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1. The 2023 WSES guidelines on the management of trauma in elderly and frail patients

Author

Belinda De Simone, Elie Chouillard, Mauro Podda, Nikolaos Pararas, Gustavo de Carvalho Duarte, Paola Fugazzola, Arianna Birindelli, Federico Coccolini, Andrea Polistena, Maria Grazia Sibilla, Vitor Kruger, Gustavo P. Fraga, Giulia Montori, Emanuele Russo, Tadeja Pintar, Luca Ansaloni, Nicola Avenia, Salomone Di Saverio, Ari Leppäniemi, Andrea Lauretta, Massimo Sartelli, Alessandro Puzziello, Paolo Carcoforo, Vanni Agnoletti, Luca Bissoni, Arda Isik, Yoram Kluger, Ernest E. Moore, Oreste Marco Romeo, Fikri M. Abu-Zidan, Solomon Gurmu Beka, Dieter G. Weber, Edward C. T. H. Tan, Ciro Paolillo, Yunfeng Cui, Fernando Kim, Edoardo Picetti, Isidoro Di Carlo, Adriana Toro, Gabriele Sganga, Federica Sganga, Mario Testini, Giovanna Di Meo, Andrew W. Kirkpatrick, Ingo Marzi, Nicola déAngelis, Michael Denis Kelly, Imtiaz Wani, Boris Sakakushev, Miklosh Bala, Luigi Bonavina, Joseph M. Galante, Vishal G. Shelat, Lorenzo Cobianchi, Francesca Dal Mas, Manos Pikoulis, Dimitrios Damaskos, Raul Coimbra, Jugdeep Dhesi, Melissa Red Hoffman, Philip F. Stahel, Ronald V. Maier, Andrey Litvin, Rifat Latifi, Walter L. Biffl, and Fausto Catena

Subjects
Elderly, Geriatric patient, Trauma management, Imaging, Laboratory test, Trauma score, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

Published
2024
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2. Acute cholecystitis: how to avoid subtotal cholecystectomy—preliminary results

Author

Adriana Toro, Martina Rapisarda, Davide Maugeri, Alessandro Terrasi, Luisa Gallo, Luca Ansaloni, Fausto Catena, and Isidoro Di Carlo

Subjects
Acute cholecystitis, Cholecystectomy, Cystic duct, Gallbladder stones, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The aim of this manuscript is to illustrate a new method permitting safe cholecystectomy in terms of complications with respect to the common bile duct (CBD). Methods The core of this new technique is identification of the continuity of the cystic duct with the infundibulum. The cystic duct can be identified between the inner gallbladder wall and inflamed outer wall. Results In the last 2 years, from January 2019 until December 2021, 3 patients have been treated with the reported technique without complications. Conclusions Among the various cholecystectomy procedures, this is a new approach that ensures the safety of the structures of Calot’s triangle while providing the advantages gained from total removal of the gallbladder.

Published
2024
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3. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma

Author

Giacomo Sermonesi, Brian W. C. A. Tian, Carlo Vallicelli, Fikri M. Abu‑Zidan, Dimitris Damaskos, Michael Denis Kelly, Ari Leppäniemi, Joseph M. Galante, Edward Tan, Andrew W. Kirkpatrick, Vladimir Khokha, Oreste Marco Romeo, Mircea Chirica, Manos Pikoulis, Andrey Litvin, Vishal Girishchandra Shelat, Boris Sakakushev, Imtiaz Wani, Ibrahima Sall, Paola Fugazzola, Enrico Cicuttin, Adriana Toro, Francesco Amico, Francesca Dal Mas, Belinda De Simone, Michael Sugrue, Luigi Bonavina, Giampiero Campanelli, Paolo Carcoforo, Lorenzo Cobianchi, Federico Coccolini, Massimo Chiarugi, Isidoro Di Carlo, Salomone Di Saverio, Mauro Podda, Michele Pisano, Massimo Sartelli, Mario Testini, Andreas Fette, Sandro Rizoli, Edoardo Picetti, Dieter Weber, Rifat Latifi, Yoram Kluger, Zsolt Janos Balogh, Walter Biffl, Hans Jeekel, Ian Civil, Andreas Hecker, Luca Ansaloni, Francesca Bravi, Vanni Agnoletti, Solomon Gurmu Beka, Ernest Eugene Moore, and Fausto Catena

Subjects
Laparoscopy, Laparoscopic approach, Minimally invasive surgery/approach, Emergency general surgery, Acute care surgery, Trauma surgery hemodynamic stability, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. Methods This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. Results A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. Conclusions The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

Published
2023
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4. ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Frassini, Simone, Cobianchi, Lorenzo, Fugazzola, Paola, Biffl, Walter L., Coccolini, Federico, Damaskos, Dimitrios, Moore, Ernest E., Kluger, Yoram, Ceresoli, Marco, Coimbra, Raul, Davies, Justin, Kirkpatrick, Andrew, Di Carlo, Isidoro, Hardcastle, Timothy C., Isik, Arda, Chiarugi, Massimo, Gurusamy, Kurinchi, Maier, Ronald V., Segovia Lohse, Helmut A., Jeekel, Hans, Boermeester, Marja A., Abu-Zidan, Fikri, Inaba, Kenji, Weber, Dieter G., Augustin, Goran, Bonavina, Luigi, Velmahos, George, Sartelli, Massimo, Di Saverio, Salomone, Ten Broek, Richard P. G., Granieri, Stefano, Dal Mas, Francesca, Farè, Camilla Nikita, Peverada, Jacopo, Zanghì, Simone, Viganò, Jacopo, Tomasoni, Matteo, Dominioni, Tommaso, Cicuttin, Enrico, Hecker, Andreas, Tebala, Giovanni D., Galante, Joseph M., Wani, Imtiaz, Khokha, Vladimir, Sugrue, Michael, Scalea, Thomas M., Tan, Edward, Malangoni, Mark A., Pararas, Nikolaos, Podda, Mauro, De Simone, Belinda, Ivatury, Rao, Cui, Yunfeng, Kashuk, Jeffry, Peitzman, Andrew, Kim, Fernando, Pikoulis, Emmanouil, Sganga, Gabriele, Chiara, Osvaldo, Kelly, Michael D., Marzi, Ingo, Picetti, Edoardo, Agnoletti, Vanni, De’Angelis, Nicola, Campanelli, Giampiero, de Moya, Marc, Litvin, Andrey, Martínez-Pérez, Aleix, Sall, Ibrahima, Rizoli, Sandro, Tomadze, Gia, Sakakushev, Boris, Stahel, Philip F., Civil, Ian, Shelat, Vishal, Costa, David, Chichom-Mefire, Alain, Latifi, Rifat, Chirica, Mircea, Amico, Francesco, Pardhan, Amyn, Seenarain, Vidya, Boyapati, Nikitha, Hatz, Basil, Ackermann, Travis, Abeyasundara, Sandun, Fenton, Linda, Plani, Frank, Sarvepalli, Rohit, Rouhbakhshfar, Omid, Caleo, Pamela, Ho-Ching Yau, Victor, Clement, Kristenne, Christou, Erasmia, Castillo, Ana María González, Gosal, Preet K. S., Balasubramaniam, Sunder, Hsu, Jeremy, Banphawatanarak, Kamon, Pisano, Michele, Adriana, Toro, Michele, Altomare, Cioffi, Stefano P. B., Spota, Andrea, Catena, Fausto, and Ansaloni, Luca

Published
2023
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5. Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Simone Frassini, Lorenzo Cobianchi, Paola Fugazzola, Walter L. Biffl, Federico Coccolini, Dimitrios Damaskos, Ernest E. Moore, Yoram Kluger, Marco Ceresoli, Raul Coimbra, Justin Davies, Andrew Kirkpatrick, Isidoro Di Carlo, Timothy C. Hardcastle, Arda Isik, Massimo Chiarugi, Kurinchi Gurusamy, Ronald V. Maier, Helmut A. Segovia Lohse, Hans Jeekel, Marja A. Boermeester, Fikri Abu-Zidan, Kenji Inaba, Dieter G. Weber, Goran Augustin, Luigi Bonavina, George Velmahos, Massimo Sartelli, Salomone Di Saverio, Richard P. G. Ten Broek, Stefano Granieri, Francesca Dal Mas, Camilla Nikita Farè, Jacopo Peverada, Simone Zanghì, Jacopo Viganò, Matteo Tomasoni, Tommaso Dominioni, Enrico Cicuttin, Andreas Hecker, Giovanni D. Tebala, Joseph M. Galante, Imtiaz Wani, Vladimir Khokha, Michael Sugrue, Thomas M. Scalea, Edward Tan, Mark A. Malangoni, Nikolaos Pararas, Mauro Podda, Belinda De Simone, Rao Ivatury, Yunfeng Cui, Jeffry Kashuk, Andrew Peitzman, Fernando Kim, Emmanouil Pikoulis, Gabriele Sganga, Osvaldo Chiara, Michael D. Kelly, Ingo Marzi, Edoardo Picetti, Vanni Agnoletti, Nicola De’Angelis, Giampiero Campanelli, Marc de Moya, Andrey Litvin, Aleix Martínez-Pérez, Ibrahima Sall, Sandro Rizoli, Gia Tomadze, Boris Sakakushev, Philip F. Stahel, Ian Civil, Vishal Shelat, David Costa, Alain Chichom-Mefire, Rifat Latifi, Mircea Chirica, Francesco Amico, Amyn Pardhan, Vidya Seenarain, Nikitha Boyapati, Basil Hatz, Travis Ackermann, Sandun Abeyasundara, Linda Fenton, Frank Plani, Rohit Sarvepalli, Omid Rouhbakhshfar, Pamela Caleo, Victor Ho-Ching Yau, Kristenne Clement, Erasmia Christou, Ana María González Castillo, Preet K. S. Gosal, Sunder Balasubramaniam, Jeremy Hsu, Kamon Banphawatanarak, Michele Pisano, Adriana Toro, Altomare Michele, Stefano P. B. Cioffi, Andrea Spota, Fausto Catena, and Luca Ansaloni

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published
2023
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6. It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Author

Massimo Sartelli, Francesco M. Labricciosa, Federico Coccolini, Raul Coimbra, Fikri M. Abu-Zidan, Luca Ansaloni, Majdi N. Al-Hasan, Shamshul Ansari, Philip S. Barie, Miguel Angel Caínzos, Marco Ceresoli, Massimo Chiarugi, Jeffrey A. Claridge, Enrico Cicuttin, Evan Patchen Dellinger, Donald E. Fry, Xavier Guirao, Timothy Craig Hardcastle, Andreas Hecker, Ari K. Leppäniemi, Andrey Litvin, Sanjay Marwah, Emilio Maseda, John E. Mazuski, Ziad Ahmed Memish, Andrew W. Kirkpatrick, Leonardo Pagani, Mauro Podda, Huseyin Kemal Rasa, Boris E. Sakakushev, Robert G. Sawyer, Fabio Tumietto, Yonghong Xiao, Wedad Faraj Aboubreeg, Harissou Adamou, Lali Akhmeteli, Emrah Akin, Maria Grazia Alberio, Felipe Alconchel, Ibrahim Amadou Magagi, Ana Belén Araúz, Giulio Argenio, Boyko C. Atanasov, Semra Demirli Atici, Selmy Sabry Awad, Efstratia Baili, Lovenish Bains, Miklosh Bala, Oussama Baraket, Suman Baral, Vladislav A. Belskii, Moussa Benboubker, Offir Ben-Ishay, Pierpaolo Bordoni, Abdalia Boumédiène, Giuseppe Brisinda, Laura Cavazzuti, Sujith J. Chandy, Maria Michela Chiarello, Nicola Cillara, Guglielmo Clarizia, Maria-Elena Cocuz, Iuliu Gabriel Cocuz, Luigi Conti, Raffaella Coppola, Yunfeng Cui, Jacek Czepiel, Fabrizio D’Acapito, Dimitrios Damaskos, Koray Das, Belinda De Simone, Samir Delibegovic, Zaza Demetrashvili, Dzemail S. Detanac, Sameer Dhingra, Stefano Di Bella, Evgeni N. Dimitrov, Agron Dogjani, Mario D’Oria, Irina Magdalena Dumitru, Mutasim M. Elmangory, Octavian Enciu, Massimo Fantoni, Daniela Filipescu, Francesco Fleres, Domitilla Foghetti, Pietro Fransvea, Mahir Gachabayov, Rita Galeiras, Gianni Gattuso, Wagih M. Ghannam, Valeria Ghisetti, Giorgio Giraudo, Kebebe Bekele Gonfa, Emre Gonullu, Yousif Tag Elsir Y. Hamad, Matthias Hecker, Arda Isik, Nizar Ismail, Azzain Ismail, Sumita Agarwal Jain, Souha S. Kanj, Garima Kapoor, Ilias Karaiskos, Alfie J. Kavalakat, Jakub Kenig, Faryal Khamis, Vladimir Khokha, Ronald Kiguba, Jae Il Kim, Yoshiro Kobe, Kenneth Yuh Yen Kok, Bojan M. Kovacevic, Igor Andreevich Kryvoruchko, Akira Kuriyama, Aitor Landaluce-Olavarria, Konstantinos Lasithiotakis, Varut Lohsiriwat, Eftychios Lostoridis, Davide Luppi, Gustavo Miguel Machain Vega, Marc Maegele, Athanasios Marinis, Gennaro Martines, Aleix Martínez-Pérez, Damien Massalou, Cristian Mesina, Gökhan Metan, María Guadalupe Miranda-Novales, Shyam Kumar Mishra, Mohaned Ibrahim Hussein Mohamed, Ali Yasen Y. Mohamedahmed, Ismael Mora-Guzmán, Francesk Mulita, Ana-Maria Musina, Pradeep H. Navsaria, Ionut Negoi, Gabriela Elisa Nita, Donal B. O’Connor, Carlos Alberto Ordoñez, Desiré Pantalone, Arpád Panyko, Aristeidis Papadopoulos, Nikolaos Pararas, Francesco Pata, Tapan Patel, Gianluca Pellino, Teresa Perra, Gennaro Perrone, Antonio Pesce, Tadeja Pintar, Georgi Ivanov Popivanov, Alberto Porcu, Martha Alexa Quiodettis, Razrim Rahim, Ashrarur Rahman Mitul, Martin Reichert, Miran Rems, Glendee Yolande Reynolds Campbell, Nuno Rocha-Pereira, Gabriel Rodrigues, Gustavo Eduardo Roncancio Villamil, Stefano Rossi, Ibrahima Sall, Hossein Samadi Kafil, Diego Sasia, Jeremiah Seni, Charalampos Seretis, Mario Serradilla-Martín, Vishal G. Shelat, Boonying Siribumrungwong, Mihail Slavchev, Leonardo Solaini, Boun Kim Tan, Antonio Tarasconi, Dario Tartaglia, Elena Adelina Toma, Gia Tomadze, Adriana Toro, Marcos Roberto Tovani-Palone, Harry van Goor, Alin Vasilescu, Andras Vereczkei, Massimiliano Veroux, Sergio Alberto Weckmann, Lukas Werner Widmer, AliIbrahim Yahya, Sanoop K. Zachariah, Andee Dzulkarnaen Zakaria, Nadezhda Zubareva, Wietse P. Zuidema, Isidoro Di Carlo, Francesco Cortese, Gian Luca Baiocchi, Ronald V. Maier, and Fausto Catena

Subjects
Cross-sectional survey, Antimicrobial stewardship, Antibiotic prescribing, Antibiotic resistance, Infection prevention and control, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.

Published
2022
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7. Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Author

Adriana Toro, Michele Teodoro, Mansoor Khan, Elena Schembari, Salomone Di Saverio, Fausto Catena, and Isidoro Di Carlo

Subjects
Gallbladder, Difficulty cholecystectomy, Laparoscopic subtotal cholecystectomy, Complications, Clavien–Dindo classification, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. Patients and methods A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Results Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. Conclusion In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

Published
2021
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8. Single segment of spleen autotransplantation, after splenectomy for trauma, can restore splenic functions

Author

Adriana Toro, Nunziatina Laura Parrinello, Elena Schembari, Maurizio Mannino, Giuseppe Corsale, Anna Triolo, Filippo Palermo, Alessandra Romano, Francesco Di Raimondo, and Isidoro Di Carlo

Subjects
Spleen, Abdominal trauma, Splenic function, Splenic autotransplantation, Splenectomy, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Splenectomy is sometimes necessary after abdominal trauma, but splenectomized patients are at risk of sepsis due to impaired immunological functions. To overcome this risk, autotransplantation of the spleen by using a new technique has been proposed, but so far, a demonstration of functionality of the transplanted tissue is lacking. Methods We therefore evaluated 5 patients who underwent a splenic autotransplant in comparison with 5 splenectomized patients without splenic autotransplant and 7 normal subjects. Results We confirmed that the patients not undergoing autotransplantation, when compared to normal subjects, had a higher platelet count, higher percentage of micronucleated reticulocytes (p = 0.002), increased levels of naive B lymphocytes (p = 0.01), a defect of class-switched memory (p = 0.001) and class-unswitched memory B cells (p = 0.002), and increased levels of PD1 on T lymphocytes CD8+ (p = 0.08). In contrast, no significant differences for any of the abovementioned parameters were recorded between patients who underwent spleen autotransplantation and normal subjects. Conclusion These findings suggest that splenic autotransplantation is able to restore an adequate hemocatheretic activity as well as recover the immunological deficit after splenectomy.

Published
2020
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9. Small bowel lymphoma presenting as inguinal hernia: case report and literature review

Author

Michele Teodoro, Maurizio Mannino, Marco Vitale, Edoardo Mattone, Valentina Palumbo, Filippo Fraggetta, Adriana Toro, and Isidoro Di Carlo

Subjects
Bowel, Lymphoma, Inguinal, Hernia, Surgery, RD1-811, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Inguinal hernia is one of the most common benign pathologies that primarily affects men. Primary gastrointestinal non-Hodgkin’s lymphoma (PGI NHL) is the most common type of extranodal lymphoma. This study reports a rare case in which these two conditions co-exist. Case presentation An 85-year-old male complained of bowel movement pattern change, abdominal distension and loss of weight, without vomiting but with nausea. A computed tomographic scan of the abdomen showed a small bowel obstruction caused by a migration of a small bowel loop in the right inguinal canal, with a clinically non-reducible inguinal hernia. The patient underwent surgery. The histopathological report showed small bowel large B cell non-Hodgkin’s lymphoma. Conclusion When the diagnosis of the contents of an inguinal hernia is not well-established, surgery should be performed as soon as possible to ensure the cure of the disease and the correct diagnosis of the contents.

Published
2018
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10. Role of intraoperative cholangiography for detecting residual stones after biliary pancreatitis: still useful? A retrospective study

Author

Abdelrahman Abdelaal, Moamena El-Matbouly, Ibnouf Sulieman, Ahmad Elfaki, Tamer El-Bakary, Sherif Abdelaziem, Salahdin Gehani, Adriana Toro, and Isidoro Di Carlo

Subjects
Acute biliary pancreatitis, Intraoperative cholangiography, Common bile duct, Laparoscopic cholecystectomy, Intraoperative common bile duct exploration, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Intraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure. Methods Demographic and clinical factors were assessed in patients with mild ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, χ 2 or Fisher’s exact tests to compare proportions and the nonparametric Mann–Whitney U test for analysis of values with abnormal distribution were used. Results The study included 113 patients, 82 males (72.6%) and 31 females (27.4%), of mean age 46.9 ± 14.7 years (range 18–86 years). All preoperative laboratory indicators were elevated. The group of the patients with stones in the CBD diagnosed by IOC was divided in patients with diameters 0.001). Conclusions IOC is useful to diagnose residual CBD stones, without increasing complications related to the procedure itself.

Published
2017
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11. Phantosmia May Predict Long‐Term Measurable Olfactory Dysfunction After <scp>COVID</scp> ‐19

Author

Jai‐Sen Leung, Valentina Paz Cordano, Eduardo Fuentes‐López, Antonia Elisa Lagos, Francisco Gustavo García‐Huidobro, Rodrigo Aliaga, Luis Antonio Díaz, Tamara García‐Salum, Erick Salinas, Adriana Toro, Claudio Andrés Callejas, Arnoldo Riquelme, James N. Palmer, Rafael A. Medina, and Claudia González G

Subjects
Adult, Male, Smell, Olfaction Disorders, Otorhinolaryngology, SARS-CoV-2, Anosmia, Humans, COVID-19, Female, Prospective Studies, Middle Aged
Abstract

Persistent olfactory dysfunction (OD) after 6 months caused by SARS-CoV-2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of long-term OD and identify predisposing factors.A prospective cohort study was conducted on 100 adults with COVID-19. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and a symptom survey at the onset of disease and 30 days later. Patients with persistent quantitative OD at the second assessment were reevaluated after 1 year. Demographic variables, symptoms, and the degree of smell loss were analyzed.Participants included 100 patients. The mean age was 42.2 ± 15.6 years, 55 (55%) were female, and 56 (56%) were outpatients. Baseline smell loss was identified in 75/100 (75%) patients, decreasing to 39/95 (40%) after 1 month, and persisting in 29 patients after 1 year. Phantosmia at baseline was the only risk factor identified for persistent OD after 1 year (relative risk 2.51; 95% confidence interval 1.53-4.12; p 0.001). Regardless of the outcome in smell function, a significant decline in olfaction was associated with the presence of phantosmia at 1 month (β = -12.39; 95% CI -19.82 to -4.95; p 0.01).SARS-CoV-2 (2019-2020 variants) produced a highly frequent OD that persisted in 29% of the patients after 1 year. The presence of phantosmia at baseline and 1 month was associated with a worse evolution, but phantosmia may interfere with the performance in an identification smell test. A longer follow-up is required in these patients.2 Laryngoscope, 132:2445-2452, 2022.

Published
2022
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13. ECLAPTE:Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Frassini, Simone, Cobianchi, Lorenzo, Fugazzola, Paola, Biffl, Walter L., Coccolini, Federico, Damaskos, Dimitrios, Moore, Ernest E., Kluger, Yoram, Ceresoli, Marco, Coimbra, Raul, Davies, Justin, Kirkpatrick, Andrew, Di Carlo, Isidoro, Hardcastle, Timothy C., Isik, Arda, Chiarugi, Massimo, Gurusamy, Kurinchi, Maier, Ronald V., Segovia Lohse, Helmut A., Jeekel, Hans, Boermeester, Marja A., Abu-Zidan, Fikri, Inaba, Kenji, Weber, Dieter G., Augustin, Goran, Bonavina, Luigi, Velmahos, George, Sartelli, Massimo, Di Saverio, Salomone, Ten Broek, Richard P.G., Granieri, Stefano, Dal Mas, Francesca, Farè, Camilla Nikita, Peverada, Jacopo, Zanghì, Simone, Viganò, Jacopo, Tomasoni, Matteo, Dominioni, Tommaso, Cicuttin, Enrico, Hecker, Andreas, Tebala, Giovanni D., Galante, Joseph M., Wani, Imtiaz, Khokha, Vladimir, Sugrue, Michael, Scalea, Thomas M., Tan, Edward, Malangoni, Mark A., Pararas, Nikolaos, Podda, Mauro, De Simone, Belinda, Ivatury, Rao, Cui, Yunfeng, Kashuk, Jeffry, Peitzman, Andrew, Kim, Fernando, Pikoulis, Emmanouil, Sganga, Gabriele, Chiara, Osvaldo, Kelly, Michael D., Marzi, Ingo, Picetti, Edoardo, Agnoletti, Vanni, De'Angelis, Nicola, Campanelli, Giampiero, de Moya, Marc, Litvin, Andrey, Martínez-Pérez, Aleix, Sall, Ibrahima, Rizoli, Sandro, Tomadze, Gia, Sakakushev, Boris, Stahel, Philip F., Civil, Ian, Shelat, Vishal, Costa, David, Chichom-Mefire, Alain, Latifi, Rifat, Chirica, Mircea, Amico, Francesco, Pardhan, Amyn, Seenarain, Vidya, Boyapati, Nikitha, Hatz, Basil, Ackermann, Travis, Abeyasundara, Sandun, Fenton, Linda, Plani, Frank, Sarvepalli, Rohit, Rouhbakhshfar, Omid, Caleo, Pamela, Ho-Ching Yau, Victor, Clement, Kristenne, Christou, Erasmia, Castillo, Ana María González, Gosal, Preet K.S., Balasubramaniam, Sunder, Hsu, Jeremy, Banphawatanarak, Kamon, Pisano, Michele, Adriana, Toro, Michele, Altomare, Cioffi, Stefano P.B., Spota, Andrea, Catena, Fausto, Ansaloni, Luca, Frassini, Simone, Cobianchi, Lorenzo, Fugazzola, Paola, Biffl, Walter L., Coccolini, Federico, Damaskos, Dimitrios, Moore, Ernest E., Kluger, Yoram, Ceresoli, Marco, Coimbra, Raul, Davies, Justin, Kirkpatrick, Andrew, Di Carlo, Isidoro, Hardcastle, Timothy C., Isik, Arda, Chiarugi, Massimo, Gurusamy, Kurinchi, Maier, Ronald V., Segovia Lohse, Helmut A., Jeekel, Hans, Boermeester, Marja A., Abu-Zidan, Fikri, Inaba, Kenji, Weber, Dieter G., Augustin, Goran, Bonavina, Luigi, Velmahos, George, Sartelli, Massimo, Di Saverio, Salomone, Ten Broek, Richard P.G., Granieri, Stefano, Dal Mas, Francesca, Farè, Camilla Nikita, Peverada, Jacopo, Zanghì, Simone, Viganò, Jacopo, Tomasoni, Matteo, Dominioni, Tommaso, Cicuttin, Enrico, Hecker, Andreas, Tebala, Giovanni D., Galante, Joseph M., Wani, Imtiaz, Khokha, Vladimir, Sugrue, Michael, Scalea, Thomas M., Tan, Edward, Malangoni, Mark A., Pararas, Nikolaos, Podda, Mauro, De Simone, Belinda, Ivatury, Rao, Cui, Yunfeng, Kashuk, Jeffry, Peitzman, Andrew, Kim, Fernando, Pikoulis, Emmanouil, Sganga, Gabriele, Chiara, Osvaldo, Kelly, Michael D., Marzi, Ingo, Picetti, Edoardo, Agnoletti, Vanni, De'Angelis, Nicola, Campanelli, Giampiero, de Moya, Marc, Litvin, Andrey, Martínez-Pérez, Aleix, Sall, Ibrahima, Rizoli, Sandro, Tomadze, Gia, Sakakushev, Boris, Stahel, Philip F., Civil, Ian, Shelat, Vishal, Costa, David, Chichom-Mefire, Alain, Latifi, Rifat, Chirica, Mircea, Amico, Francesco, Pardhan, Amyn, Seenarain, Vidya, Boyapati, Nikitha, Hatz, Basil, Ackermann, Travis, Abeyasundara, Sandun, Fenton, Linda, Plani, Frank, Sarvepalli, Rohit, Rouhbakhshfar, Omid, Caleo, Pamela, Ho-Ching Yau, Victor, Clement, Kristenne, Christou, Erasmia, Castillo, Ana María González, Gosal, Preet K.S., Balasubramaniam, Sunder, Hsu, Jeremy, Banphawatanarak, Kamon, Pisano, Michele, Adriana, Toro, Michele, Altomare, Cioffi, Stefano P.B., Spota, Andrea, Catena, Fausto, and Ansaloni, Luca

Abstract

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Published
2023

15. Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Author

Cobianchi, Lorenzo, Piccolo, Daniele, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Balch, Jeremy, Biffl, Walter, Butturini, Giovanni, Catena, Fausto, Coccolini, Federico, Denicolai, Stefano, De Simone, Belinda, Frigerio, Isabella, Fugazzola, Paola, Marseglia, Gianluigi, Marseglia, Giuseppe Roberto, Martellucci, Jacopo, Modenese, Mirko, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Kaafarani, Haytham M, Loftus, Tyler J, Kenneth Lyle Abbott, Abubaker Abdelmalik, Nebyou Seyoum Abebe, Fikri Abu-Zidan, Yousif Abdallah Yousif Adam, Harissou Adamou, Dmitry Mikhailovich Adamovich, Ferdinando Agresta, Antonino Agrusa, Emrah Akin, Mario Alessiani, Henrique Alexandrino, Syed Muhammad Ali, Vasilescu Alin Mihai, Pedro Miguel Almeida, Mohammed Mohammed Al-Shehari, Michele Altomare, Francesco Amico, Michele Ammendola, Jacopo Andreuccetti, Elissavet Anestiadou, Peter Angelos, Alfredo Annicchiarico, Amedeo Antonelli, Daniel Aparicio-Sanchez, Antonella Ardito, Giulio Argenio, Catherine Claude Arvieux, Ingolf Harald Askevold, Boyko Tchavdarov Atanasov, Goran Augustin, Selmy Sabry Awad, Giulia Bacchiocchi, Carlo Bagnoli, Hany Bahouth, Efstratia Baili, Lovenish Bains, Gian Luca Baiocchi, Miklosh Bala, Carmen Balagué, Dimitrios Balalis, Edoardo Baldini, Oussama Baraket, Suman Baral, Mirko Barone, Alberto Gonzãlez Barranquero, Jorge Arturo Barreras, Gary Alan Bass, Zulfu Bayhan, Giovanni Bellanova, Offir Ben-Ishay, Fabrizio Bert, Valentina Bianchi, Helena Biancuzzi, Chiara Bidoli, Raluca Bievel Radulescu, Mark Brian Bignell, Alan Biloslavo, Daniele Bissacco, Roberto Bini, Paolo Boati, Guillaume Boddaert, Branko Bogdanic, Cristina Bombardini, Luigi Bonavina, Luca Bonomo, Andrea Bottari, Konstantinos Bouliaris, Gioia Brachini, Antonio Brillantino, Giuseppe Brisinda, Maloni Mamada Bulanauca, Luis Antonio Buonomo, Jakob Burcharth, Salvatore Buscemi, Francesca Calabretto, Giacomo Calini, Valentin Calu, Fabio Cesare Campanile, Riccardo Campo Dall Orto, Andrea Campos-Serra, Stefano Campostrini, Recayi Capoglu, Joao Miguel Carvas, Marco Cascella, Gianmaria Casoni Pattacini, Valerio Celentano, Danilo Corrado Centonze, Marco Ceresoli, Dimitrios Chatzipetris, Antonella Chessa, Maria Michela Chiarello, Mircea Chirica, Serge Chooklin, Christos Chouliaras, Sharfuddin Chowdhury, Pasquale Cianci, Nicola Cillara, Stefania Cimbanassi, Stefano Piero Bernardo Cioffi, Elif Colak, Enrique Colás Ruiz, Luigi Conti, Alessandro Coppola, Tiago Correia De Sa, Silvia Dantas Costa, Valerio Cozza, Giuseppe Curro', Kirsten Felicia Ann-Sophie Aimee Dabekaussen, Fabrizio D'Acapito, Dimitrios Damaskos, Giancarlo D'Ambrosio, Koray Das, Richard Justin Davies, Andrew Charles De Beaux, Sara Patricia De Lebrusant Fernandez, Alessandro De Luca, Francesca De Stefano, Luca Degrate, Zaza Demetrashvili, Andreas Kyriacou Demetriades, Dzemail Smail Detanac, Agnese Dezi, Giuseppe Di Buono, Isidoro Di Carlo, Pierpaolo Di Lascio, Marcello Di Martino, Salomone Di Saverio, Bogdan 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Giove, Giorgio Giraudo, Mario Giuffrida, Michela Giulii Capponi, Emanuel Gois Jr, Carlos Augusto Gomes, Felipe Couto Gomes, Ricardo Alessandro Teixeira Gonsaga, Emre Gonullu, Jacques Goosen, Tatjana Goranovic, Raquel Gracia-Roman, Giorgio Maria Paolo Graziano, Ewen Alexander Griffiths, Tommaso Guagni, Dimitar Bozhidarov Hadzhiev, Muad Gamil Haidar, Hytham K S Hamid, Timothy Craig Hardcastle, Firdaus Hayati, Andrew James Healey, Andreas Hecker, Matthias Hecker, Edgar Fernando Hernandez Garcia, Adrien Montcho Hodonou, Eduardo Cancio Huaman, Martin Huerta, Aini Fahriza Ibrahim, Basil Mohamed Salabeldin Ibrahim, Giuseppe Ietto, Marco Inama, Orestis Ioannidis, Arda Isik, Nizar Ismail, Azzain Mahadi Hamid Ismail, Ruhi Fadzlyana Jailani, Ji Young Jang, Christos Kalfountzos, Sujala Niatarika Rajsain Kalipershad, Emmanouil Kaouras, Lewis Jay Kaplan, Yasin Kara, Evika Karamagioli, Aleksandar Karamarkovia, Ioannis Katsaros, Alfie J Kavalakat, Aristotelis Kechagias, Jakub Kenig, Boris Juli Kessel, 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Lewi, Kara, Yasin, Karamagioli, Evika, Karamarkovia, Aleksandar, Katsaros, Ioanni, J Kavalakat, Alfie, Kechagias, Aristoteli, Kenig, Jakub, Juli Kessel, Bori, S Khan, Jim, Khokha, Vladimir, Il Kim, Jae, Wallace Kirkpatrick, Andrew, Klappenbach, Roberto, Kluger, Yoram, Kobe, Yoshiro, Kofopoulos Lymperis, Efstratio, Yuh Yen Kok, Kenneth, Kong, Victor, P Korkolis, Dimitri, Koukoulis, Georgio, Kovacevic, Bojan, Favali Kruger, Vitor, A Kryvoruchko, Igor, Kurihara, Hayato, Kuriyama, Akira, Landaluce-Olavarria, Aitor, Lapolla, Pierfrancesco, Leppäniemi, Ari, Licari, Leo, Lisi, Giorgio, Litvin, Andrey, Lizarazu, Aintzane, Llaquet Bayo, Heura, Lohsiriwat, Varut, Cristina Lopes Moreira, Claudia, Lostoridis, Eftychio, Tovar Luna, Agustãn, Luppi, Davide, V, Gustavo Miguel Machain, Maegele, Marc, Maggiore, Daniele, Magnone, Stefano, V Maier, Ronald, Major, Piotr, Manangi, Mallikarjuna, Manetti, Andrea, Mantoglu, Bari, Marafante, Chiara, Mariani, Federico, Marinis, Athanasio, Antonio Sbalcheiro Mariot, Evandro, Martines, Gennaro, Martinez Perez, Aleix, Martino, Costanza, Mascagni, Pietro, Massalou, Damien, Massaro, Maurizio, Matías-García, Belen, Mazzarella, Gennaro, Mazzarolo, Giorgio, Bessa Melo, Renato, Mendoza-Moreno, Fernando, Meric, Serhat, Meyer, Jeremy, Miceli, Luca, V Michalopoulos, Nikolao, Milana, Flavio, Mingoli, Andrea, S Mishra, Tushar, Mohamed, Muyed, Isam Eldin Abbas Mohamed, Musab, Yasen Mohamedahmed, Ali, Jibreel Suliman Mohammed, Mohammed, Mohan, Rajashekar, E Moore, Ernest, Morales-Garcia, Dieter, Ns Muhrbeck, Mã, Mulita, Francesk, Mohamed Siddig Mustafa, Sami, Maria Muttillo, Edoardo, David Naimzada, Mukhammad, H Navsaria, Pradeep, Negoi, Ionut, Nespoli, Luca, Nguyen, Christine, Kibret Nidaw, Melkamu, Nigri, Giuseppe, Nikolopoulos, Ioanni, Brendan O'Connor, Donal, Damilola Ogundipe, Habeeb, Oliveri, Cristina, Olmi, Stefano, Cun Wang Ong, Ernest, Orecchia, Luca, V Osipov, Aleksei, Faeid Othman, Muhammad, Pace, Marco, Pacilli, Mario, Pagani, Leonardo, Palomba, Giuseppe, Pantalone, Desire', Panyko, Arpad, Paolillo, Ciro, Virgilio Papa, Mario, Papaconstantinou, Dimitrio, Papadoliopoulou, Maria, Papadopoulos, Aristeidi, Papis, Davide, Pararas, Nikolao, Gustavo Parreira, Jose, Geordie Parry, Neil, Pata, Francesco, Patel, Tapan, Paterson-Brown, Simon, Pavone, Giovanna, Pecchini, Francesca, Pegoraro, Veronica, Pellino, Gianluca, Pelloni, Maria, Peloso, Andrea, Perea Del Pozo, Eduardo, Goncalves Pereira, Rita, Monteiro Pereira, Bruno, Lizarazu Perez, Aintzane, Pérez, Silvia, Perra, Teresa, Perrone, Gennaro, Pesce, Antonio, Petagna, Lorenzo, Petracca, Giovanni, Phupong, Vorapong, Picardi, Biagio, Picciariello, Arcangelo, Piccoli, Micaela, Picetti, Edoardo, Pikoulis Pikoulis, Emmanouil, Pintar, Tadeja, Pirozzolo, Giovanni, Piscioneri, Francesco, Podda, Mauro, Porcu, Alberto, Privitera, Francesca, Punzo, Clelia, Quaresima, Silvia, Alexa Quiodettis, Martha, Qvist, Niel, Rahim, Razrim, Ramalho de Almeida, Filipe, Bin Ramely, Rosnelifaizur, Kemal Rasa, Huseyin, Reichert, Martin, Reinisch-Liese, Alexander, Renne, Angela, Riccetti, Camilla, Rita Rodriguez-Luna, Maria, Roizblatt, Daniel, Romanzi, Andrea, Romeo, Luigi, Pietro Maria Roscio, Francesco, Bin Rosnelifaizur, Ramely, Rossi, Stefano, M Rubiano, Andre, Ruiz-Ucar, Elena, Evgeniev Sakakushev, Bori, Carlos Salamea, Juan, Sall, Ibrahima, Bhagya Samarakoon, Lasitha, Sammartano, Fabrizio, Sanchez Arteaga, Alejandro, Sanchez-Cordero, Sergi, Pietro Maria Santoanastaso, Domenico, Sartelli, Massimo, Sasia, Diego, Sato, Norio, Savchuk, Artem, Grant Sawyer, Robert, Scaioli, Giacomo, Schizas, Dimitrio, Sebastiani, Simone, Seeliger, Barbara, Alfredo Segovia Lohse, Helmut, Seretis, Charalampo, Sermonesi, Giacomo, Serradilla-Martin, Mario, G Shelat, Vishal, Shlyapnikov, Sergei, Sidiropoulos, Theodoro, Lages Simoes, Romeo, Siragusa, Leandro, Siribumrungwong, Boonying, Slavchev, Mihail, Solaini, Leonardo, Soldini, Gabriele, Sopuev, Andrey, Soreide, Kjetil, Sovatzidis, Apostolo, Frank Stahel, Philip, Strickland, Matt, Arif Hameed Sultan, Mohamed, Sydorchuk, Ruslan, Sydorchuk, Larysa, Muhammad Ali Muhammad Syed, Syed, Tallon-Aguilar, Lui, Marco Tamburini, Andrea, Tamini, Nicolò, H Tan, Edward C T, Huei Tan, Jih, Tarasconi, Antonio, Tartaglia, Nicola, Tartaglia, Giuseppe, Tartaglia, Dario, Vincent Taylor, John, Domenico Tebala, Giovanni, Teuben, Michel, Theodorou, Alexi, Tolonen, Matti, Tomasicchio, Giovanni, Toro, Adriana, Torre, Beatrice, Triantafyllou, Tania, Trigiante Trigiante, Giuseppe, Tripepi, Marzia, Trostchansky, Julio, Tsekouras, Konstantino, Turrado-Rodriguez, Victor, Tutino, Roberta, Uccelli, Matteo, Angelov Uchikov, Petar, Ugarte-Sierra, Bakarne, Tapani Ukkonen, Mika, Vailas, Michail, G Vassiliu, Panteleimon, Garcia Vazquez, Alain, Galeiras Vazquez, Rita, Velmahos, George, Ezequiel Verde, Juan, Manuel Verde, Juan, Veroux, Massimiliano, Viganò, Jacopo, Vilallonga, Ramon, Visconti, Diego, Vittori, Alessandro, Waledziak, Maciej, Wannatoop, Tongporn, Werner Widmer, Luka, Samuel James Wilson, Michael, Woltz, Sarah, Hway Wong, Ting, Xenaki, Sofia, Yu, Byungchul, Yule, Steven, Koshy Zachariah, Sanoop, Zacharis, Georgio, Zaghi, Claudia, Dzulkarnaen Zakaria, Andee, A Zambrano, Diego, Zampitis, Nikolao, Zampogna, Biagio, Zanghì, Simone, Zantedeschi, Maristella, Zapsalis, Konstantino, Zattoni, Fabio, Zese, Monica, Cobianchi L., Piccolo D., Mas F.D., Agnoletti V., Ansaloni L., Balch J., Biffl W., Butturini G., Catena F., Coccolini F., Denicolai S., De Simone B., Frigerio I., Fugazzola P., Marseglia G., Marseglia G.R., Martellucci J., Modenese M., Previtali P., Ruta F., Venturi A., Kaafarani H.M., Loftus T.J., Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Team Dynamics Study Group, Cobianchi, L, Piccolo, D, Dal Mas, F, Agnoletti, V, Ansaloni, L, Balch, J, Biffl, W, Butturini, G, Catena, F, Coccolini, F, Denicolai, S, De Simone, B, Frigerio, I, Fugazzola, P, Marseglia, G, Martellucci, J, Modenese, M, Previtali, P, Ruta, F, Venturi, A, Kaafarani, H, Loftus, T, Abbott, K, Abdelmalik, A, Abebe, N, Abu-Zidan, F, Adam, Y, Adamou, H, Adamovich, D, Agresta, F, Agrusa, A, Akin, E, Alessiani, M, Alexandrino, H, Ali, S, Mihai, V, Almeida, P, Al-Shehari, M, Altomare, M, Amico, F, Ammendola, M, Andreuccetti, J, Anestiadou, E, Angelos, P, Annicchiarico, A, Antonelli, A, Aparicio-Sanchez, D, Ardito, A, Argenio, G, Arvieux, C, Askevold, I, Atanasov, B, Augustin, G, Awad, S, Bacchiocchi, G, Bagnoli, C, Bahouth, H, Baili, E, Bains, L, Baiocchi, G, Bala, M, Balague, C, Balalis, D, Baldini, E, Baraket, O, Baral, S, Barone, M, Barranquero, A, Barreras, J, Bass, G, Bayhan, Z, Bellanova, G, Ben-Ishay, O, Bert, F, Bianchi, V, Biancuzzi, H, Bidoli, C, Radulescu, R, Bignell, M, Biloslavo, A, Bini, R, Bissacco, D, Boati, P, Boddaert, G, Bogdanic, B, Bombardini, C, Bonavina, L, Bonomo, L, Bottari, A, Bouliaris, K, Brachini, G, Brillantino, A, Brisinda, G, Bulanauca, M, Buonomo, L, Burcharth, J, Buscemi, S, Calabretto, F, Calini, G, Calu, V, Campanile, F, Dall'Orto, R, Campos-Serra, A, Campostrini, S, Capoglu, R, Carvas, J, Cascella, M, Pattacini, G, Celentano, V, Centonze, D, Ceresoli, M, Chatzipetris, D, Chessa, A, Chiarello, M, Chirica, M, Chooklin, S, Chouliaras, C, Chowdhury, S, Cianci, P, Cillara, N, Cimbanassi, S, Cioffi, S, Colak, E, Ruiz, E, Conti, L, Coppola, A, De Sa, T, Costa, S, Cozza, V, Curro', G, Dabekaussen, K, D'Acapito, F, Damaskos, D, D'Ambrosio, G, Das, K, Davies, R, De Beaux, A, Fernandez, S, De Luca, A, De Stefano, F, Degrate, L, Demetrashvili, Z, Demetriades, A, Detanac, D, Dezi, A, Di Buono, G, Di Carlo, I, Di Lascio, P, Di Martino, M, Di Saverio, S, Diaconescu, B, Diaz, J, Dibra, R, Dimitrov, E, Dinuzzi, V, Dios-Barbeito, S, Diyani, J, Dogjani, A, Domanin, M, D'Oria, M, Munoz-Cruzado, V, East, B, Ekelund, M, Ekwen, G, Elbaih, A, Elhadi, M, Enninghorst, N, Ernisova, M, Escalera-Antezana, J, Esposito, S, Esposito, G, Estaire, M, Fare, C, Farre, R, Favi, F, Ferrario, L, Vajana, A, Filisetti, C, Fleres, F, Fonseca, V, Forero-Torres, A, Forfori, F, Fortuna, L, Fradelos, E, Fraga, G, Fransvea, P, Frassini, S, Frazzetta, G, Pizzocaro, E, Frountzas, M, Gachabayov, M, Galeiras, R, Vazquez, A, Gargarella, S, Garzali, I, Ghannam, W, Ghazi, F, Gillman, L, Gioco, R, Giordano, A, Giordano, L, Giove, C, Giraudo, G, Giuffrida, M, Capponi, M, Gois, E, Gomes, C, Gomes, F, Gonsaga, R, Gonullu, E, Goosen, J, Goranovic, T, Gracia-Roman, R, Graziano, G, Griffiths, E, Guagni, T, Hadzhiev, D, Haidar, M, Hamid, H, Hardcastle, T, Hayati, F, Healey, A, Hecker, A, Hecker, M, Garcia, E, Hodonou, A, Huaman, E, Huerta, M, Ibrahim, A, Ibrahim, B, Ietto, G, Inama, M, Ioannidis, O, Isik, A, Ismail, N, Ismail, A, Jailani, R, Jang, J, Kalfountzos, C, Kalipershad, S, Kaouras, E, Kaplan, L, Kara, Y, Karamagioli, E, Karamarkovia, A, Katsaros, I, Kavalakat, A, Kechagias, A, Kenig, J, Kessel, B, Khan, J, Khokha, V, Kim, J, Kirkpatrick, A, Klappenbach, R, Kluger, Y, Kobe, Y, Lymperis, E, Kok, K, Kong, V, Korkolis, D, Koukoulis, G, Kovacevic, B, Kruger, V, Kryvoruchko, I, Kurihara, H, Kuriyama, A, Landaluce-Olavarria, A, Lapolla, P, Leppaniemi, A, Licari, L, Lisi, G, Litvin, A, Lizarazu, A, Bayo, H, Lohsiriwat, V, Moreira, C, Lostoridis, E, Luna, A, Luppi, D, Machain, V, Maegele, M, Maggiore, D, Magnone, S, Maier, R, Major, P, Manangi, M, Manetti, A, Mantoglu, B, Marafante, C, Mariani, F, Marinis, A, Mariot, E, Martines, G, Perez, A, Martino, C, Mascagni, P, Massalou, D, Massaro, M, Matias-Garcia, B, Mazzarella, G, Mazzarolo, G, Melo, R, Mendoza-Moreno, F, Meric, S, Meyer, J, Miceli, L, Michalopoulos, N, Milana, F, Mingoli, A, Mishra, T, Mohamed, M, Mohamedahmed, A, Mohammed, M, Mohan, R, Moore, E, Morales-Garcia, D, Muhrbeck, M, Mulita, F, Mustafa, S, Muttillo, E, Naimzada, M, Navsaria, P, Negoi, I, Nespoli, L, Nguyen, C, Nidaw, M, Nigri, G, Nikolopoulos, I, O'Connor, D, Ogundipe, H, Oliveri, C, Olmi, S, Ong, E, Orecchia, L, Osipov, A, Othman, M, Pace, M, Pacilli, M, Pagani, L, Palomba, G, Pantalone, D, Panyko, A, Paolillo, C, Papa, M, Papaconstantinou, D, Papadoliopoulou, M, Papadopoulos, A, Papis, D, Pararas, N, Parreira, J, Parry, N, Pata, F, Patel, T, Paterson-Brown, S, Pavone, G, Pecchini, F, Pegoraro, V, Pellino, G, Pelloni, M, Peloso, A, Del Pozo, E, Pereira, R, Pereira, B, Perez, S, Perra, T, Perrone, G, Pesce, A, Petagna, L, Petracca, G, Phupong, V, Picardi, B, Picciariello, A, Piccoli, M, Picetti, E, Pikoulis, E, Pintar, T, Pirozzolo, G, Piscioneri, F, Podda, M, Porcu, A, Privitera, F, Punzo, C, Quaresima, S, Quiodettis, M, Qvist, N, Rahim, R, de Almeida, F, Ramely, R, Rasa, H, Reichert, M, Reinisch-Liese, A, Renne, A, Riccetti, C, Rodriguez-Luna, M, Roizblatt, D, Romanzi, A, Romeo, L, Roscio, F, Rosnelifaizur, R, Rossi, S, Rubiano, A, Ruiz-Ucar, E, Sakakushev, B, Salamea, J, Sall, I, Samarakoon, L, Sammartano, F, Arteaga, A, Sanchez-Cordero, S, Santoanastaso, D, Sartelli, M, Sasia, D, Sato, N, Savchuk, A, Sawyer, R, Scaioli, G, Schizas, D, Sebastiani, S, Seeliger, B, Lohse, H, Seretis, C, Sermonesi, G, Serradilla-Martin, M, Shelat, V, Shlyapnikov, S, Sidiropoulos, T, Simoes, R, Siragusa, L, Siribumrungwong, B, Slavchev, M, Solaini, L, Soldini, G, Sopuev, A, Soreide, K, Sovatzidis, A, Stahel, P, Strickland, M, Sultan, M, Sydorchuk, R, Sydorchuk, L, Syed, S, Tallon-Aguilar, L, Tamburini, A, Tamini, N, Tan, E, Tan, J, Tarasconi, A, Tartaglia, N, Tartaglia, G, Tartaglia, D, Taylor, J, Tebala, G, Teuben, M, Theodorou, A, Tolonen, M, Tomasicchio, G, Toro, A, Torre, B, Triantafyllou, T, Trigiante, G, Tripepi, M, Trostchansky, J, Tsekouras, K, Turrado-Rodriguez, V, Tutino, R, Uccelli, M, Uchikov, P, Ugarte-Sierra, B, Ukkonen, M, Vailas, M, Vassiliu, P, Vazquez, R, Velmahos, G, Verde, J, Veroux, M, Vigano, J, Vilallonga, R, Visconti, D, Vittori, A, Waledziak, M, Wannatoop, T, Widmer, L, Wilson, M, Woltz, S, Wong, T, Xenaki, S, Yu, B, Yule, S, Zachariah, S, Zacharis, G, Zaghi, C, Zakaria, A, Zambrano, D, Zampitis, N, Zampogna, B, Zanghi, S, Zantedeschi, M, Zapsalis, K, Zattoni, F, and Zese, M

Subjects
Settore SECS-P/10 - Organizzazione Aziendale, Settore MED/18 - Chirurgia Generale, Artificial intelligence, Settore SECS-P/07 - Economia Aziendale, Decision aid, Emergency Medicine, Decision aids, Surgery, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Trauma and emergency surgery, Clinical decision-making, Survey
Abstract

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

Published
2023
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16. The Coconut Technique: A New Method to Perform Safe Cholecystectomy for Acute Cholecystitis

Author

Adriana TORO, Chiara MAZZONE, Emanuele Gaspare Fontana, Salomone Di Saverio, Luca Ansaloni, Fausto Catena, and Isidoro Di Carlo

Abstract

Introduction Aim of this manuscript is to illustrate a new method permitting total cholecystectomy in terms of safety with respect to the CBD. Methods The core of this new technique is the identification of the continuity of the cystic duct with the infundibulum. The cystic duct is identified between internal gallbladder wall and external inflamed wall. Results In the last 2 years, 3 patients have been treated with the reported technique without complications. Conclusions Among the various cholecystectomy procedures, this is a new approach that ensures the safety of Calot’s triangle structures while providing the advantages gained from total removal of the gallbladder.

Published
2022
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17. What is changing in indications and treatment of hepatic hemangiomas. A review

Author

Adriana Toro, Ahmed-Emad Mahfouz, Annalisa Ardiri, Michele Malaguarnera, Giulia Malaguarnera, Francesco Loria, Gaetano Bertino, and Isidoro Di Carlo

Subjects
Hepatic surgery, Hemangiomas of the liver, Radiofrequency ablation, Benign tumors of the lliver, Hepatic transplantation, Specialties of internal medicine, RC581-951
Abstract

Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. Patients affected by hemangioma usually have their tumor diagnosed by ultrasound abdominal examination for a not well defined pain, but pain persist after treatment of the hemangioma. The causes of pain can be various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease.The malignant trasformation is pratically inexistent. Different imaging modalities are used to diagnosis liver hemangioma including ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging, and less frequently scintigraphy, positron-emission tomography combined with CT (PET/CT) and angiography. Imaging-guided biopsy of hemangioma is usually not resorted to except in extremely atypical cases. The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.

Published
2014
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19. Splenic Autotransplantation Is Always Valid after Splenectomy

Author

Isidoro Di Carlo and Adriana Toro

Subjects
splenectomy, autotransplantation, opsi, spleen injury, Surgery, RD1-811
Abstract

When splenectomy is performed, autotransplantation is the only method to preserve splenic function. The most frequently used technique for splenic autotransplantation in humans is the implantation of multiple sections of the splenic parenchyma into pouches created in the greater omentum. However, this technique of autotransplantation is associated with complications. For this reason, a technique in which only one 35-g slice of spleen is transplanted into the greater omentum but positioned within the native hypochondrium can be considered safe and useful for patients. Experimental studies continue to add valuable information to the ongoing research in the field of autotransplantation, providing a baseline for future studies in humans and adding arguments in favor of autotransplantation when the spleen cannot be preserved.

Published
2017
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20. TachoSil use in abdominal surgery: a review

Author

Giulio Reale, Maurizio Mannino, Adriana Toro, and et al

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Adriana Toro, Maurizio Mannino, Giulio Reale, Isidoro Di CarloDepartment of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, ItalyAbstract: The success of any surgical procedure is based on adequate hemostasis. Many different biomaterial products can be used to achieve that aim. The products that can be used during surgery may be classified as topical hemostats, sealants, and adhesives. Hemostats can clot blood. Sealants can create sealing barriers. Adhesives bond tissue together. Collagen, gelatin, and cellulose are hemostat agents. TachoSil® is a development of TachoComb® and TachoComb® H. TachoComb is made with equine collagen, bovine thrombin, bovine aprotinin, and human fibrinogen. The clinical efficacy of TachoSil was shown firstly by a clinical study of hepatic surgery. In the study, TachoSil proved to be superior to argon beamer in obtaining effective and fast intraoperative hemostasis. Following the study, many applications in different fields of surgery have been reported in the literature. The use of TachoSil in open abdominal surgery and its relevant results have encouraged the use of TachoSil in laparoscopic surgery. Unfortunately, its use in laparoscopy has not become as popular as it is in open surgery, due to a lack of efficacious techniques. Immunologic reactions to compounds of TachoSil and the transmission of infectious diseases are two major risks concerning topical hemostasis. Even though the risk of severe immunologic reactions to bovine material is low, TachoSil has gradually replaced all bovine material with material of human origin and has therefore eliminated the associated risks of bovine material. TachoSil has a good satisfaction rate among surgeons and reduces both the operating time for patients and the time spent in intensive care units.Keywords: TachoSil, abdominal surgery, hemostasis

Published
2011

23. Laparoscopy as a Diagnostic and Definitive Therapeutic Tool in Cases of Inflamed Simple Lymphatic Cysts of the Mesentery

Author

Abdelrahman Abdelaal, Ibnouf Sulieman, Zia Aftab, Ayman Ahmed, Saif Al-Mudares, Mohannad Al Tarakji, Ahmad Almuzrakchi, Adriana Toro, and Isidoro Di Carlo

Subjects
Surgery, RD1-811
Abstract

Mesenteric cysts are rare benign abdominal tumors. These cysts, especially those of lymphatic origin, very rarely become inflamed. The diagnosis of inflamed lymphatic cysts of the mesentery may be difficult. We herein report two cases of inflamed simple lymphatic cysts of the mesentery definitively diagnosed and excised by laparoscopy.

Published
2015
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24. A Lethal Complication after Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma

Author

Adriana Toro, Gaetano Bertino, Maria Concetta Arcerito, Maurizio Mannnino, Annalisa Ardiri, Domenico Patane’, and Isidoro Di Carlo

Subjects
Surgery, RD1-811
Abstract

Background. The current standard of care for patients with large or multinodular noninvasive hepatocellular carcinoma is conventional transarterial chemoembolization (TACE). TACE may also be performed with drug-eluting beads, but serious complications of this procedure have been reported. Methods. Aim of this report is to present a patient affected by multifocal HCC who underwent TACE with drug-eluting bead (DEB-TACE). Results. Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death. Conclusion. We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area. This activity that can extend to the surrounding healthy hepatic tissues may continue indefinitely.

Published
2015
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26. Prospective assessment of smell and taste impairment in a South-American coronavirus disease 2019 (COVID-19) cohort: Association with the need for hospitalization and reversibility of dysfunction

Author

Antonia Lagos, Rodrigo Aliaga, Tamara García-Salum, Rafael A. Medina, Erick Salinas, Eduardo Fuentes-López, Adriana Toro, James N. Palmer, Claudio Callejas, Luis Antonio Díaz, Francisco García-Huidobro, Claudia González, and Arnoldo Riquelme

Subjects
Adult, Male, medicine.medical_specialty, Taste, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Anosmia, Olfaction Disorders, Taste Disorders, Hyposmia, Risk Factors, COVID‐19, Internal medicine, Outpatients, medicine, risk for hospitalization, Immunology and Allergy, Humans, Prospective Studies, Chile, UPSIT, business.industry, SARS-CoV-2, hyposmia, COVID-19, Recovery of Function, Middle Aged, Dysgeusia, Hospitalization, Research Note, Otorhinolaryngology, South american, Cohort, Female, dysgeusia, medicine.symptom, business, anosmia, Follow-Up Studies
Published
2021

27. Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Author

Adriana Toro, Annalisa Ardiri, Maurizio Mannino, Antonio Politi, Andrea Di Stefano, Zia Aftab, Abdelrahman Abdelaal, Maria Concetta Arcerito, Andrea Cavallaro, Marco Cavallaro, Gaetano Bertino, and Isidoro Di Carlo

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Introduction. Aim of the present work is to review the literature to point out the role of laparoscopic reversal of Hartmann procedure. Material and Methods. Number of patients, age, sex, etiology, Hinchey classification, interval between procedure and reversal, position of the first trocars, mean operative time (min), number and causes of conversion, length of stay, mortality, complications, and quality of life were considered. Results. 238 males (52.4%) and 216 females (47.6%) between 38 and 67 years were analyzed. The etiology was diverticulitis in 292 patients (72.1%), carcinoma in 43 patients (10.6%), and other in 70 patients (17.3%). Only 7 articles (22.6%) reported Hinchey classification. The interval between initial procedure and reversal was between 50 and 330 days. The initial trocar was open positioned in 182 patients (43.2%) through umbilical incision, in 177 patients (41.9%) in right upper quadrant, and in 63 patients (14.9%) in colostomy site. The operative time was between 69 and 285 minutes. A total of 83 patients (12.1%) were converted and the causes were reported in 67.4%. The length of stay was between 3 and 12 days. 5 patients (0.7%) died. The complications concern 112 cases (16.4%). Conclusion. The laparoscopic Hartmann’s reversal is safer and achieves faster positive results.

Published
2014
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28. Impact of the SARS-CoV-2 pandemic on emergency surgery services-a multi-national survey among WSES members

Author

Reichert, Martin, Sartelli, Massimo, Weigand, Markus A, Doppstadt, Christoph, Hecker, Matthias, Reinisch-Liese, Alexander, Bender, Fabienne, Askevold, Ingolf, Padberg, Winfried, Coccolini, Federico, Catena, Fausto, Hecker, Andreas, Abakar, Abdullaev, Adrian, Camacho-Ortiz, Adriana, Toro, Alain, Chichom-Mefire, Aleix, Martínez-Pérez, Alfie, J Kavalakat, Ali Yasen Y, Mohamedahmed, Andrey,Litvin, Antonio, Brillantino, Antonio, Pesce, Arda, Isik, Aristotelis, Kechagias, Azzain M H, Ismail, Baris, Mantoglu, Basil, Ibrahim, Birgit, Hecker, Boris, Sakakushev, Charalampos, Seretis, Dimitrios, Manatakis, Edgar Fernando, Hernández García, Eli, olak, Elmin, Steyn, Emrah, Akin, Emre, Gonullu, Fabio Cesare, Campanile, Francesco, Pata, Francesco, Roscio, Fredrik, Linder, Gia, Tomadze, Gianluca, Pellino, Gianmaria, Casoni Pattacini, Giovanni, Pirozzolo, Gustavo M, Machain, Gustavo P, Fraga, Hazim Abdulnassir, Eltyeb, Ioannis, Nikolopoulos, Isidoro, Di Carlo, Jae Il, Kim, Jesus-Manuel, Saenz-Terrazas, Juan Carlos, Rodriguez Sanjuan, Juliane, Liese, Justin, Davies, Kim, Platte, Lawrence, Lottenberg, Leonardo, Pagani, Leonardo, Solaini, Lisa, Miller, Lovenish Bains, Luis Buonomo, Maciej Walędziak, Mahir Gachabayov, Marc Maegele, Marco Catarci, Marco Vittorio Rossi Ardizzone Alberio, Maria Grazia Alberio, Massimiliano Veroux, Matteo Nardi, Mauro Podda, Michael Sugrue, Michele Pisano, Mihail Slavchev, Mika Ukkonen, Miklosh Bala, Mircea Chirica, Mouaqit Ouadii, Orestis Ioannidis, Osvaldo Chiara, Pankaj Kumar, Per Örtenwall, Pradeep Navsaria, Raul Coimbra, Riccardo Somigli, Robert G Sawyer, Saad Shebrain, Salomone Di Saverio, Sanjay Marwah, Sergio Zegarra, Shahd Nour, Shahed Abdelmahmoud, Stefano Magnone, Syed Muhammad Ali, Tadeja Pintar, Tushar S Mishra, Valentina Tomajer, Varut Lohsiriwat, Vijay Shivpuje, Vladimir Khokha, Yoshiro Kobe, Zaza Demetrashvili, Reichert, Martin, Sartelli, Massimo, Weigand, Markus A, Doppstadt, Christoph, Hecker, Matthia, Reinisch-Liese, Alexander, Bender, Fabienne, Askevold, Ingolf, Padberg, Winfried, Coccolini, Federico, Catena, Fausto, Hecker, Andrea, Abakar, Abdullaev, Adrian, Camacho-Ortiz, Adriana, Toro, Alain, Chichom-Mefire, Aleix, Martínez-Pérez, Alfie, J Kavalakat, Ali Yasen Y, Mohamedahmed, Andrey,Litvin, Antonio, Brillantino, Antonio, Pesce, Arda, Isik, Aristotelis, Kechagia, Azzain M H, Ismail, Baris, Mantoglu, Basil, Ibrahim, Birgit, Hecker, Boris, Sakakushev, Charalampos, Sereti, Dimitrios, Manataki, Edgar Fernando, Hernández García, Eli, olak, Elmin, Steyn, Emrah, Akin, Emre, Gonullu, Fabio Cesare, Campanile, Francesco, Pata, Francesco, Roscio, Fredrik, Linder, Gia, Tomadze, Gianluca, Pellino, Gianmaria, Casoni Pattacini, Giovanni, Pirozzolo, Gustavo M, Machain, Gustavo P, Fraga, Hazim Abdulnassir, Eltyeb, Ioannis, Nikolopoulo, Isidoro, Di Carlo, Jae Il, Kim, Jesus-Manuel, Saenz-Terraza, Juan Carlos, Rodriguez Sanjuan, Juliane, Liese, Justin, Davie, Kim, Platte, Lawrence, Lottenberg, Leonardo, Pagani, Leonardo, Solaini, Lisa, Miller, Lovenish Bains, Luis Buonomo, Maciej Walędziak, Mahir Gachabayov, Marc Maegele, Marco Catarci, Marco Vittorio Rossi Ardizzone Alberio, Maria Grazia Alberio, Massimiliano Veroux, Matteo Nardi, Mauro Podda, Michael Sugrue, Michele Pisano, Mihail Slavchev, Mika Ukkonen, Miklosh Bala, Mircea Chirica, Mouaqit Ouadii, Orestis Ioannidis, Osvaldo Chiara, Pankaj Kumar, Per Örtenwall, Pradeep Navsaria, Raul Coimbra, Riccardo Somigli, Robert G Sawyer, Saad Shebrain, Salomone Di Saverio, Sanjay Marwah, Sergio Zegarra, Shahd Nour, Shahed Abdelmahmoud, Stefano Magnone, Syed Muhammad Ali, Tadeja Pintar, Tushar S Mishra, Valentina Tomajer, Varut Lohsiriwat, Vijay Shivpuje, Vladimir Khokha, Yoshiro Kobe, Zaza Demetrashvili, Reichert, M., Sartelli, M., Weigand, M. A., Doppstadt, C., Hecker, M., Reinisch-Liese, A., Bender, F., Askevold, I., Padberg, W., Coccolini, F., Catena, F., Hecker, A., Abdullaev, A., Camacho-Ortiz, A., Toro, A., Chichom-Mefire, A., Martinez-Perez, A., Kavalakat, A. J., Mohamedahmed, A. Y. Y., Litvin, A., Brillantino, A., Pesce, A., Isik, A., Kechagias, A., Ismail, A. M. H., Mantoglu, B., Ibrahim, B., Hecker, B., Sakakushev, B., Seretis, C., Manatakis, D., Garcia, E. F. H., Colak, E., Steyn, E., Akin, E., Gonullu, E., Campanile, F. C., Pata, F., Roscio, F., Linder, F., Tomadze, G., Pellino, G., Casoni Pattacini, G., Pirozzolo, G., Machain, G. M., Fraga, G. P., Eltyeb, H. A., Nikolopoulos, I., Di Carlo, I., Kim, J. I., Saenz-Terrazas, J. -M., Sanjuan, J. C. R., Liese, J., Davies, J., Platte, K., Lottenberg, L., Pagani, L., Solaini, L., Miller, L., Bains, L., Buonomo, L., Waledziak, M., Gachabayov, M., Maegele, M., Catarci, M., Alberio, M. V. R. A., Alberio, M. G., Veroux, M., Nardi, M., Podda, M., Sugrue, M., Pisano, M., Slavchev, M., Ukkonen, M., Bala, M., Chirica, M., Ouadii, M., Ioannidis, O., Chiara, O., Kumar, P., Ortenwall, P., Navsaria, P., Coimbra, R., Somigli, R., Sawyer, R. G., Shebrain, S., Di Saverio, S., Marwah, S., Zegarra, S., Nour, S., Abdelmahmoud, S., Magnone, S., Muhammad Ali, S., Pintar, T., Mishra, T. S., Tomajer, V., Lohsiriwat, V., Shivpuje, V., Khokha, V., Kobe, Y., Demetrashvili, Z., and Tampere University

Subjects
lcsh:Surgery, Appendicitis, Cholecystitis, COVID-19, Emergency surgery, SARS-CoV-2, WSES, Emergency Service, Hospital, Facilities and Services Utilization, General Surgery, Global Health, Health Care Surveys, Humans, Surgical Procedures, Operative, Hospital, Cholecystiti, Appendiciti, ddc:610, Emergency Service, Surgical Procedures, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RD1-811, lcsh:RC86-88.9, 3126 Surgery, anesthesiology, intensive care, radiology, Operative, Health Care Survey, Research Article, Human
Abstract

Background: The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods: A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results: Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions: The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services. publishedVersion

Published
2020

29. Response to: Surgical approach for totally implantable venous access port: a full strategy to avoid the percutaneous approach complications

Author

Emanule Gaspare Fontana, Isidoro Di Carlo, and Adriana Toro

Subjects
For Debate, Catheterization, Central Venous, medicine.medical_specialty, Surgical approach, business.industry, MEDLINE, Percutaneous approach, Vascular surgery, Implantable venous access port, Surgery, Cardiac surgery, Vascular Surgery, Thoracic Surgery, Traumatic Surgery, Abdominal Surgery, General Surgery, Cardiac Surgery, Cardiothoracic surgery, Catheterization, Peripheral, Central Venous Catheters, Humans, Medicine, business, Abdominal surgery
Published
2021

30. Laparoscopic Subtotal Cholecystectomy and Other Laparoscopic Techniques

Author

Maurizio Mannino, Adriana Toro, Elena Schembari, Piero Marco Fisichella, and Isidoro Di Carlo

Subjects
medicine.medical_specialty, Surgical strategy, medicine.diagnostic_test, business.industry, General surgery, Laparoscopic subtotal cholecystectomy, medicine.medical_treatment, Bile leakage, Severe inflammation, Increased risk, medicine, Cholecystectomy, Laparoscopy, business, Laparoscopic cholecystectomy
Abstract

In the past, a severe inflammation was a difficulty to complete a laparoscopic cholecystectomy for the increased risk of vasculo-biliary injuries. Today, if in laparoscopy a “critical view of safety” (CVS) is not possible, to avoid damages, several laparoscopic rescue procedures have been proposed. The first one and the most safe is to change technique abandoning the research of CVS to perform a laparoscopic subtotal cholecystectomy. Mandatory is that the decision of changing the surgical strategy should be made before doing vascular or biliary injuries. In this chapter, all the tricks to complete the usual cholecystectomy are reported. But when the safety of the patient is in danger, we report all the alternative laparoscopic techniques to finish the procedure safely. Finally, all the outcomes conclude the chapter.

Published
2021
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31. Open Partial or Subtotal Cholecystectomy: Techniques and Indications

Author

Elena Schembari, Isidoro Di Carlo, Maurizio Mannino, and Adriana Toro

Subjects
medicine.medical_specialty, medicine.diagnostic_test, Bile duct, business.industry, medicine.medical_treatment, Open surgery, General surgery, Gold standard, Cystic artery, Subtotal cholecystectomy, medicine.anatomical_structure, medicine.artery, medicine, Cystic duct, Cholecystectomy, business, Laparoscopy
Abstract

Laparoscopic cholecystectomy is the gold standard for gallstone disease. But when a high grade of inflammation is present, the identification of the bile duct, the cystic duct, and the cystic artery became difficult. In this case, conversion to open surgery represents a good option for the safety of the patient. Two techniques for open surgery in case of difficult cholecystectomy are reported in the literature: partial and subtotal cholecystectomy. All the evolutive surgical steps adopted for this technique in the last centuries, all the algorithms to anticipate the conversions from laparoscopy, actual surgical techniques, and complications are reported in the present chapter.

Published
2021
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32. Viral shedding dynamics reveals sputum as a reliable and cost-saving specimen for SARS-CoV-2 diagnosis within the first 10 days since symptom onset: A prospective cohort study

Author

Luis Antonio Díaz, Gonzalo Valenzuela, Leonardo I. Almonacid, Tamara Garcia, Sebastián Valderrama, Rafael A. Medina, Adriana Toro, Marcos Ortega, Fabiola Perazzo, Eileen F. Serrano, Erick Salinas, Jorge E Levican-Asenjo, Maria Jose Avendano, Viviana P. Montecinos, Luis Rojas, Arnoldo Riquelme, and Catalina Pardo-Roa

Subjects
medicine.medical_specialty, Longitudinal study, business.industry, Convalescence, media_common.quotation_subject, Concordance, Article, Internal medicine, Ambulatory, medicine, Sputum, Viral shedding, medicine.symptom, Prospective cohort study, business, Kappa, media_common
Abstract

BackgroundCoronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome virus (SARS-CoV-2) is challenging global public health, due to an increasing demand for testing and the shortage of diagnostic supplies. Nasopharyngeal swab (NPS) is considered the optimal sample for SARS-CoV2 diagnosis and sputum (SPT) has been proposed as an economic alternative. However, the temporal concordance of diagnosis in NPS and SPT has not been addressed.MethodsThrough a longitudinal study we compared the shedding dynamics of SARS-CoV-2 RNA evaluated by RT-qPCR in serially collected SPT and NPS obtained from 82 ambulatory and hospitalized patients during acute infection and convalescence. The concordance during the follow-up and cost analysis between both collected specimens was evaluated.FindingsWe analyzed 379 samples, 177 NPS and 202 SPT. The highest proportion of positive samples was detected within the first 15 days after the symptoms onset. The median time of positivity was higher for NPS (median= 25 days) than SPT (median= 21 days). There was no significant difference in the median RT-qPCR CTvalues between both sample types. The temporal categorization of matched-paired samples indicated substantial correlation (r=0·6023) and substantial agreement (87·23%) during the first ten days since symptoms onset (kappa = 0·697). A cost analysis demonstrated a significant saving when the SPT specimen was used.InterpretationSputum is a feasible and cost-saving alternative to NPS, providing an equivalent value for the detection and follow-up of SARS-CoV-2 RNA.FundingAgencia Nacional de Investigación y Desarrollo (ANID) of Chile, NIH-NIAID USA.

Published
2020
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34. Intestinal obstruction due to congenital bands in adults who have never had abdominal surgery Two case reports and a review of the literature

Author

Giacomo, Menconi, Elena, Schembari, Valentina, Randazzo, Edoardo, Mattone, Ornella, Coco, Maurizio, Mannino, Isidoro, Di Carlo, and Adriana, Toro

Subjects
Aged, 80 and over, Male, Ileal Diseases, Ileum, Ischemia, Humans, Female, Tissue Adhesions, Tomography, X-Ray Computed, Models, Biological, Intestinal Obstruction, Aged, Hernia, Abdominal
Abstract

Congenital abdominal bands are a very rare entity and are often silent for a person's entire life. In a very few circumstances, however, they can manifest with clinical symptoms. Diagnosis of these bands is very challenging as the patient has never submitted for abdominal surgery and imaging, laboratory tests and clinical examination can be silent or unspecific. Two patients were admitted to and operated on in our hospital between June 2017 and July 2018. All patients had a bowel obstruction at the time of presentation, presenting no emission of faeces or gas. Conservative therapy was tried in one case, and surgical intervention was required. At surgery, both patients were found to have congenital bands causing the occlusion. The postoperative courses were uneventful. Small bowel obstruction (SBO) by congenital bands remains a challenging disease for surgeons. Diagnosis of SBO has to be suspected even if radiology does not indicate any relevant features. Laparoscopy should be the preferred approach, but if not feasible, then open surgery can resolve the case. KEY WORDS: Adhesions, Congenital bands, Intestinal occlusion, Laparoscopy.Le aderenze addominali congenite sono molto rare, solitamente asintomatiche tali da passare misconosciute per tutta la vita. In rari casi, tuttavia, possono manifestarsi con sintomi clinici. La diagnosi è molto impegnativa poiché il paziente non riporta in anamnesi interventi o esami radiologici addominali pregressi. Inoltre gli esami ematochimici e l’esame clinico possono essere non indicativi o non specifici. Due pazienti sono stati ricoverati e operati presso la nostra unità operativa complessa di Chirurgia Generale tra giugno 2017 e luglio 2018. Entrambi i pazienti presentavano un quadro di occlusione intestinale al momento del ricovero con alvo chiuso a feci e gas. In un caso è stata tentata la terapia conservativa. Entrambi i pazienti sono stati sottoposti a trattamento chirurgico che ha evidenziato la presenza di una briglia aderenziale congenita, causa dell’occlusione. Il decorso post operatorio è stato regolare in assenza di complicanze. L’ostruzione dell’intestino tenue (SBO) causata da briglie aderenziali congenite è una patologia rara rappresentante una sfida per il chirurgo. La diagnosi di SBO deve essere sospettata, anche quando gli esami radiologici non evidenziano alcuna patologica responsabile del quadro occlusivo intestinale in pazienti che non sono mai stati sottoposti a chirurgia addominale. La laparoscopia va utilizzata come primo approccio, riservandosi comunque la possibilità della chirurgia.

Published
2020

35. Proyecto: Condominio Villa del Atleta

Author

Adriana Toro Lira Poggi

Subjects
Marketing strategies, Viviendas, Housing, Campañas publicitarias, Advertising campaigns, Sales, Estrategias de marketing, Compraventa
Abstract

Se plantea el lanzamiento al mercado inmobiliario del condominio “Villa del Atleta”, ubicado en Villa El Salvador, Lima, Perú. Para ello, se dará a conocer sus principales características y se destacarán los atributos de éste complejo habitacional, así como las facilidades de financiamiento para futuros compradores. La investigación realizada permite evidenciar hallazgos tanto del público objetivo y del rubro inmobiliario, que permiten realizar una propuesta comunicacional y mix de medios que apunte al éxito comercial de éste proyecto.

Published
2019

36. Which is Better for Patients with Breast Cancer: Totally Implanted Vascular Access Devices (TIVAD) or Peripherally Inserted Central Catheter (PICC)?

Author

Edoardo Mattone, Adriana Toro, Elena Schembari, and Isidoro Di Carlo

Subjects
medicine.medical_specialty, business.industry, Vascular surgery, medicine.disease, Peripherally inserted central catheter, Surgery, Cardiac surgery, Rare Diseases, Breast cancer, Cardiothoracic surgery, Catheterization, Peripheral, Humans, Medicine, business, Vascular Access Devices, Abdominal surgery
Published
2019
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37. Is Laparoscopy Really Advantageous for Splenectomy Patients?

Author

Daniele Livera, Marco Vitale, Adriana Toro, and Isidoro Di Carlo

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, General surgery, Splenectomy, Vascular surgery, Humans, Treatment Outcome, Laparoscopy, Surgery, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Cardiothoracic surgery, 030220 oncology & carcinogenesis, medicine, 030211 gastroenterology & hepatology, business, Abdominal surgery
Published
2018

38. Hydatid Cyst of the Liver: A Challenge that can be Amplified Shifting from Open to Laparoscopic Surgery

Author

Elena Schembari, Isidoro Di Carlo, Adriana Toro, and Edoardo Mattone

Subjects
Laparoscopic surgery, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hydatid cyst, Vascular surgery, Echinococcosis, Echinococcosis, Hepatic, Humans, Liver, Laparoscopy, Surgery, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Hepatic, Cardiothoracic surgery, 030220 oncology & carcinogenesis, medicine, 030211 gastroenterology & hepatology, business, Abdominal surgery
Published
2018

39. Rare Benign Tumors of the Liver: Still Rare?

Author

Nicoletta Bertino, Gabriele Pricoco, Adriana Toro, Davide Campagna, Evelise Frazzetto, Michele Malaguarnera, Maria Domenica Amaradio, Giulia Malaguarnera, Giorgia Ferraro, Stefano GiuseppeCalvagno, Shirin Demma, Annalisa Ardiri, Elisa Basile, Gaetano Bertino, Mariano Malaguarnera, Maria Proiti, and Isidoro Di Carlo

Subjects
medicine.medical_specialty, medicine.medical_treatment, Biliary cystadenoma, Asymptomatic, Multimodal Imaging, medicine, Medical imaging, Humans, Invited Reviews, benign tumors, hepatic cystic tumors, polycystic liver disease, liver macro-regenerative nodules, hepatic mesenchymal hamartoma, hepatic angiomyolipoma, Nodular regenerative hyperplasia, Hepatic angiomyolipoma, Health risk, medicine.diagnostic_test, Liver macro-regenerative nodules, business.industry, Cysts, Polycystic liver disease, Liver Diseases, Ultrasound, Liver Neoplasms, Gastroenterology, Magnetic resonance imaging, medicine.disease, Prognosis, Radiation therapy, Oncology, Hepatic cystic tumors, Hepatic benign tumors, Radiology, medicine.symptom, business, Hepatic mesenchymal hamartoma
Abstract

Background Benign liver tumors are common. They do not spread to other areas of the body, and they usually do not pose a serious health risk. In fact, in most cases, benign liver tumors are not diagnosed because patients are asymptomatic. When they are detected, it’s usually because the person has had medical imaging tests, such as an ultrasound (US), computed tomography (CT) scan, or magnetic resonance imaging (MRI), for another condition. Materials and methods A search of the literature was made using cancer literature and the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatic benign tumors”, “hepatic cystic tumors”, “polycystic liver disease”, “liver macroregenerative nodules”, “hepatic mesenchymal hamartoma”, “hepatic angiomyolipoma”, “biliary cystadenoma”, and “nodular regenerative hyperplasia”. Discussion and conclusion Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world; there is an increasing incidence worldwide. Approximately 750,000 new cases are reported per year. More than 75 % of cases occur in the Asia-Pacific region, largely in association with chronic hepatitis B virus (HBV) infection. The incidence of HCC is increasing in the USA and Europe because of the increased incidence of hepatitis C virus (HCV) infection. Unlike the liver HCC, benign tumors are less frequent. However, they represent a chapter always more interesting of liver disease. In fact, a careful differential diagnosis with the forms of malignant tumor is often required in such a way so as to direct the patient to the correct therapy. In conclusion, many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required, and/or surgical removal is needed. In the majority of cases of benign hepatic tumors, no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.

Published
2014

40. Spontaneous hemoperitoneum, due to bleeding from retroperitoneal varices, in a cirrhotic patient: a case report

Author

Ahmad Abutaka, Abdulrahman Abu Sabeib, Adriana Toro, Renol M. Koshy, and Isidoro Di Carlo

Subjects
medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Case Report, Case Reports, 03 medical and health sciences, hemorrhagic shock, 0302 clinical medicine, Laparotomy, medicine, Hemoperitoneum, hemoperitoneum, Anamnesis, business.industry, portal hypertension, Cirrhotic patient, varices, General Medicine, medicine.disease, Surgery, 030220 oncology & carcinogenesis, Portal hypertension, 030211 gastroenterology & hepatology, Radiology, Presentation (obstetrics), medicine.symptom, Varices, business
Abstract

Key Clinical Message Hemoperitoneum from retroperitoneal varices in cirrhotic is very rare. This condition should be taken into account based on anamnesis, clinical features, and laboratory findings; but due to the unstable presentation, diagnosis remains a challenge. Emergency laparotomy could be effective treatment, but the prognosis remains poor related to the hepatic reserve.

Published
2015

41. Splenic Autotransplantation Is Always Valid after Splenectomy

Author

Adriana Toro and Isidoro Di Carlo

Subjects
Splenic function, medicine.medical_specialty, animal structures, medicine.medical_treatment, Splenectomy, Spleen, 030230 surgery, Transplantation, Autologous, Mice, 03 medical and health sciences, 0302 clinical medicine, Splenic autotransplantation, Splenic parenchyma, medicine, Animals, Humans, business.industry, Greater omentum, Hypochondrium, Autotransplantation, Surgery, medicine.anatomical_structure, Liver, 030220 oncology & carcinogenesis, business, Omentum
Abstract

When splenectomy is performed, autotransplantation is the only method to preserve splenic function. The most frequently used technique for splenic autotransplantation in humans is the implantation of multiple sections of the splenic parenchyma into pouches created in the greater omentum. However, this technique of autotransplantation is associated with complications. For this reason, a technique in which only one 35-g slice of spleen is transplanted into the greater omentum but positioned within the native hypochondrium can be considered safe and useful for patients. Experimental studies continue to add valuable information to the ongoing research in the field of autotransplantation, providing a baseline for future studies in humans and adding arguments in favor of autotransplantation when the spleen cannot be preserved.

Published
2017

42. The enigma of primary and secondary encapsulating peritoneal sclerosis

Author

Mohamed Khairat, Adriana Toro, Ahmed Nafea Suliman, S. Abdelaziem, Omer Al Yahri, Sharon Mathew, Adham Darweesh, Isidoro Di Carlo, and Hisham Allam

Subjects
Adult, Male, Abdominal pain, Encapsulating Peritoneal Sclerosis, medicine.medical_specialty, Ethnic origin, Peritoneal encapsulation, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Humans, Medicine, Abdominal cocoon syndrome, Pathological, Aged, Retrospective Studies, Past medical history, business.industry, Encapsulating peritoneal sclerosis, Peritoneal Fibrosis, General Medicine, Emergency department, Middle Aged, Surgery, 030220 oncology & carcinogenesis, Radiological weapon, Female, 030211 gastroenterology & hepatology, medicine.symptom, business, Research Article
Abstract

Background Encapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment. Methods A retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied. Results A total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF. Conclusions Currently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.

Published
2016
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43. Health-related quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment

Author

Isidoro Di Carlo, Elia Pulvirenti, Filippo Palermo, and Adriana Toro

Subjects
Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Radiofrequency ablation, Health Status, medicine.medical_treatment, Emotions, Catheter ablation, law.invention, Quality of life, law, medicine, Carcinoma, Hepatectomy, Humans, Interpersonal Relations, Chemoembolization, Therapeutic, Transcatheter arterial chemoembolization, Aged, Aged, 80 and over, Family Health, Hepatitis, business.industry, Liver Neoplasms, Middle Aged, medicine.disease, Combined Modality Therapy, Surgery, Treatment Outcome, Oncology, Hepatocellular carcinoma, Catheter Ablation, Quality of Life, Female, Neoplasm Recurrence, Local, business
Abstract

Background Aim of this work was to compare quality of life (QoL) of patients affected by HCC and submitted to hepatic resection (HR), transarterial chemoembolization (TACE), radiofrequency ablation (RFA), or no treatment (NT). Methods Patients affected by HCC between 2001 and 2009 were considered for this study. Gender, diabetes, hepatitis status, Child grade, tumor size, and recurrence were analyzed. QoL was assessed before treatment and 3, 6, 12, and 24 months after, using a FACT-Hep questionnaire. P value was considered significant if Results Fourteen patients (27.45%) were treated with HR, 15 patients (29.41%) underwent TACE, RFA was performed in 9 patients (17.65%), and 13 patients (25.49%) were not treated. Physical well-being, social/family well-being, emotional well-being, functional well-being and additional concerns 24 months after HR were significantly higher compared to all other treatments. Conclusions Hepatic resection provides the best QoL at 24 months. RFA provides a worse QoL compared to HR, but a higher QoL compared to TACE or NT.

Published
2012
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44. Could antibiotic prophylaxis be not necessary to implant totally implantable venous access devices? Randomized prospective study

Author

Adriana Toro, Giuseppe Scibilia, S. Cordio, Elia Pulvirenti, Filippo Palermo, and Isidoro Di Carlo

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Antineoplastic Agents, Skin infection, Ceftazidime, law.invention, Randomized controlled trial, law, Neoplasms, White blood cell, medicine, Humans, Surgical Wound Infection, Antibiotic prophylaxis, Prospective cohort study, Aged, Cephalic vein, Chemotherapy, business.industry, Infusion Pumps, Implantable, Antibiotic Prophylaxis, Middle Aged, medicine.disease, Anti-Bacterial Agents, Surgery, medicine.anatomical_structure, Oncology, Equipment Contamination, Female, Implant, business
Abstract

Background The growing use of totally implantable venous access devices (TIVAD) has caused the simultaneous increase of various complications. Among these, one of the most encountered is the infection of the subcutaneous pocket in which the device is positioned, or the infection of TIVAD itself. The aim of this study is to evaluate the role of the antibiotic in the prevention of the infection of both the surgical site and the TIVAD within 30 days after the implant. Methods The authors enrolled one hundred eight consecutive patients divided into two randomized arms each of 54 patients: group A (antibiotic), group B (no antibiotic). All patients were affected by solid tumors needing chemotherapy continuously. TIVADs were implanted surgically in cephalic vein. On the first, third, and seventh postoperative days, the following manifestations were considered as signs or symptoms of infection: pain, localized swelling, redness, and heat; white blood cell count was performed in the in-hospital laboratory. Body temperatures were checked twice a day for 7 days. A statistical analysis of the results was performed. Results No sign of infection was recorded in both groups. Body temperatures and white blood cell counts remained within normal limits in both groups. One month after the procedure no patients recorded any sign of skin infection or body temperature increase. Conclusions The study suggests that, following strict methods of pre- and postoperative care, TIVADs in patients with solid tumors may be surgically implanted without any antibiotic prophylaxis.

Published
2011
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46. An update on indications for treatment of solid hepatic neoplasms in noncirrhotic liver

Author

Adriana Toro, Elia Pulvirenti, and Isidoro Di Carlo

Subjects
Hepatic Hemangioma, Noncirrhotic liver, Cancer Research, medicine.medical_specialty, Carcinoma, Hepatocellular, Asymptomatic, Hepatic neoplasms, medicine, Humans, Laparoscopy, medicine.diagnostic_test, Cysts, business.industry, Liver Neoplasms, Focal nodular hyperplasia, General Medicine, Hepatocellular adenoma, Prognosis, medicine.disease, Surgery, Oncology, Focal Nodular Hyperplasia, Hepatic surgery, medicine.symptom, Hemangioma, business
Abstract

During recent years, we have experienced an increased detection of previously unsuspected liver masses in otherwise asymptomatic patients owing to the widespread application of imaging techniques. Regardless of the malignant or cystic tissues, a remarkable percentage of these masses are represented by benign solid neoplasms. Treatment of benign liver tumors still represents a major concern in the hepatic surgery field. Indications for surgery have remained unchanged for many years, but the laparoscopic approach could determine in some cases a broadening of indications, which may result in overtreatment. In this article, the main surgical indication for hepatic hemangioma, focal nodular hyperplasia and hepatocellular adenoma are discussed with regard to the most recent advancements in literature. In addition, a separate section deals with the role of laparoscopy in the treatment of benign liver neoplasms.

Published
2010
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47. Adenoma or Atypical Hepatic Focal Nodular Hyperplasia: Role of Preoperative Imaging and Laparoscopic Treatment

Author

Isidoro Di Carlo, Adriana Toro, Elia Pulvirenti, and Gian Domenico Priolo

Subjects
Diagnostic Imaging, medicine.medical_specialty, Adenoma, medicine.medical_treatment, Adenoma, Liver Cell, Diagnosis, Differential, medicine, Medical imaging, Hepatectomy, Humans, Laparoscopy, medicine.diagnostic_test, business.industry, Liver Neoplasms, Focal nodular hyperplasia, Magnetic resonance imaging, Nodule (medicine), Middle Aged, Hepatocellular adenoma, medicine.disease, Focal Nodular Hyperplasia, Female, Surgery, Radiology, medicine.symptom, business
Abstract

Differentiation of focal nodular hyperplasia (FNH) and other hypervascular liver lesions, such as hepatocellular adenoma (HCA), is important because of the drastically different therapeutic approach. However, FNH can be well distinguished only if it shows a typical aspect; alternatively, in the case of atypical FNH, imaging findings are not specific enough to provide a secure diagnosis and histologic verification of the lesion is required. In addition, HCA cannot be identified conclusively by any current available imaging technique and it can be at best suspected strongly, and this suspicion may lead to liver resection. Herein we report a case of a patient with an unusual FNH nodule presenting at ultrasonographic scanning as an isoechoic mass arising from hepatic segment 4b; the diagnostic indecision between FNH and HCA was not definitively solved even after computed tomography scan and magnetic resonance imaging and the patient was scheduled for a laparoscopic resection. The pathologic examination diagnosed an atypical FNH nodule. The clinical doubt between FNH and HCA remains a problem affecting the clinicians, and more effort should be made in the direction of a better preoperative differentiation of such different conditions. Surgical resection should not be considered as the failure of the preoperative diagnostic attempt, but as the mainstay for a definitive and sure diagnosis.

Published
2010
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48. Does Converted Open Subtotal Cholecystectomy Definitively Cure a Diseased Gallbladder?

Author

Isidoro Di Carlo, Maurizio Mannino, Adriana Toro, and Carlo Bortolussi

Subjects
medicine.medical_specialty, business.industry, Gallbladder, 030230 surgery, Subtotal cholecystectomy, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Medicine, Cholecystectomy, business
Published
2018
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49. Increased Use of Percutaneous Technique for Totally Implantable Venous Access Devices. Is It Real Progress? A 27-Year Comprehensive Review on Early Complications

Author

Adriana Toro, Isidoro Di Carlo, Maurizio Mannino, and Elia Pulvirenti

Subjects
Catheterization, Central Venous, Hemoptysis, medicine.medical_specialty, Percutaneous, Antineoplastic Agents, Catheters, Indwelling, Quality of life, Neoplasms, Atrial Fibrillation, medicine, Humans, Hemothorax, Hematoma, business.industry, Incidence, Pneumothorax, Arteries, Infusion Pumps, Implantable, Long-Term Care, Surgery, Venous access, Parenteral nutrition, Oncology, Concomitant, Quality of Life, Implant, business
Abstract

First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant.An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous technique), and immediate complications occurrence.A total of 952 reports were screened, and finally only 45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in 11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%, compared with 0.9% subsequent to cutdown technique.Despite the increased use of percutaneous technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications.

Published
2010
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50. Modified Subtotal Cholecystectomy: Results of a Laparotomy Procedure During the Laparoscopic Era

Author

Elia Pulvirenti, Adriana Toro, Giuseppe Corsale, and Isidoro Di Carlo

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Gallbladder disease, Young Adult, Postoperative Complications, Laparotomy, medicine, Humans, Laparoscopy, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Gallbladder, General surgery, Explorative laparotomy, Length of Stay, Middle Aged, medicine.disease, Endoscopy, Surgery, Treatment Outcome, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, Female, Cholecystectomy, business, Abdominal surgery
Abstract

Laparoscopic cholecystectomy is now indisputably the gold standard for managing most gallbladder diseases. However, subversion of the Calot triangle anatomy cannot always be managed by laparoscopy and often requires a laparotomy conversion. This report discusses our patients treated with our personal technique. Patients undergoing subtotal cholecystectomy performed by the same surgeon with a personal technique from January 1999 to December 2007 were considered for the present study. Sex, age, symptoms, co-morbidities, diagnostic modality, time between hospitalization and surgery, length of postsurgical hospitalization, morbidity and mortality, and follow-up were assessed. Four men and six women, aged 23 to 88 years, were included. Every patient had symptoms of acute cholecystitis. Four patients had had symptoms for an average of 2.5 days and six for an average of 5.1 h. All patients were studied by ultrasonography, and seven underwent computed tomography. The operation was performed within 48 h in all patients. The average hospital stay from surgery to discharge was different for patients who underwent primary open cholecystectomy (10 days, range 5–16 days) and those having a conversion after a laparoscopic attempt (7.8 days, range 4–16 days). During the postoperative period only one patient presented a self-limiting biliary leak. No postoperative mortality occurred. At follow-up, any recurrences of stone in the biliary tract or newly formed pouch were recorded. The results suggest that this new approach can be considered effective in every instance of subversion of the normal anatomy of Calot’s triangle.

Published
2009
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