 30 patients; no cases of de novo reflux, esophagitis, or anastomotic ulcers occurred. Conclusion: Braun anastomosis seems to be a useful surgical tool to prevent the onset of de novo reflux, esophagitis, and anastomotic ulcers.

Published
2019

7. Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre

Author

Riccardo Giorgi, M. Bonaldi, Matteo Uccelli, D. Ferrari, Ayman Ismail, A. Delcarro, Giovanni Cesana, Adelinda Angela Giulia Zanoni, Roberta Villa, Francesca Ciccarese, Alberto Oldani, S. Olmi, Carolina Rubicondo, S. De Carli, Zanoni, A. A. G., Delcarro, A., Ciccarese, F., Villa, R., Oldani, A., Giorgi, R., Rubicondo, C., Bonaldi, M., Cesana, G., Uccelli, M., De Carli, S., Ismail, A., Ferrari, D., and Olmi, S.

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Pain, Hernia, Inguinal, TAPP repair, Young Adult, Incarcerated and strangulated inguinal hernias, medicine, Humans, Hernia, Laparoscopy, Herniorrhaphy, Aged, Retrospective Studies, Aged, 80 and over, Groin, medicine.diagnostic_test, business.industry, Postoperative complication, Perioperative, Bowel resection, Middle Aged, Surgical Mesh, medicine.disease, Hernia repair, Surgery, medicine.anatomical_structure, Treatment Outcome, Seroma, Emergency, Female, business, Follow-Up Studies
Abstract

Purpose: Aim of this study was to analyse feasibility, safety and effectiveness of laparoscopic transperitoneal hernia repair (TAPP) approach to inguinal hernias in the emergency setting, with a longer follow-up than the studies present in literature. Methods: We retrospectively analysed all patients who underwent emergency TAPP hernia repair in San Marco Hospital (Zingonia, Italy), from September 2010 to June 2020. A prospectively collected database of 685 consecutive TAPP hernia repair was reviewed. Feasibility and safety were evaluated through operative time, conversion rate, perioperative mortality, morbidity and prosthesis infection rate. Effectiveness was assessed by recurrence and complication rate, acute (during admission) and chronic (during follow-up) pain by Visual Analogic Scale (VAS), and recovery to normal activity in a long-term follow-up (mean period 1718days). Results: The final study group included 47 patients. The mean age was 59.6years (range 22–89), 29 patients were male and 18 were female. The mean operation time was 64min. Two cases were converted to open approach (4%). In four cases bowel resection became necessary (8.5%). Appendicectomy and omentectomy occurred once and twice, respectively (2% and 4%), and orchiectomy was required in two patients (4%). Seroma was the only postoperative complication that we registered in four patients.During a mean follow-up period of 1718days, there was no recurrence of the hernia or other complications. Five patients referred mild occasional groin pain (VAS < 3), with quick relief without taking any pain killers. Conclusion: TAPP approach is a safe, feasible and effective therapeutic option for groin hernias in emergency setting. No recurrence or severe complications were reported in over 4years of follow-up.

Published
2021

8. Surgical Outcomes of Rectal Resection: Our 10 Years Experience

Author

Giovanni Cesana, Stefano Olmi, Riccardo Giorgi, Matteo Uccelli, Roberta Villa, Francesca Ciccarese, Alberto Oldani, Stefano Maria De Carli, Oldani, A., Cesana, G., Uccelli, M., Ciccarese, F., Giorgi, R., De Carli, S. M., Villa, R., and Olmi, S.

Subjects
Adult, Male, Laparoscopic surgery, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Fistula, laparoscopy, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, rectal surgery, medicine, cancer, Humans, Laparoscopy, Aged, Retrospective Studies, Aged, 80 and over, Proctectomy, medicine.diagnostic_test, Rectal Neoplasms, business.industry, Mortality rate, Cancer, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Amputation, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Complication, business, Follow-Up Studies
Abstract

Background: Colorectal cancer, one of the most common tumor- and cancer-related deaths worldwide, requires a multidisciplinary management including neoadjuvant chemoradiotherapy and surgery. Laparoscopic surgery for rectal cancer is gaining popularity due to its safety profile and good oncological results, if performed by experienced surgeons in specialized centers. This study describes our 10 years experience in minimally invasive rectal cancer surgery. Methods: We have retrospectively evaluated a series of 140 patients treated with laparoscopic approach for rectal malignant and benign diseases. Results: A total of 134 patients (95.7%) underwent anterior rectal resection, in the remaining 6 cases (4.3%) abdominoperineal amputation was performed. All but 13 cases have been treated with laparoscopic approach, with conversion rate of 5.7%. Postoperative morbidity rate was 8.6% (2 cases of peritoneal bleeding and 10 cases of anastomotic fistulae; in 2 cases, fistula occurred in patients previously treated with chemoradiation). Conclusions: Conventional laparoscopy can provide adequate oncological outcomes even in patients with advanced rectal cancer, with advantages in terms of postoperative hospital stay, recovery time, acceptable operative time, and low complication and conversion rates.

Published
2019

9. Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients

Author

Francesca Ciccarese, Alberto Oldani, Stefano Olmi, Simone Targa, Riccardo Giorgi, Matteo Uccelli, Giovanni Cesana, Stefano Maria De Carli, Uccelli, M., Targa, S., Cesana, G. C., Oldani, A., Ciccarese, F., Giorgi, R., De Carli, S. M., and Olmi, S.

Subjects
Adult, Male, medicine.medical_specialty, Sleeve gastrectomy, Gastric leak, Adolescent, medicine.medical_treatment, Operative Time, Blood Loss, Surgical, Bariatric Surgery, Anastomotic Leak, Fibrin Tissue Adhesive, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, Gastrectomy, Laparotomy, Surgical Stapling, medicine, Humans, Fibrin glue, Laparoscopy, Aged, Retrospective Studies, Laparoscopic sleeve gastrectomy, medicine.diagnostic_test, business.industry, Bleeding, Mean age, Surgical procedures, Middle Aged, Surgery, Obesity, Morbid, Obesity surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Body mass index
Abstract

Laparoscopic Sleeve Gastrectomy (LSG) is one of the most performed surgical procedures in bariatric surgery. Staple line leak and bleeding are by far the two most feared complications after LSG. In this study, we retrospectively compared the efficacy of Fibrin Glue in preventing staple line leak and bleeding. From September 2019 to January 2020, 450 obese patients underwent elective LSG and were placed into groups with Fibrin Glue reinforcement (Group A) or without Fibrin Glue reinforcement (Group B). Primary endpoints were postoperative staple line leak and bleeding; while, secondary endpoints were reintervention rate, total operative time and mortality. Mean Body Mass Index (BMI) was 45.4 ± 7.9kg/m2 (range: 35.1–81.8). Mean age was 43.3 ± 11.8years (range: 18–65). No intraoperative complications or conversion to laparotomy were reported. Mean operative time was comparable between the groups (48 ± 18min in Group A vs 48 ± 14min in Group B; p > 0.05). No decrease in overall postoperative complications was found in Group A (5.1% vs 7.0%; p > 0.05), but after stratification according to Clavien–Dindo classification, we found a higher rate of Grade II (0.0% vs 1.6%; p < 0.05) and Grade IIIb (0.0% vs 1%; p < 0.05) complications in group B. Our study showed that Fibrin Glue as a reinforcement method during LSG is a reliable tool, without affecting the operative time of surgery and mortality. A significant reduction in complications (Clavien–Dindo grade II and grade IIIb) was observed in patients undergoing LSG with Fibrin Glue.

Published
2020

10. Laparoscopic Surgery of Gastric Cancer with D2 Lymphadenectomy and Omentum Preservation: Our 10 Years Experience

Author

Alberto Oldani, Adelinda Angela Giulia Zanoni, Carolina Rubicondo, Stefano Olmi, Ayman Ismail, Matteo Uccelli, Giovanni Cesana, Riccardo Giorgi, Roberta Villa, Francesca Ciccarese, Stefano Maria De Carli, Olmi, S., Uccelli, M., Oldani, A., Cesana, G., Ciccarese, F., Giorgi, R., Villa, R., De Carli, S. M., Zanoni, A. A. G., Rubicondo, C., and Ismail, A.

Subjects
Laparoscopic surgery, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, laparoscopy, Gastrectomy, Stomach Neoplasms, medicine, Humans, omentum preservation, Laparoscopy, Aged, Retrospective Studies, Aged, 80 and over, D2 lymphadenectomy, medicine.diagnostic_test, business.industry, gastric cancer, Cancer, Retrospective cohort study, Middle Aged, medicine.disease, gastrectomy, humanities, Surgery, body regions, Treatment Outcome, lymphadenectomy, Lymph Node Excision, Lymphadenectomy, Female, business, Laparoscopic treatment, Omentum, Follow-Up Studies
Abstract

Introduction: The debate is still open about laparoscopic treatment of gastric cancer. The aim of this retrospective study is to analyze our short-, medium-, and long-term surgical and oncological results in laparoscopic treatment of gastric cancer with D2 lymphadenectomy and omentum preservation. Materials and Methods: From January 2010 to June 2018, after >150 surgical procedures for gastric cancer performed by minimally invasive approach, we performed 100 laparoscopic subtotal gastrectomies and 38 total gastrectomies, both for early gastric cancer (EGC) and advanced gastric cancer (AGC). We always made a D2 lymphadenectomy or higher. As often as possible, we performed omentum-preserving technique. Primary outcomes analyzed included incidence of medical and surgical complications. Secondary outcomes analyzed were survival probability and incidence of relapse. Every patient read and signed informed consent before surgery. Results: Mean operative time: 2.4 ± 0.7 hours (range 1.2-4.7 hours). Rate of conversions: 14.5% (20/138); intraoperative complications: 1.4% (2/138) and positive resection margins: 6.5% (9/138). Overall incidence of duodenal fistula: 3.6% (5/138). Rate of reoperation was 7.3% (10/138). Postoperative complications according to Clavien-Dindo classification: I 3.6% (5/138); II 13.0% (18/138); III 5.8% (8/138); III B 0.7% (1/138); V 1.4% (2/138). Overall survival with 60 months follow-up was 58%. Overall 60 months incidence of relapse was 44%. Patients with omentum preservation had a lower incidence of relapse than patients with omentectomy (40% versus 57% P =.002). Conclusions: Laparoscopic treatment of gastric cancer with D2 lymphadenectomy and omentum preservation is safe and feasible, both for EGC and for AGC. Although this study has limitations, omentum-preserving technique was associated with a statistically lower recurrence rate.

Published
2020

11. 'COVID-19 and Obesity: Postoperative Risk in Patients Who Have Undergone Bariatric Surgery. Preliminary Report from High Volume Center in Italy (Lombardy)'

Author

Simone Targa, Stefano Olmi, Francesca Ciccarese, Giovanni Cesana, Ayman Ismail, Alberto Oldani, Roberta Villa, Adelinda Angela Giulia Zanoni, Matteo Uccelli, Stefano Maria De Carli, Riccardo Giorgi, Uccelli, M., Cesana, G. C., Ciccarese, F., Oldani, A., Zanoni, A. A. G., De Carli, S. M., Giorgi, R., Villa, R., Ismail, A., Targa, S., and Olmi, S.

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Nutrition and Dietetics, Coronavirus disease 2019 (COVID-19), business.industry, Endocrinology, Diabetes and Metabolism, General surgery, MEDLINE, medicine.disease, Obesity, Postoperative risk, Preliminary report, High volume center, medicine, Surgery, In patient, business, Letter to the Editor
Published
2020

12. Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center

Author

Riccardo Giorgi, Giovanni Cesana, Stefano Maria De Carli, Alberto Oldani, Roberta Villa, Ayman Ismail, Stefano Olmi, Francesca Ciccarese, Adelinda Angela Giulia Zanoni, Matteo Uccelli, Carolina Rubicondo, Olmi, S., Cesana, G., Rubicondo, C., Oldani, A., Uccelli, M., De Carli, S., Ciccarese, F., Giorgi, R., Villa, R., Zanoni, A., and Ismail, A.

Subjects
Sleeve gastrectomy, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Anastomotic Leak, Bariatric complications, 03 medical and health sciences, 0302 clinical medicine, Bariatrics, Gastrectomy, medicine, Humans, In patient, Lost to follow-up, Subclinical infection, Leakage (electronics), Retrospective Studies, Nutrition and Dietetics, Second line treatment, business.industry, Incidence (epidemiology), Stomach, Stent, Endogastric stent, Surgery, Obesity, Morbid, 030211 gastroenterology & hepatology, Laparoscopy, business, Leakage
Abstract

Purpose: To propose an algorithm of treatment for leakage after laparoscopic sleeve gastrectomy (LSG). Materials and Methods: Sixty-nine patients who developed gastric leakage out of 4294 patients who underwent LSG from 2010 to 2018 were considered in this study. Patients’ outcomes in terms of incidence of resolution and time to leakage resolution were compared by leakage characteristics and type of treatment. Three patients were lost to follow up. Results: Leakage occurred in a median of 6days from surgery, and for majority of patients (80.3%), it was in the upper part of the sleeve. The median dimension of leakage was 6.5mm. Low level leakage resulted in a lower time of resolution (p< 0.001). Patients with clinical leakage were treated with surgery or endoscopic placement of a self-expandable metal stent (SEMS). The median time of leakage resolution was 42days. The hospitalization time for SEMS was shorter with a 68.3% of complete resolution compared with the 29.4% of surgery. In patients with subclinical and small leakage, a conservative treatment was successful in 87.5%. Overall 39.4% of patients needed a second line treatment after that the first failed. Conclusion: Leakage could be treated conservatively if subclinical and < 5mm. Surgery is mandatory if a perigastric collection is present or an organ lesion is suspected. SEMS seems to be the best option to treat high level leakage.

Published
2020

13. Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up

Author

Alberto Oldani, Riccardo Giorgi, Roberta Villa, Giovanni Cesana, Stefano Olmi, Francesca Ciccarese, Stefano Maria De Carli, Matteo Uccelli, Olmi, S., Uccelli, M., Cesana, G. C., Ciccarese, F., Oldani, A., Giorgi, R., De Carli, S. M., and Villa, R.

Subjects
Male, medicine.medical_specialty, Sleeve gastrectomy, medicine.medical_treatment, Perforation (oil well), Population, Fundoplication, 030209 endocrinology & metabolism, Gastroesophageal reflux disease, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Weight loss, Gastrectomy, medicine, Humans, Esophagus, education, Retrospective Studies, education.field_of_study, business.industry, Stomach, GERD, medicine.disease, Dysphagia, digestive system diseases, Surgery, Obesity, Morbid, medicine.anatomical_structure, Treatment Outcome, Italy, 030211 gastroenterology & hepatology, Female, Laparoscopy, medicine.symptom, business, Esophagitis, Follow-Up Studies
Abstract

Background Gastroesophageal reflux disease (GERD), including erosive esophagitis, is highly prevalent in the obese population. Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. The relationship between LSG and GERD has gained increasing attention. This retrospective study aimed to assess the effectiveness of combined LSG and modified Rossetti antireflux fundoplication for the treatment of GERD on morbidly obese patients after bariatric surgery. Objectives To assess the effectiveness, on morbid obese patients, of combined SG and Rossetti fundoplication for the treatment of GERD in obese patients. Setting Public Hospital, Italy. Methods From January 2015 to May 2018, 220 obese patients (167 female; 53 male) underwent LSG and modified Rossetti antireflux fundoplication procedure, performed by 4 different expert bariatric surgeons. Data have been collected in an Excel file and processed by XLStat to perform statistical analyses. We analyzed short-term complications and medium-term results with 24-month follow-up in terms of weight loss, remission of co-morbidities, and resolution of GERD. Results Mean BMI was 42.58 ± 5.93 kg/m2 (range, 31.70–63.16). Patients suffering from GERD before surgery were 137 of 220 (62.3%). No intraoperative complications or conversion were reported. Regular postoperative course was recorded in 90% of patients (198 of 220 patients). Gastric perforation has always occurred on the fundoplicated portion of the stomach. This perforation, which is different from the well-known post-LSG gastric fistula, may be because of incorrect gastric fundus manipulation. Rate of reoperation was 14 of 220 (6.4%). A good sense of repletion without episodes of vomiting, nausea, or dysphagia was reported in 95% of the analyzed patients. Of patients, 98.5% did not suffer from reflux symptoms and did not take proton pump inhibitors. A decrease in BMI and percent of total weight loss at follow-up were comparable with LSG. Endoscopic follow-up is still ongoing. Improvement in esophagitis was observed in 63 of 65 (96.92%) patients and all 4 patients shows improvement in Barrett’s esophagus. Conclusions LSG and modified Rossetti antireflux fundoplication procedure is a tolerated and feasible procedure in obese patients, with good postoperative weight loss results and improvement in GERD.

Published
2020

14. Modified Sleeve Gastrectomy Combined with Laparoscopic Rossetti Fundoplication and Vascularization Assessment with Indocyanine Green

Author

Matteo Uccelli, Giovanni Cesana, Stefano Olmi, Riccardo Giorgi, Francesca Ciccarese, Giulia David, Stefano Maria De Carli, Olmi, S., David, G., Cesana, G., Ciccarese, F., Giorgi, R., De Carli, S., and Uccelli, M.

Subjects
Adult, Indocyanine Green, Sleeve gastrectomy, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Gastric bypass, Diagnostic Techniques, Cardiovascular, Fundoplication, 030209 endocrinology & metabolism, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Gastrectomy, medicine, Esophagitis, Humans, Endoscopy, Digestive System, Postoperative Period, Risk factor, Bariatric surgery, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Reflux, medicine.disease, digestive system diseases, Obesity, Morbid, Endoscopy, Surgery, Gastrointestinal Tract, Gastroesophageal reflux, chemistry, Gastroesophageal Reflux, GERD, Laparoscopy, 030211 gastroenterology & hepatology, business, Indocyanine green
Abstract

Aim: Morbid obesity is a key risk factor for gastroesophageal reflux; the aim of this study is to describe the technique of modified laparoscopic Rossetti fundoplication to treat morbid obesity related to GERD. Methods: This is a video/dynamic manuscript on operative technique. We present the case of a 38-year-old patient referred to our institution for morbid obesity (BMI 43kg/m2) related to GERD symptoms with grade A esophagitis at the preoperative upper gastro intestinal endoscopy and in daily therapy with PPI since years. The patient was scheduled for a laparoscopic sleeve gastrectomy combined with Rossetti fundoplication. Results: Intraoperative and postoperative course were uneventful. One year later, the BMI is 27.9kg/m2 and at clinical and endoscopic follow-up demonstrates absence of esophagitis and any PPI therapy is needed. Conclusion: The modified sleeve gastrectomy combined with laparoscopic Rossetti fundoplication seems to be a safe, effective procedure and a suitable alternative to gastric bypass in obese patients with GERD.

Published
2019

15. Surgical Outcomes of Laparoscopic Right Colectomy with Complete Mesocolic Excision

Author

Francesca Ciccarese, Riccardo Giorgi, Giovanni Cesana, Alberto Oldani, Stefano Olmi, Roberta Villa, Matteo Uccelli, Stefano Maria De Carli, Olmi, S., Oldani, A., Cesana, G., Ciccarese, F., Uccelli, M., Giorgi, R., Villa, R., and De Carli, S. M.

Subjects
Adult, Male, 050101 languages & linguistics, medicine.medical_specialty, Operative Time, Adenocarcinoma, Anastomosis, Central Vascular Ligation, 050105 experimental psychology, Postoperative Complications, Robotic Surgical Procedures, medicine, Humans, Minimally Invasive Surgical Procedures, 0501 psychology and cognitive sciences, Robotic surgery, Laparoscopy, Complete Mesocolic Excision, Colectomy, Peritoneal Neoplasms, Aged, Retrospective Studies, Aged, 80 and over, Gastric emptying, medicine.diagnostic_test, business.industry, Mortality rate, 05 social sciences, Retrospective cohort study, Perioperative, Length of Stay, Middle Aged, Colorectal cancer, Laparoscopic right colectomy, Surgery, Treatment Outcome, Colonic Neoplasms, Right Colectomy, Female, business, Research Article, Mesocolon
Abstract

Background and Objectives: Literature demonstrates that colorectal cancer is nowadays one of the most common malignancies. Laparoscopy and robotic surgery are progressively gaining popularity in the treatment of colo-rectal tumors. Complete mesocolic excision and central vascular ligation have been widely adopted with encouraging results in terms of an improvement of overall sur-vival, but some studies in the literature seem to demon-strate a higher morbidity rate. Methods: We conducted a retrospective study from 01/ 01/2010 to 30/04/2019 on a series of 250 patients, 155 males (62%) and 95 females (38%) who underwent right colectomy with minimally invasive approach, complete mesocolic excision, central vascular ligation, and intracor-poreal anastomosis. Results: No perioperative mortality occurred. Postoperative morbidity rate was 6%, including 10 cases of anasto-motic leak (5%). Conversion rate was 2.5%. Mean hospital stay was 6 days (range, 4 –25 days). Mean operative time was 70 minutes (range, 50 –130 minutes). No cases of duodenal or pancreatic damages, no chronic pain or di-arrhea, and no severe alteration of bowel function were recorded. We observed only 3 cases of transient delayed gastric emptying. Conclusions: Laparoscopic right colectomy with complete mesocolic excision, central vascular ligation and intracorporeal anastomosis leads to encouraging oncolog-ical mid-and long-term outcomes with low complications rates.

Published
2020

16. Laparoscopic Abdominal Wall Hernia Repair

Author

Matteo Uccelli, Stefano Maria De Carli, Stefano Olmi, Alberto Oldani, Roberta Villa, Giovanni Cesana, Francesca Ciccarese, Riccardo Giorgi, Olmi, S., Uccelli, M., Cesana, G. C., Oldani, A., Giorgi, R., De Carli, S. M., Ciccarese, F., and Villa, R.

Subjects
Male, incisional hernia, Abdominal Hernia, medicine.medical_treatment, laparoscopic repair, Abdominal wall, Recurrence, Risk Factors, intraperitoneal onlay mesh, Fixation (histology), Aged, 80 and over, 05 social sciences, ventral hernia, Middle Aged, Hernia repair, Ventral hernia, Treatment Outcome, medicine.anatomical_structure, Female, Research Article, Adult, 050101 languages & linguistics, medicine.medical_specialty, Incisional hernia, Operative Time, Intraperitoneal onlay mesh, 050105 experimental psychology, medicine, Incisional Hernia, Humans, 0501 psychology and cognitive sciences, Hernia, Herniorrhaphy, Aged, Retrospective Studies, business.industry, Abdominal Wall, Odds ratio, Length of Stay, Surgical Mesh, medicine.disease, Hernia, Ventral, Confidence interval, Surgery, Laparoscopic repair, Laparoscopy, business, Follow-Up Studies
Abstract

Background and Objectives: The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair. Methods: This was a retrospective, single-center, obser-vational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery. Results: A total of 1,029 patients were included. The median surgery time was 40 min (range 30–55) and the median length of hospital stay was 2 d (range 2–3). Intra-operative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo clas-sification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P < .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P < .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P < .001, 95% confidence interval, 21.53– 577.67). Conclusion: This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.

Published
2020

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