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3. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

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Perrone, G, Giuffrida, M, Abu-Zidan, F, Kruger, V, Livrini, M, Petracca, G, Rossi, G, Tarasconi, A, Tian, B, Bonati, E, Mentz, R, Mazzini, F, Campana, J, Gasser, E, Kafka-Ritsch, R, Felsenreich, D, Dawoud, C, Riss, S, Gomes, C, Gomes, F, Gonzaga, R, Canton, C, Pereira, B, Fraga, G, Zem, L, Cordeiro-Fonseca, V, de Mesquita Tauil, R, Atanasov, B, Belev, N, Kovachev, N, Melendez, L, Dimova, A, Dimov, S, Zelic, Z, Augustin, G, Bogdanic, B, Moric, T, Chouillard, E, Bajul, M, De Simone, B, Panis, Y, Esposito, F, Notarnicola, M, Lauka, L, Fabbri, A, Hentati, H, Fnaiech, I, Aurelien, V, Bougard, M, Roulet, M, Demetrashvili, Z, Pipia, I, Merabishvili, G, Bouliaris, K, Koukoulis, G, Doudakmanis, C, Xenaki, S, Chrysos, E, Kokkinakis, S, Vassiliu, P, Michalopoulos, N, Margaris, I, Kechagias, A, Avgerinos, K, Katunin, J, Lostoridis, E, Nagorni, E, Pujante, A, Mulita, F, Maroulis, I, Vailas, M, Marinis, A, Siannis, I, Bourbouteli, E, Manatakis, D, Tasis, N, Acheimastos, V, Maria, S, Stylianos, K, Kuzeridis, H, Korkolis, D, Fradelos, E, Kavalieratos, G, Petropoulou, T, Polydorou, A, Papacostantinou, I, Triantafyllou, T, Kimpizi, D, Theodorou, D, Toutouzas, K, Chamzin, A, Frountzas, M, Schizas, D, Karavokyros, I, Syllaios, A, Charalabopoulos, A, Boura, M, Baili, E, Ioannidis, O, Loutzidou, L, Anestiadou, E, Tsouknidas, I, Petrakis, G, Polenta, E, Bains, L, Gupta, R, Singh, S, Khanduri, A, Bala, M, Kedar, A, Pisano, M, Podda, M, Pisanu, A, Martines, G, Trigiante, G, Lantone, G, Agrusa, A, Di Buono, G, Buscemi, S, Veroux, M, Gioco, R, Veroux, G, Oragano, L, Zonta, S, Lovisetto, F, Feo, C, Pesce, A, Fabbri, N, Marino, F, Perrone, F, Vincenti, L, Papagni, V, Picciariello, A, Rossi, S, Picardi, B, Del Monte, S, Visconti, D, Osella, G, Petruzzelli, L, Pignata, G, Andreuccetti, J, D'Alessio, R, Buonfantino, M, Guaitoli, E, Spinelli, S, Sampietro, G, Corbellini, C, Lorusso, L, Frontali, A, Pezzoli, I, Bonomi, A, Chierici, A, Cotsoglou, C, Manca, G, Delvecchio, A, Musa, N, Casati, M, Letizia, L, Abate, E, Ercolani, G, D'Acapito, F, Solaini, L, Guercioni, G, Cicconi, S, Sasia, D, Borghi, F, Giraudo, G, Sena, G, Castaldo, P, Cardamone, E, Portale, G, Zuin, M, Spolverato, Y, Esposito, M, Isernia, R, Di Salvo, M, Manunza, R, Esposito, G, Agus, M, Asti, E, Bernardi, D, Tonucci, T, Luppi, D, Casadei, M, Bonilauri, S, Pezzolla, A, Panebianco, A, Laforgia, R, De Luca, M, Zese, M, Parini, D, Jovine, E, De Sario, G, Lombardi, R, Aprea, G, Palomba, G, Capuano, M, Argenio, G, Orio, G, Armellino, M, Troian, M, Guerra, M, Nagliati, C, Biloslavo, A, Germani, P, Aizza, G, Monsellato, I, Chahrour, A, Anania, G, Bombardini, C, Bagolini, F, Sganga, G, Fransvea, P, Bianchi, V, Boati, P, Ferrara, F, Palmieri, F, Cianci, P, Gattulli, D, Restini, E, Cillara, N, Cannavera, A, Nita, G, Sarnari, J, Roscio, F, Clerici, F, Scandroglio, I, Berti, S, Cadeo, A, Filippelli, A, Conti, L, Grassi, C, Cattaneo, G, Pighin, M, Papis, D, Gambino, G, Bertino, V, Schifano, D, Prando, D, Fogato, L, Cavallo, F, Ansaloni, L, Picheo, R, Pontarolo, N, Depalma, N, Spampinato, M, D'Ugo, S, Lepre, L, Capponi, M, Campa, R, Sarro, G, Dinuzzi, V, Olmi, S, Uccelli, M, Ferrari, D, Inama, M, Moretto, G, Fontana, M, Favi, F, Picariello, E, Rampini, A, Barberis, A, Azzinnaro, A, Oliva, A, Totaro, L, Benzoni, I, Ranieri, V, Capolupo, G, Carannante, F, Caricato, M, Ronconi, M, Casiraghi, S, Casole, G, Pantalone, D, Alemanno, G, Scheiterle, M, Ceresoli, M, Cereda, M, Fumagalli, C, Zanzi, F, Bolzon, S, Guerra, E, Lecchi, F, Cellerino, P, Ardito, A, Scaramuzzo, R, Balla, A, Lepiane, P, Tartaglia, N, Ambrosi, A, Pavone, G, Palini, G, Veneroni, S, Garulli, G, Ricci, C, Torre, B, Russo, I, Rottoli, M, Tanzanu, M, Belvedere, A, Milone, M, Manigrasso, M, De Palma, G, Piccoli, M, Pattacini, G, Magnone, S, Bertoli, P, Massucco, P, Palisi, M, Luzzi, A, Fleres, F, Clarizia, G, Spolini, A, Kobe, Y, Toma, T, Shimamura, F, Parker, R, Ranketi, S, Mitei, M, Svagzdys, S, Pauzas, H, Zilinskas, J, Poskus, T, Kryzauskas, M, Jakubauskas, M, Zakaria, A, Zakaria, Z, Wong, M, Jusoh, A, Zakaria, M, Cruz, D, Elizalde, A, Reynaud, A, Hernandez, E, Monroy, J, Hinojosa-Ugarte, D, Quiodettis, M, Du Bois, M, Latorraca, J, Major, P, Pedziwiatr, M, Pisarska-Adamczyk, M, Waledziak, M, Kwiatkowski, A, Czyzykowski, L, da Costa, S, Ferreira, A, Almeida, F, Rocha, R, Carneiro, C, Perez, D, Carvas, J, Rocha, C, Ferreira, C, Marques, R, Fernandes, U, Leao, P, Goulart, A, Pereira, R, Patrocinio, S, de Mendonca, N, Manso, M, Morais, H, Cardoso, P, Calu, V, Miron, A, Toma, E, Gachabayov, M, Abdullaev, A, Litvin, A, Nechay, T, Tyagunov, A, Yuldashev, A, Bradley, A, Wilson, M, Panyko, A, Lateckova, Z, Lacko, V, Lesko, D, Soltes, M, Radonak, J, Turrado-Rodriguez, V, Termes-Serra, R, Morales-Sevillano, X, Lapolla, P, Mingoli, A, Brachini, G, Degiuli, M, Sofia, S, Reddavid, R, de Manzoni Garberini, A, Buffone, A, del Pozo, E, Aparicio-Sanchez, D, Dos Barbeito, S, Estaire-Gomez, M, Viton-Herrero, R, de los Angeles Gil Olarte-Marquez, M, Gil-Martinez, J, Alconchel, F, Nicolas-Lopez, T, Rahy-Martin, A, Pelloni, M, Banolas-Suarez, R, Mendoza-Moreno, F, Nisa, F, Diez-Alonso, M, Rodas, M, Agundez, M, Andres, M, Moreira, C, Perez, A, Ponce, I, Gonzalez-Castillo, A, Membrilla-Fernandez, E, Salvans, S, Serradilla-Martin, M, Pardo, P, Rivera-Alonso, D, Dziakova, J, Huguet, J, Valle, N, Ruiz, E, Valcarcel, C, Moreno, C, Salazar, Y, Garcia, J, Mico, S, Lopez, J, Farre, S, Gomez, M, Petit, N, Titos-Garcia, A, Aranda-Narvaez, J, Romacho-Lopez, L, Sanchez-Guillen, L, Aranaz-Ostariz, V, Bosch-Ramirez, M, Martinez-Perez, A, Martinez-Lopez, E, Sebastian-Tomas, J, Jimenez-Riera, G, Jimenez-Vega, J, Cuellar, J, Campos-Serra, A, Munoz-Campana, A, Gracia-Roman, R, Alegre, J, Pinto, F, O'Sullivan, S, Antona, F, Jimenez, B, Lopez-Sanchez, J, Carmona, Z, Fernandez, R, Sierra, I, de Leon, L, Moreno, V, Iglesias, E, Cumplido, P, Bravo, A, Simo, I, Dominguez, C, Caamano, A, Lozano, R, Martinez, M, Torres, A, de Quiros, J, Pellino, G, Cloquell, M, Moller, E, Jalal-Eldin, S, Abdoun, A, Hamid, H, Lohsiriwat, V, Mongkhonsupphawan, A, Baraket, O, Ayed, K, Abbassi, I, Ali, A, Ammar, H, Kchaou, A, Tlili, A, Zribi, I, Colak, E, Polat, S, Koylu, Z, Guner, A, Usta, M, Reis, M, Mantoglu, B, Gonullu, E, Akin, E, Altintoprak, F, Bayhan, Z, Firat, N, Isik, A, Memis, U, Bayrak, M, Altintas, Y, Kara, Y, Bozkurt, M, Kocatas, A, Das, K, Seker, A, Ozer, N, Atici, S, Tuncer, K, Kaya, T, Ozkan, Z, Ilhan, O, Agackiran, I, Uzunoglu, M, Demirbas, E, Altinel, Y, Meric, S, Hacim, N, Uymaz, D, Omarov, N, Balik, E, Tebala, G, Khalil, H, Rana, M, Khan, M, Florence, C, Swaminathan, C, Leo, C, Liasis, L, Watfah, J, Trostchansky, I, Delgado, E, Pontillo, M, Latifi, R, Coimbra, R, Edwards, S, Lopez, A, Velmahos, G, Dorken, A, Gebran, A, Palmer, A, Oury, J, Bardes, J, Seng, S, Coffua, L, Ratnasekera, A, Egodage, T, Echeverria-Rosario, K, Armento, I, Napolitano, L, Sangji, N, Hemmila, M, Quick, J, Austin, T, Hyman, T, Curtiss, W, Mcclure, A, Cairl, N, Biffl, W, Truong, H, Schaffer, K, Reames, S, Banchini, F, Capelli, P, Coccolini, F, Sartelli, M, Bravi, F, Vallicelli, C, Agnoletti, V, Baiocchi, G, Catena, F, Perrone G., Giuffrida M., Abu-Zidan F., Kruger V. F., Livrini M., Petracca G. L., Rossi G., Tarasconi A., Tian B. W. C. A., Bonati E., Mentz R., Mazzini F. N., Campana J. P., Gasser E., Kafka-Ritsch R., Felsenreich D. M., Dawoud C., Riss S., Gomes C. A., Gomes F. C., Gonzaga R. A. T., Canton C. A. B., Pereira B. M., Fraga G. P., Zem L. G., Cordeiro-Fonseca V., de Mesquita Tauil R., Atanasov B., Belev N., Kovachev N., Melendez L. J. J., Dimova A., Dimov S., Zelic Z., Augustin G., Bogdanic B., Moric T., Chouillard E., Bajul M., De Simone B., Panis Y., Esposito F., Notarnicola M., Lauka L., Fabbri A., Hentati H., Fnaiech I., Aurelien V., Bougard M., Roulet M., Demetrashvili Z., Pipia I., Merabishvili G., Bouliaris K., Koukoulis G., Doudakmanis C., Xenaki S., Chrysos E., Kokkinakis S., Vassiliu P., Michalopoulos N., Margaris I., Kechagias A., Avgerinos K., Katunin J., Lostoridis E., Nagorni E. -A., Pujante A., Mulita F., Maroulis I., Vailas M., Marinis A., Siannis I., Bourbouteli E., Manatakis D. K., Tasis N., Acheimastos V., Maria S., Stylianos K., Kuzeridis H., Korkolis D., Fradelos E., Kavalieratos G., Petropoulou T., Polydorou A., Papacostantinou I., Triantafyllou T., Kimpizi D., Theodorou D., Toutouzas K., Chamzin A., Frountzas M., Schizas D., Karavokyros I., Syllaios A., Charalabopoulos A., Boura M., Baili E., Ioannidis O., Loutzidou L., Anestiadou E., Tsouknidas I., Petrakis G., Polenta E., Bains L., Gupta R., Singh S. K., Khanduri A., Bala M., Kedar A., Pisano M., Podda M., Pisanu A., Martines G., Trigiante G., Lantone G., Agrusa A., Di Buono G., Buscemi S., Veroux M., Gioco R., Veroux G., Oragano L., Zonta S., Lovisetto F., Feo C. V., Pesce A., Fabbri N., Marino F., Perrone F., Vincenti L., Papagni V., Picciariello A., Rossi S., Picardi B., Del Monte S. R., Visconti D., Osella G., Petruzzelli L., Pignata G., Andreuccetti J., D'Alessio R., Buonfantino M., Guaitoli E., Spinelli S., Sampietro G. M., Corbellini C., Lorusso L., Frontali A., Pezzoli I., Bonomi A., Chierici A., Cotsoglou C., Manca G., Delvecchio A., Musa N., Casati M., Letizia L., Abate E., Ercolani G., D'Acapito F., Solaini L., Guercioni G., Cicconi S., Sasia D., Borghi F., Giraudo G., Sena G., Castaldo P., Cardamone E., Portale G., Zuin M., Spolverato Y., Esposito M., Isernia R. M., Di Salvo M., Manunza R., Esposito G., Agus M., Asti E. L. G., Bernardi D. T., Tonucci T. P., Luppi D., Casadei M., Bonilauri S., Pezzolla A., Panebianco A., Laforgia R., De Luca M., Zese M., Parini D., Jovine E., De Sario G., Lombardi R., Aprea G., Palomba G., Capuano M., Argenio G., Orio G., Armellino M. F., Troian M., Guerra M., Nagliati C., Biloslavo A., Germani P., Aizza G., Monsellato I., Chahrour A. C., Anania G., Bombardini C., Bagolini F., Sganga G., Fransvea P., Bianchi V., Boati P., Ferrara F., Palmieri F., Cianci P., Gattulli D., Restini E., Cillara N., Cannavera A., Nita G. E., Sarnari J., Roscio F., Clerici F., Scandroglio I., Berti S., Cadeo A., Filippelli A., Conti L., Grassi C., Cattaneo G. M., Pighin M., Papis D., Gambino G., Bertino V., Schifano D., Prando D., Fogato L., Cavallo F., Ansaloni L., Picheo R., Pontarolo N., Depalma N., Spampinato M., D'Ugo S., Lepre L., Capponi M. G., Campa R. D., Sarro G., Dinuzzi V. P., Olmi S., Uccelli M., Ferrari D., Inama M., Moretto G., Fontana M., Favi F., Picariello E., Rampini A., Barberis A., Azzinnaro A., Oliva A., Totaro L., Benzoni I., Ranieri V., Capolupo G. T., Carannante F., Caricato M., Ronconi M., Casiraghi S., Casole G., Pantalone D., Alemanno G., Scheiterle M., Ceresoli M., Cereda M., Fumagalli C., Zanzi F., Bolzon S., Guerra E., Lecchi F., Cellerino P., Ardito A., Scaramuzzo R., Balla A., Lepiane P., Tartaglia N., Ambrosi A., Pavone G., Palini G. M., Veneroni S., Garulli G., Ricci C., Torre B., Russo I. S., Rottoli M., Tanzanu M., Belvedere A., Milone M., Manigrasso M., De Palma G. D., Piccoli M., Pattacini G. C., Magnone S., Bertoli P., Massucco P., Palisi M., Luzzi A. -P., Fleres F., Clarizia G., Spolini A., Kobe Y., Toma T., Shimamura F., Parker R., Ranketi S., Mitei M., Svagzdys S., Pauzas H., Zilinskas J., Poskus T., Kryzauskas M., Jakubauskas M., Zakaria A. D., Zakaria Z., Wong M. P. -K., Jusoh A. C., Zakaria M. N., Cruz D. R., Elizalde A. B. R., Reynaud A. B., Hernandez E. E. L., Monroy J. M. V. P., Hinojosa-Ugarte D., Quiodettis M., Du Bois M. E., Latorraca J., Major P., Pedziwiatr M., Pisarska-Adamczyk M., Waledziak M., Kwiatkowski A., Czyzykowski L., da Costa S. D., Pereira B., Ferreira A. R. O., Almeida F., Rocha R., Carneiro C., Perez D. P., Carvas J., Rocha C., Ferreira C., Marques R., Fernandes U., Leao P., Goulart A., Pereira R. G., Patrocinio S. D. D., de Mendonca N. G. G., Manso M. I. C., Morais H. M. C., Cardoso P. S., Calu V., Miron A., Toma E. A., Gachabayov M., Abdullaev A., Litvin A., Nechay T., Tyagunov A., Yuldashev A., Bradley A., Wilson M., Panyko A., Lateckova Z., Lacko V., Lesko D., Soltes M., Radonak J., Turrado-Rodriguez V., Termes-Serra R., Morales-Sevillano X., Lapolla P., Mingoli A., Brachini G., Degiuli M., Sofia S., Reddavid R., de Manzoni Garberini A., Buffone A., del Pozo E. P., Aparicio-Sanchez D., Dos Barbeito S., Estaire-Gomez M., Viton-Herrero R., de los Angeles Gil Olarte-Marquez M. a., Gil-Martinez J., Alconchel F., Nicolas-Lopez T., Rahy-Martin A. C., Pelloni M., Banolas-Suarez R., Mendoza-Moreno F., Nisa F. G. -M., Diez-Alonso M., Rodas M. E. V., Agundez M. C., Andres M. I. P., Moreira C. C. L., Perez A. L., Ponce I. A., Gonzalez-Castillo A. M., Membrilla-Fernandez E., Salvans S., Serradilla-Martin M., Pardo P. S., Rivera-Alonso D., Dziakova J., Huguet J. M., Valle N. P., Ruiz E. C., Valcarcel C. R., Moreno C. R., Salazar Y. T. M., Garcia J. J. R., Mico S. S., Lopez J. R., Farre S. P., Gomez M. S., Petit N. M., Titos-Garcia A., Aranda-Narvaez J. M., Romacho-Lopez L., Sanchez-Guillen L., Aranaz-Ostariz V., Bosch-Ramirez M., Martinez-Perez A., Martinez-Lopez E., Sebastian-Tomas J. C., Jimenez-Riera G., Jimenez-Vega J., Cuellar J. A. N., Campos-Serra A., Munoz-Campana A., Gracia-Roman R., Alegre J. M., Pinto F. L., O'Sullivan S. N., Antona F. B., Jimenez B. M., Lopez-Sanchez J., Carmona Z. G., Fernandez R. T., Sierra I. B., de Leon L. R. G., Moreno V. P., Iglesias E., Cumplido P. L., Bravo A. A., Simo I. R., Dominguez C. L., Caamano A. G., Lozano R. C., Martinez M. D., Torres A. N., de Quiros J. T. M. B., Pellino G., Cloquell M. M., Moller E. G., Jalal-Eldin S., Abdoun A. K., Hamid H. K. S., Lohsiriwat V., Mongkhonsupphawan A., Baraket O., Ayed K., Abbassi I., Ali A. B., Ammar H., Kchaou A., Tlili A., Zribi I., Colak E., Polat S., Koylu Z. A., Guner A., Usta M. A., Reis M. E., Mantoglu B., Gonullu E., Akin E., Altintoprak F., Bayhan Z., Firat N., Isik A., Memis U., Bayrak M., Altintas Y., Kara Y., Bozkurt M. A., Kocatas A., Das K., Seker A., Ozer N., Atici S. D., Tuncer K., Kaya T., Ozkan Z., Ilhan O., Agackiran I., Uzunoglu M. Y., Demirbas E., Altinel Y., Meric S., Hacim N. A., Uymaz D. S., Omarov N., Balik E., Tebala G. D., Khalil H., Rana M., Khan M., Florence C., Swaminathan C., Leo C. A., Liasis L., Watfah J., Trostchansky I., Delgado E., Pontillo M., Latifi R., Coimbra R., Edwards S., Lopez A., Velmahos G., Dorken A., Gebran A., Palmer A., Oury J., Bardes J. M., Seng S. S., Coffua L. S., Ratnasekera A., Egodage T., Echeverria-Rosario K., Armento I., Napolitano L. M., Sangji N. F., Hemmila M., Quick J. A., Austin T. R., Hyman T. S., Curtiss W., McClure A., Cairl N., Biffl W. L., Truong H. P., Schaffer K., Reames S., Banchini F., Capelli P., Coccolini F., Sartelli M., Bravi F., Vallicelli C., Agnoletti V., Baiocchi G. L., Catena F., Perrone, G, Giuffrida, M, Abu-Zidan, F, Kruger, V, Livrini, M, Petracca, G, Rossi, G, Tarasconi, A, Tian, B, Bonati, E, Mentz, R, Mazzini, F, Campana, J, Gasser, E, Kafka-Ritsch, R, Felsenreich, D, Dawoud, C, Riss, S, Gomes, C, Gomes, F, Gonzaga, R, Canton, C, Pereira, B, Fraga, G, Zem, L, Cordeiro-Fonseca, V, de Mesquita Tauil, R, Atanasov, B, Belev, N, Kovachev, N, Melendez, L, Dimova, A, Dimov, S, Zelic, Z, Augustin, G, Bogdanic, B, Moric, T, Chouillard, E, Bajul, M, De Simone, B, Panis, Y, Esposito, F, Notarnicola, M, Lauka, L, Fabbri, A, Hentati, H, Fnaiech, I, Aurelien, V, Bougard, M, Roulet, M, Demetrashvili, Z, Pipia, I, Merabishvili, G, Bouliaris, K, Koukoulis, G, Doudakmanis, C, Xenaki, S, Chrysos, E, Kokkinakis, S, Vassiliu, P, Michalopoulos, N, Margaris, I, Kechagias, A, Avgerinos, K, Katunin, J, Lostoridis, E, Nagorni, E, Pujante, A, Mulita, F, Maroulis, I, Vailas, M, Marinis, A, Siannis, I, Bourbouteli, E, Manatakis, D, Tasis, N, Acheimastos, V, Maria, S, Stylianos, K, Kuzeridis, H, Korkolis, D, Fradelos, E, Kavalieratos, G, Petropoulou, T, Polydorou, A, Papacostantinou, I, Triantafyllou, T, Kimpizi, D, Theodorou, D, Toutouzas, K, Chamzin, A, Frountzas, M, Schizas, D, Karavokyros, I, Syllaios, A, Charalabopoulos, A, Boura, M, Baili, E, Ioannidis, O, Loutzidou, L, Anestiadou, E, Tsouknidas, I, Petrakis, G, Polenta, E, Bains, L, Gupta, R, Singh, S, Khanduri, A, Bala, M, Kedar, A, Pisano, M, Podda, M, Pisanu, A, Martines, G, Trigiante, G, Lantone, G, Agrusa, A, Di Buono, G, Buscemi, S, Veroux, M, Gioco, R, Veroux, G, Oragano, L, Zonta, S, Lovisetto, F, Feo, C, Pesce, A, Fabbri, N, Marino, F, Perrone, F, Vincenti, L, Papagni, V, Picciariello, A, Rossi, S, Picardi, B, Del Monte, S, Visconti, D, Osella, G, Petruzzelli, L, Pignata, G, Andreuccetti, J, D'Alessio, R, Buonfantino, M, Guaitoli, E, Spinelli, S, Sampietro, G, Corbellini, C, Lorusso, L, Frontali, A, Pezzoli, I, Bonomi, A, Chierici, A, Cotsoglou, C, Manca, G, Delvecchio, A, Musa, N, Casati, M, Letizia, L, Abate, E, Ercolani, G, D'Acapito, F, Solaini, L, Guercioni, G, Cicconi, S, Sasia, D, Borghi, F, Giraudo, G, Sena, G, Castaldo, P, Cardamone, E, Portale, G, Zuin, M, Spolverato, Y, Esposito, M, Isernia, R, Di Salvo, M, Manunza, R, Esposito, G, Agus, M, Asti, E, Bernardi, D, Tonucci, T, Luppi, D, Casadei, M, Bonilauri, S, Pezzolla, A, Panebianco, A, Laforgia, R, De Luca, M, Zese, M, Parini, D, Jovine, E, De Sario, G, Lombardi, R, Aprea, G, Palomba, G, Capuano, M, Argenio, G, Orio, G, Armellino, M, Troian, M, Guerra, M, Nagliati, C, Biloslavo, A, Germani, P, Aizza, G, Monsellato, I, Chahrour, A, Anania, G, Bombardini, C, Bagolini, F, Sganga, G, Fransvea, P, Bianchi, V, Boati, P, Ferrara, F, Palmieri, F, Cianci, P, Gattulli, D, Restini, E, Cillara, N, Cannavera, A, Nita, G, Sarnari, J, Roscio, F, Clerici, F, Scandroglio, I, Berti, S, Cadeo, A, Filippelli, A, Conti, L, Grassi, C, Cattaneo, G, Pighin, M, Papis, D, Gambino, G, Bertino, V, Schifano, D, Prando, D, Fogato, 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Abstract

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.

Published
2024

9. Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey

Author

Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, Antonino, Agrusa, Daniele, Aguzzi, Mariantonietta, Alagia, Laura, Alberici, Marco Ettore Allaix, Luisa, Ambrosio, Alfonso, Amendola, Michele, Ammendola, Pietro Maria Amodio, Gabriele, Anania, Jacopo, Andreuccetti, Alfredo, Annichiarico, Pietro, Anoldo, Alessandro, Anselmo, Giovanni, Aprea, Giacomo, Arcuri, Alberto, Arezzo, Giulia, Armatura, Giulia, Bagaglini, Francesco, Bagolini, Beatrice, Bailetti, Gianluca, Baiocchi, Edoardo, Baldini, Elisa, Bannone, Mirko, Barone, Gianluca, Baronio, Raffaele, Basile, Bellucci, Marco, Andrea Benedetti Cacciaguerra, Ilaria, Benzoni, Francesco, Bianco, Giuseppe, Boccia, Cristina, Bombardini, Luigi, Boni, Dario, Bono, Luca Domenico Bonomo, Giulia, Bonventre, Andrea, Bottari, Claudio, Botti, Giacomo, Brentegani, Mattia, Buonomo, Umberto, Bracale, Cosimo, Callari, Luca, Calligaris, Pietro Giorgio Calò, Angelo, Cangiano, Lorenzo, Capezzuoli, Gabriella Teresa Capolupo, Marianna, Capuano, Filippo, Carannante, Eugenia, Cardamone, Teresa, Carfora, Chiara, Caricato, Pietro, Carnevali, Francesco Maria Carrano, Lorenzo, Casali, Gianmaria Casoni Pataccini, Gianluca, Cassese, Simone, Castiglioni, Flavia, Cavicchi, Ceccarelli, Graziano, Giovanni, Cestaro, Pasquale, Cianci, Claudio, Cimmino, Marco, Clementi, Coletta, Diego, Riccardo, Conventi, Corallino, Diletta, Maurizio, Costantini, Lorenzo, Crepaz, Diego, Cuccurullo, Curci, FABIO PIO, Giuseppe, Currò, Giorgio, Dalmonte, Giovanni, D'Alterio, Michele, D'Ambra, D'Ambrosio, Giancarlo, Anna, D'Amore, Michele De Capua, Simona, Deidda, Daniele, Delogu, Maurizio De Luca, Nicolò De Manzini, DE STEFANI, Elena, Giuseppe Di Buono, Marcello Di Martino, DI TOMASO, Anna, Ugo, Elmore, CORDOVA HERENCIA, INGRID ELVA, Giovanni, Emiliani, Sofia, Esposito, Fazio, Federico, Federico, Festa, Marcello, Filotico, Fiocca, Fausto, Irene, Fiume, Francesco, Fleres, Giulia, Fontana, Tommaso, Fontana, Edoardo, Forcignanò, Giampaolo, Formisano, Laura, Fortuna, Uberto Fumagalli Romario, Andrea, Galderisi, Raffaele, Galleano, Carlo, Gazia, Alessio, Giordano, Giorgio, Giraudo, Maria Carmela Giuffrida, Simona, Giura, Anna, Guida, Antonio Maria Iannello, Marco, Inama, Sara, Ingallinella, Iossa, Angelo, Livio, Iudici, Laracca, GIOVANNI GUGLIELMO, LARGHI LAUREIRO, Zoe, Saverio, Latteri, Luca, Leonardi, Pasquale, Lepiane, Edelweiss, Licitra, Paolo, Locurto, Sarah Lo Faso, Nicola, Luciani, Luzza, Luigi, Magaletti, Sara, Michele, Manigrasso, Alessandra, Marano, Francesco, Marchetti, Alessandra, Marello, Nicolò, Mariani, Jacopo Nicolò Marin, Gennaro, Martines, Laura, Mastrangelo, Antonio, Matarangolo, Marco, Materazzo, Mazzarella, Gennaro, Giorgio, Mazzarolo, Maria Paola Menna, Meoli, Francesca, Marco, Milone, Elisabetta, Moggia, Davide, Moioli, Sarah, Molfino, Vitantonio, Mongelli, Roberto, Montalti, Giulia, Montori, Luca, Morelli, Gianluigi, Moretto, Muttillo, EDOARDO MARIA, Irnerio, Muttillo, Francesca, Notte, Alessandro, M Paganini, Gianluca, Pagano, Palmieri, Livia, Giuseppe, Palomba, Valentina, Palumbo, Panetta, Cristina, Giulia, Paradiso, Beniamino, Pascotto, Passannanti, Daniele, Renato, Patrone, Francesca, Pecchini, Francesca, Pego, Fabio, Pelle, Perrotta, Nicola, Wanda, Petz, Biagio, Picardi, Picchetto, Andrea, Chiara, Piceni, Pietricola, Giulia, Enrico, Pinotti, Felice, Pirozzi, Paolo, Pizzini, Poillucci, Gaetano, Ilaria, Puccica, Lorenzo, Ramaci, Rapanotti, Eleonora, Daniela, Rega, Angelica, Reggiani, Giorgio, Romano, Gregorio, Romeo, Luigi, Romeo, Gianluca, Rompianesi, Stefano, Rossi, Edoardo, Saladino, Roberto, Santambrogio, Federica, Saraceno, Giuliano, Sarro, Diego, Sasia, Grazia, Savino, Rosa, Scaramuzzo, Antonio, Sciuto, Michela, Scollica, Giovanni, Scudo, Ardit, Seitaj, Carlo, Serra, Francesco, Serra, Pierpaolo, Sileri, Leandro, Siragusa, Carmen, Sorrentino, Giuseppe, Surfaro, Ernesto, Tartaglia, Beatrice, Torre, Andrea, Tufo, Matteo, Uccelli, Alessandro, Ussia, Vaccari, Samuele, Marina, Valente, Sara, Vertaldi, Alessandro, Vitali, Luca, Zaccherini, Luigi, Zorcolo, Noemi, Zorzetti, Balla, A., Sartori, A., Botteri, E., Podda, M., Ortenzi, M., Silecchia, G., Guerrieri, M., Agresta, F., Agrusa, A., Aguzzi, D., Alagia, M., Alberici, L., Allaix, M. E., Ambrosio, L., Amendola, A., Ammendola, M., Amodio, P. M., Anania, G., Andreuccetti, J., Annichiarico, A., Anoldo, P., Anselmo, A., Aprea, G., Arcuri, G., Arezzo, A., Armatura, G., Bagaglini, G., Bagolini, F., Bailetti, B., Baiocchi, G., Baldini, E., Bannone, E., Barone, M., Baronio, G., Basile, R., Bellucci, M., Cacciaguerra, A. B., Benzoni, I., Bianco, F., Boccia, G., Bombardini, C., Boni, L., Bono, D., Bonomo, L. D., Bonventre, G., Bottari, A., Botti, C., Brentegani, G., Buonomo, M., Bracale, U., Callari, C., Calligaris, L., Calo, P. G., Cangiano, A., Capezzuoli, L., Capolupo, G. T., Capuano, M., Carannante, F., Cardamone, E., Carfora, T., Caricato, C., Carnevali, P., Carrano, F. M., Casali, L., Pataccini, G. C., Cassese, G., Castiglioni, S., Cavicchi, F., Ceccarelli, G., Cestaro, G., Cianci, P., Cimmino, C., Clementi, M., Coletta, D., Conventi, R., Corallino, D., Costantini, M., Crepaz, L., Cuccurullo, D., Curci, F. P., Curro, G., Dalmonte, G., D'Alterio, G., D'Ambra, M., D'Ambrosio, G., D'Amore, A., De Capua, M., Deidda, S., Delogu, D., De Luca, M., De Manzini, N., De Stefani, E., Di Buono, G., Di Martino, M., Di Tomaso, A., Elmore, U., Herencia, I. E. C., Emiliani, G., Esposito, S., Fazio, F., Festa, F., Filotico, M., Fiocca, F., Fiume, I., Fleres, F., Fontana, G., Fontana, T., Forcignano, E., Formisano, G., Fortuna, L., Romario, U. F., Galderisi, A., Galleano, R., Gazia, C., Giordano, A., Giraudo, G., Giuffrida, M. C., Giura, S., Guida, A., Iannello, A. M., Inama, M., Ingallinella, S., Iossa, A., Iudici, L., Laracca, G. G., Laureiro, Z. L., Latteri, S., Leonardi, L., Lepiane, P., Licitra, E., Locurto, P., Faso, S. L., Luciani, N., Luzza, L., Magaletti, S., Manigrasso, M., Marano, A., Marchetti, F., Marello, A., Mariani, N., Marin, J. N., Martines, G., Mastrangelo, L., Matarangolo, A., Materazzo, M., Mazzarella, G., Mazzarolo, G., Menna, M. P., Meoli, F., Milone, M., Moggia, E., Moioli, D., Molfino, S., Mongelli, V., Montalti, R., Montori, G., Morelli, L., Moretto, G., Muttillo, E. M., Muttillo, I., Notte, F., Paganini, A. M., Pagano, G., Palmieri, L., Palomba, G., Palumbo, V., Panetta, C., Paradiso, G., Pascotto, B., Passannanti, D., Patrone, R., Pecchini, F., Pego, F., Pelle, F., Perrotta, N., Petz, W., Picardi, B., Picchetto, A., Piceni, C., Pietricola, G., Pinotti, E., Pirozzi, F., Pizzini, P., Poillucci, G., Puccica, I., Ramaci, L., Rapanotti, E., Rega, D., Reggiani, A., Romano, G., Romeo, G., Romeo, L., Rompianesi, G., Rossi, S., Saladino, E., Santambrogio, R., Saraceno, F., Sarro, G., Sasia, D., Savino, G., Scaramuzzo, R., Sciuto, A., Scollica, M., Scudo, G., Seitaj, A., Serra, C., Serra, F., Sileri, P., Siragusa, L., Sorrentino, C., Surfaro, G., Tartaglia, E., Torre, B., Tufo, A., Uccelli, M., Ussia, A., Vaccari, S., Valente, M., Vertaldi, S., Vitali, A., Zaccherini, L., Zorcolo, L., Zorzetti, N., Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, de Manzini, Nicolo, and ARMIS (Augmented Reality in Minimally Invasive Surgery) Collaborative, Group

Subjects
Virtual reality (VR), minimally invasive surgery (MIS), Augmented reality (AR), Minimally invasive surgery (MIS), Mixed reality (MR), Survey, Training, training, augmented reality (AR), mixed reality (MR), survey, virtual reality (VR), Settore MED/18 - Chirurgia Generale, Surgery
Abstract

Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training.

Published
2023

10. Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group.

Author

Turri G, Martinelli L, Rega D, Tamini N, Paiano L, Deidda S, Bao Q, Lorenzon L, De Luca R, Foppa C, Mari V, Taffurelli G, Picciariello A, Marsanic P, Siragusa L, Bagolini F, Nascimbeni R, Rizzo G, Vertaldi S, Zuolo M, Bianchi G, Rorato LM, Reddavid R, Gallo G, Crepaz L, Di Leo A, Trompetto M, Potenza E, Santarelli M, de'Angelis N, Ciarleglio F, Milone M, Coco C, Tiberio GA, Anania G, Sica GS, Muratore A, Altomare DF, Montroni I, De Luca M, Spinelli A, Simone M, Persiani R, Spolverato G, Restivo A, de Manzini N, Braga M, Delrio P, Verlato G, and Pedrazzani C

Abstract

Objective: The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery., Background: Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences are scarce., Methods: This is a retrospective multicenter cohort study considering patients who underwent surgery at 25 Italian centers between 2010 and 2019, with a minimum follow-up of 24 months. A total of 1883 consecutive adult patients with stage I CC treated with curative surgery were considered, and 1611 fulfilled the inclusion criteria. The primary outcome was the rate of recurrence. Secondary outcomes included survival and risk factors for recurrence., Results: Eighty patients developed cancer recurrence (5.0%), of which 90% was systemic relapse. The event was more frequent in pT2 (6.0% vs 3.2%, P = 0.013), male patients (6.1% vs 3.6%, P = 0.021), in the presence of lymphovascular invasion (7.2% vs 3.6%, P = 0.01), and in cases of partial resection (11.1% vs 4.6%, P = 0.011). Also, preoperative carcinoembryonic antigen ( P = 0.007) and tumor diameter ( P < 0.001) were higher in the group who relapsed. Most patients had isolated cancer recurrence (90%). Recurrences peaked between 10 and 18 months after surgery and declined over time. Adjusted Cox regression analysis identified tumor diameter, carcinoembryonic antigen level, lymphovascular invasion, male gender, and less than 12 analyzed lymph nodes as significant risk factors for worse recurrence-free survival., Conclusions: This study showed that a not negligible rate of stage I CC recur after curative surgery. Most relapses occur at a single site within the first 3 years after surgery. This evidence could be used to optimize postoperative follow-up., Competing Interests: Disclosure: The authors declare that they have nothing to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2024
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11. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago.

Author

Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, Rossi G, Tarasconi A, Tian BWCA, Bonati E, Mentz R, Mazzini FN, Campana JP, Gasser E, Kafka-Ritsch R, Felsenreich DM, Dawoud C, Riss S, Gomes CA, Gomes FC, Gonzaga RAT, Canton CAB, Pereira BM, Fraga GP, Zem LG, Cordeiro-Fonseca V, de Mesquita Tauil R, Atanasov B, Belev N, Kovachev N, Meléndez LJJ, Dimova A, Dimov S, Zelić Z, Augustin G, Bogdanić B, Morić T, Chouillard E, Bajul M, De Simone B, Panis Y, Esposito F, Notarnicola M, Lauka L, Fabbri A, Hentati H, Fnaiech I, Aurélien V, Bougard M, Roulet M, Demetrashvili Z, Pipia I, Merabishvili G, Bouliaris K, Koukoulis G, Doudakmanis C, Xenaki S, Chrysos E, Kokkinakis S, Vassiliu P, Michalopoulos N, Margaris I, Kechagias A, Avgerinos K, Katunin J, Lostoridis E, Nagorni EA, Pujante A, Mulita F, Maroulis I, Vailas M, Marinis A, Siannis I, Bourbouteli E, Manatakis DK, Tasis N, Acheimastos V, Maria S, Stylianos K, Kuzeridis H, Korkolis D, Fradelos E, Kavalieratos G, Petropoulou T, Polydorou A, Papacostantinou I, Triantafyllou T, Kimpizi D, Theodorou D, Toutouzas K, Chamzin A, Frountzas M, Schizas D, Karavokyros I, Syllaios A, Charalabopoulos A, Boura M, Baili E, Ioannidis O, Loutzidou L, Anestiadou E, Tsouknidas I, Petrakis G, Polenta E, Bains L, Gupta R, Singh SK, Khanduri A, Bala M, Kedar A, Pisano M, Podda M, Pisanu A, Martines G, Trigiante G, Lantone G, Agrusa A, Di Buono G, Buscemi S, Veroux M, Gioco R, Veroux G, Oragano L, Zonta S, Lovisetto F, Feo CV, Pesce A, Fabbri N, Lantone G, Marino F, Perrone F, Vincenti L, Papagni V, Picciariello A, Rossi S, Picardi B, Del Monte SR, Visconti D, Osella G, Petruzzelli L, Pignata G, Andreuccetti J, D'Alessio R, Buonfantino M, Guaitoli E, Spinelli S, Sampietro GM, Corbellini C, Lorusso L, Frontali A, Pezzoli I, Bonomi A, Chierici A, Cotsoglou C, Manca G, Delvecchio A, Musa N, Casati M, Letizia L, Abate E, Ercolani G, D'Acapito F, Solaini L, Guercioni G, Cicconi S, Sasia D, Borghi F, Giraudo G, Sena G, Castaldo P, Cardamone E, Portale G, Zuin M, Spolverato Y, Esposito M, Isernia RM, Di Salvo M, Manunza R, Esposito G, Agus M, Asti ELG, Bernardi DT, Tonucci TP, Luppi D, Casadei M, Bonilauri S, Pezzolla A, Panebianco A, Laforgia R, De Luca M, Zese M, Parini D, Jovine E, De Sario G, Lombardi R, Aprea G, Palomba G, Capuano M, Argenio G, Orio G, Armellino MF, Troian M, Guerra M, Nagliati C, Biloslavo A, Germani P, Aizza G, Monsellato I, Chahrour AC, Anania G, Bombardini C, Bagolini F, Sganga G, Fransvea P, Bianchi V, Boati P, Ferrara F, Palmieri F, Cianci P, Gattulli D, Restini E, Cillara N, Cannavera A, Nita GE, Sarnari J, Roscio F, Clerici F, Scandroglio I, Berti S, Cadeo A, Filippelli A, Conti L, Grassi C, Cattaneo GM, Pighin M, Papis D, Gambino G, Bertino V, Schifano D, Prando D, Fogato L, Cavallo F, Ansaloni L, Picheo R, Pontarolo N, Depalma N, Spampinato M, D'Ugo S, Lepre L, Capponi MG, Campa RD, Sarro G, Dinuzzi VP, Olmi S, Uccelli M, Ferrari D, Inama M, Moretto G, Fontana M, Favi F, Picariello E, Rampini A, Barberis A, Azzinnaro A, Oliva A, Totaro L, Benzoni I, Ranieri V, Capolupo GT, Carannante F, Caricato M, Ronconi M, Casiraghi S, Casole G, Pantalone D, Alemanno G, Scheiterle M, Ceresoli M, Cereda M, Fumagalli C, Zanzi F, Bolzon S, Guerra E, Lecchi F, Cellerino P, Ardito A, Scaramuzzo R, Balla A, Lepiane P, Tartaglia N, Ambrosi A, Pavone G, Palini GM, Veneroni S, Garulli G, Ricci C, Torre B, Russo IS, Rottoli M, Tanzanu M, Belvedere A, Milone M, Manigrasso M, De Palma GD, Piccoli M, Pattacini GC, Magnone S, Bertoli P, Pisano M, Massucco P, Palisi M, Luzzi AP, Fleres F, Clarizia G, Spolini A, Kobe Y, Toma T, Shimamura F, Parker R, Ranketi S, Mitei M, Svagzdys S, Pauzas H, Zilinskas J, Poskus T, Kryzauskas M, Jakubauskas M, Zakaria AD, Zakaria Z, Wong MP, Jusoh AC, Zakaria MN, Cruz DR, Elizalde ABR, Reynaud AB, Hernandez EEL, Monroy JMVP, Hinojosa-Ugarte D, Quiodettis M, Du Bois ME, Latorraca J, Major P, Pędziwiatr M, Pisarska-Adamczyk M, Walędziak M, Kwiatkowski A, Czyżykowski Ł, da Costa SD, Pereira B, Ferreira ARO, Almeida F, Rocha R, Carneiro C, Perez DP, Carvas J, Rocha C, Ferreira C, Marques R, Fernandes U, Leao P, Goulart A, Pereira RG, Patrocínio SDD, de Mendonça NGG, Manso MIC, Morais HMC, Cardoso PS, Calu V, Miron A, Toma EA, Gachabayov M, Abdullaev A, Litvin A, Nechay T, Tyagunov A, Yuldashev A, Bradley A, Wilson M, Panyko A, Látečková Z, Lacko V, Lesko D, Soltes M, Radonak J, Turrado-Rodriguez V, Termes-Serra R, Morales-Sevillano X, Lapolla P, Mingoli A, Brachini G, Degiuli M, Sofia S, Reddavid R, de Manzoni Garberini A, Buffone A, Del Pozo EP, Aparicio-Sánchez D, Dos Barbeito S, Estaire-Gómez M, Vitón-Herrero R, de Los Ángeles Gil Olarte-Marquez M, Gil-Martínez J, Alconchel F, Nicolás-López T, Rahy-Martin AC, Pelloni M, Bañolas-Suarez R, Mendoza-Moreno F, Nisa FG, Díez-Alonso M, Rodas MEV, Agundez MC, Andrés MIP, Moreira CCL, Perez AL, Ponce IA, González-Castillo AM, Membrilla-Fernández E, Salvans S, Serradilla-Martín M, Pardo PS, Rivera-Alonso D, Dziakova J, Huguet JM, Valle NP, Ruiz EC, Valcárcel CR, Moreno CR, Salazar YTM, García JJR, Micó SS, López JR, Farré SP, Gomez MS, Petit NM, Titos-García A, Aranda-Narváez JM, Romacho-López L, Sánchez-Guillén L, Aranaz-Ostariz V, Bosch-Ramírez M, Martínez-Pérez A, Martínez-López E, Sebastián-Tomás JC, Jimenez-Riera G, Jimenez-Vega J, Cuellar JAN, Campos-Serra A, Muñoz-Campaña A, Gràcia-Roman R, Alegre JM, Pinto FL, O'Sullivan SN, Antona FB, Jiménez BM, López-Sánchez J, Carmona ZG, Fernández RT, Sierra IB, de León LRG, Moreno VP, Iglesias E, Cumplido PL, Bravo AA, Simó IR, Domínguez CL, Caamaño AG, Lozano RC, Martínez MD, Torres ÁN, de Quiros JTMB, Pellino G, Cloquell MM, Moller EG, Jalal-Eldin S, Abdoun AK, Hamid HKS, Lohsiriwat V, Mongkhonsupphawan A, Baraket O, Ayed K, Abbassi I, Ali AB, Ammar H, Kchaou A, Tlili A, Zribi I, Colak E, Polat S, Koylu ZA, Guner A, Usta MA, Reis ME, Mantoglu B, Gonullu E, Akin E, Altintoprak F, Bayhan Z, Firat N, Isik A, Memis U, Bayrak M, Altıntaş Y, Kara Y, Bozkurt MA, Kocataş A, Das K, Seker A, Ozer N, Atici SD, Tuncer K, Kaya T, Ozkan Z, Ilhan O, Agackiran I, Uzunoglu MY, Demirbas E, Altinel Y, Meric S, Hacım NA, Uymaz DS, Omarov N, Balık E, Tebala GD, Khalil H, Rana M, Khan M, Florence C, Swaminathan C, Leo CA, Liasis L, Watfah J, Trostchansky I, Delgado E, Pontillo M, Latifi R, Coimbra R, Edwards S, Lopez A, Velmahos G, Dorken A, Gebran A, Palmer A, Oury J, Bardes JM, Seng SS, Coffua LS, Ratnasekera A, Egodage T, Echeverria-Rosario K, Armento I, Napolitano LM, Sangji NF, Hemmila M, Quick JA, Austin TR, Hyman TS, Curtiss W, McClure A, Cairl N, Biffl WL, Truong HP, Schaffer K, Reames S, Banchini F, Capelli P, Coccolini F, Sartelli M, Bravi F, Vallicelli C, Agnoletti V, Baiocchi GL, and Catena F

Subjects
Female, Humans, Middle Aged, Aged, Aged, 80 and over, Male, Prospective Studies, Postoperative Complications etiology, Anastomosis, Surgical methods, Emergencies, Colorectal Neoplasms surgery
Abstract

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA., Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up., Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections., Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception., (© 2024. The Author(s).)

Published
2024
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12. Unilateral Thoracoscopic Thymectomy for Thymoma: Does Side Matter? A Single Institutional Experience.

Author

Tamburini N, D'Urbano F, Bagolini F, Trapella GS, Quarantotto F, Cavallesco G, and Maniscalco P

Subjects
Humans, Male, Female, Middle Aged, Aged, Thymectomy adverse effects, Retrospective Studies, Treatment Outcome, Thoracic Surgery, Video-Assisted adverse effects, Thymoma diagnostic imaging, Thymoma surgery, Thymus Neoplasms diagnostic imaging, Thymus Neoplasms surgery
Abstract

Background: Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma., Methods: Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches., Results: Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes ( p  = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days ( p  = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups ( p  = 0.74)., Conclusion: Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2023
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13. Inferior mesenteric artery ligation level in rectal cancer surgery: still no answer-a systematic review and meta-analysis.

Author

Cirocchi R, Marchetti F, Mari G, Bagolini F, Cavaliere D, Avenia S, Anania G, Tebala G, Donini A, Davies RJ, and Fingerhut A

Subjects
Humans, Mesenteric Artery, Inferior surgery, Rectum surgery, Lymph Node Excision adverse effects, Lymph Nodes pathology, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Ligation methods, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Laparoscopy methods
Abstract

Objective: The aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA) ligation on post-operative and oncological outcomes in rectal cancer surgery., Methods: We conducted a systematic review of the literature up to 06 September 2022. Included were RCTs that compared patients who underwent high (HL) vs. anterior (LL) IMA ligation for resection of rectal cancer. The literature search was performed on Medline/PubMed, Scopus, and the Web of Science without any language restrictions. The primary endpoint was overall anastomotic leakage (AL). Secondary endpoints were oncological outcomes, intraoperative complications, urogenital functional outcomes, and length of hospital stay., Results: Eleven RCTs (1331 patients) were included. The overall rate of AL was lower in the LL group, but the difference was not statistically significant (RR 1.43, 95% CI 0.95 to 2.96). The overall number of harvested lymph nodes was higher in the LL group, but the difference was not statistically significant (MD 0.93, 95% CI - 2.21 to 0.34). The number of lymph nodes harvested was assessed in 256 patients, and all had a laparoscopic procedure. The number of lymph nodes was higher when LL was associated with lymphadenectomy of the vascular root than when IMA was ligated at its origin, but there the difference was not statistically significant (MD - 0.37, 95% CI - 1.00 to 0.26). Overall survival at 5 years was slightly better in the LL group, but the difference was not statistically significant (RR 0.98, 95% CI 0.93 to 1.05). Disease-free survival at 5 years was higher in the LL group, but the difference was not statistically significant (RR 0.97, 95% CI 0.89 to 1.04)., Conclusions: There is no evidence to support HL or LL according to results in terms of AL or oncologic outcome. Moreover, there is not enough evidence to determine the impact of the level of IMA ligation on functional outcomes. The level of IMA ligation should be chosen case by case based on expected functional and oncological outcomes., (© 2023. The Author(s).)

Published
2023
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14. Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products.

Author

Occhipinti V, Soriani P, Vavassori S, Annunziata ML, Bagolini F, Cavallaro F, Lagoussis P, Milani V, Rondonotti E, Spina L, Vecchi M, Pastorelli L, and Tontini GE

Subjects
Male, Humans, Aged, Middle Aged, Female, Bisacodyl adverse effects, Polyethylene Glycols adverse effects, Colonoscopy adverse effects, Risk Factors, Cathartics adverse effects, Diabetes Mellitus
Abstract

Introduction: Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients' characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients' tolerance and improve endoscopic outcomes., Methods: We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations., Results: We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91-7.58; low level of instruction: OR, 1.95; 95% CI, 1.11-3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20-4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09-3.88; age > 65 years: OR, 1.51; 95% CI, 1.01-2.27) preparations were identified., Conclusion: Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2023
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15. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

Author

De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, Gomes CA, Moore EE, Moug SJ, Ansaloni L, Kluger Y, Coccolini F, Landaluce-Olavarria A, Estraviz-Mateos B, Uriguen-Etxeberria A, Giordano A, Luna AP, Amín LAH, Hernández AMP, Shabana A, Dzulkarnaen ZA, Othman MA, Sani MI, Balla A, Scaramuzzo R, Lepiane P, Bottari A, Staderini F, Cianchi F, Cavallaro A, Zanghì A, Cappellani A, Campagnacci R, Maurizi A, Martinotti M, Ruggieri A, Jusoh AC, Rahman KA, Zulkifli ASM, Petronio B, Matías-García B, Quiroga-Valcárcel A, Mendoza-Moreno F, Atanasov B, Campanile FC, Vecchioni I, Cardinali L, Travaglini G, Sebastiani E, Chooklin S, Chuklin S, Cianci P, Restini E, Capuzzolo S, Currò G, Filippo R, Rispoli M, Aparicio-Sánchez D, Muñóz-Cruzado VD, Barbeito SD, Delibegovic S, Kesetovic A, Sasia D, Borghi F, Giraudo G, Visconti D, Doria E, Santarelli M, Luppi D, Bonilauri S, Grossi U, Zanus G, Sartori A, Piatto G, De Luca M, Vita D, Conti L, Capelli P, Cattaneo GM, Marinis A, Vederaki SA, Bayrak M, Altıntas Y, Uzunoglu MY, Demirbas IE, Altinel Y, Meric S, Aktimur YE, Uymaz DS, Omarov N, Azamat I, Lostoridis E, Nagorni EA, Pujante A, Anania G, Bombardini C, Bagolini F, Gonullu E, Mantoglu B, Capoglu R, Cappato S, Muzio E, Colak E, Polat S, Koylu ZA, Altintoprak F, Bayhan Z, Akin E, Andolfi E, Rezart S, Kim JI, Jung SW, Shin YC, Enciu O, Toma EA, Medas F, Canu GL, Cappellacci F, D'Acapito F, Ercolani G, Solaini L, Roscio F, Clerici F, Gelmini R, Serra F, Rossi EG, Fleres F, Clarizia G, Spolini A, Ferrara F, Nita G, Sarnari J, Gachabayov M, Abdullaev A, Poillucci G, Palini GM, Veneroni S, Garulli G, Piccoli M, Pattacini GC, Pecchini F, Argenio G, Armellino MF, Brisinda G, Tedesco S, Fransvea P, Ietto G, Franchi C, Carcano G, Martines G, Trigiante G, Negro G, Vega GM, González AR, Ojeda L, Piccolo G, Bondurri A, Maffioli A, Guerci C, Sin BH, Zuhdi Z, Azman A, Mousa H, Al Bahri S, Augustin G, Romic I, Moric T, Nikolopoulos I, Andreuccetti J, Pignata G, D'Alessio R, Kenig J, Skorus U, Fraga GP, Hirano ES, de Lima Bertuol JV, Isik A, Kurnaz E, Asghar MS, Afzal A, Akbar A, Nikolouzakis TK, Lasithiotakis K, Chrysos E, Das K, Özer N, Seker A, Ibrahim M, Hamid HKS, Babiker A, Bouliaris K, Koukoulis G, Kolla CC, Lucchi A, Agostinelli L, Taddei A, Fortuna L, Agostini C, Licari L, Viola S, Callari C, Laface L, Abate E, Casati M, Anastasi A, Canonico G, Gabellini L, Tosi L, Guariniello A, Zanzi F, Bains L, Sydorchuk L, Iftoda O, Sydorchuk A, Malerba M, Costanzo F, Galleano R, Monteleone M, Costanzi A, Riva C, Walędziak M, Kwiatkowski A, Czyżykowski Ł, Major P, Strzałka M, Matyja M, Natkaniec M, Valenti MR, Di Vita MDP, Sotiropoulou M, Kapiris S, Massalou D, Veroux M, Volpicelli A, Gioco R, Uccelli M, Bonaldi M, Olmi S, Nardi M, Livadoti G, Mesina C, Dumitrescu TV, Ciorbagiu MC, Ammendola M, Ammerata G, Romano R, Slavchev M, Misiakos EP, Pikoulis E, Papaconstantinou D, Elbahnasawy M, Abdel-Elsalam S, Felsenreich DM, Jedamzik J, Michalopoulos NV, Sidiropoulos TA, Papadoliopoulou M, Cillara N, Deserra A, Cannavera A, Negoi I, Schizas D, Syllaios A, Vagios I, Gourgiotis S, Dai N, Gurung R, Norrey M, Pesce A, Feo CV, Fabbri N, Machairas N, Dorovinis P, Keramida MD, Mulita F, Verras GI, Vailas M, Yalkin O, Iflazoglu N, Yigit D, Baraket O, Ayed K, Ghalloussi MH, Patias P, Ntokos G, Rahim R, Bala M, Kedar A, Sawyer RG, Trinh A, Miller K, Sydorchuk R, Knut R, Plehutsa O, Liman RK, Ozkan Z, Kader SA, Gupta S, Gureh M, Saeidi S, Aliakbarian M, Dalili A, Shoko T, Kojima M, Nakamoto R, Atici SD, Tuncer GK, Kaya T, Delis SG, Rossi S, Picardi B, Del Monte SR, Triantafyllou T, Theodorou D, Pintar T, Salobir J, Manatakis DK, Tasis N, Acheimastos V, Ioannidis O, Loutzidou L, Symeonidis S, de Sá TC, Rocha M, Guagni T, Pantalone D, Maltinti G, Khokha V, Abdel-Elsalam W, Ghoneim B, López-Ruiz JA, Kara Y, Zainudin S, Hayati F, Azizan N, Khei VTP, Yi RCX, Sellappan H, Demetrashvili Z, Lekiashvili N, Tvaladze A, Froiio C, Bernardi D, Bonavina L, Gil-Olarte A, Grassia S, Romero-Vargas E, Bianco F, Gumbs AA, Dogjani A, Agresta F, Litvin A, Balogh ZJ, Gendrikson G, Martino C, Damaskos D, Pararas N, Kirkpatrick A, Kurtenkov M, Gomes FC, Pisanu A, Nardello O, Gambarini F, Aref H, Angelis ND, Agnoletti V, Biondi A, Vacante M, Griggio G, Tutino R, Massani M, Bisetto G, Occhionorelli S, Andreotti D, Lacavalla D, Biffl WL, and Catena F

Subjects
Male, Humans, Middle Aged, Female, Pandemics, SARS-CoV-2, Postoperative Complications epidemiology, COVID-19 epidemiology, Cholecystitis epidemiology, Cholecystitis surgery, Cholecystitis, Acute epidemiology, Cholecystitis, Acute surgery, Sepsis
Abstract

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not., Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not., Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]., Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands., (© 2022. The Author(s).)

Published
2022
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16. Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study.

Author

Occhipinti V, Soriani P, Bagolini F, Milani V, Rondonotti E, Annunziata ML, Cavallaro F, Vavassori S, Vecchi M, Pastorelli L, and Tontini GE

Abstract

Background: Low-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials (RCT). However, most RCTs do not provide data about clinical outcomes including lesions detection rate. Moreover, real-life comparisons are lacking., Aim: To compare efficacy (both in terms of adequate bowel preparation and detection of colorectal lesions) and tolerability of a high-volume (HV: 4 L polyethylene glycol, PEG) and a low-volume (LV: 2 L PEG plus bisacodyl) bowel preparation in a real-life setting., Methods: Consecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016. Patients could choose either LV or HV preparation, with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures. Adequate bowel preparation according to Boston Bowel Preparation Scale (BBPS), clinical outcomes including polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile/serrated lesion detection rate (SDR) and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed., Results: Total 2040 patients were enrolled and 1815 (mean age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs 38.2%, P = 0.005). High-definition scopes were used in 33.4% of patients, without difference in the two groups ( P = 0.605). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs 86.6%, P = 0.098), also considering the two different schedules (HV split-dose 93.8% vs LV split-dose 93.6%, P = 1; HV day-before 85.5% vs LV day-before 82.3%, P = 0.182). Mean global BBPS score was higher for HV preparations (7.1 ± 1.7 vs 6.8 ± 1.6, P < 0.001). After adjustment for sex, age and indications for colonoscopy, HV preparation resulted higher in PDR [Odds ratio (OR) 1.32, 95%CI: 1.07-1.63, P = 0.011] and ADR (OR 1.29, 95%CI 1.02-1.63, P = 0.038) and comparable to LV in AADR (OR 1.51, 95%CI 0.97-2.35, P = 0.069), SDR and cancer detection rate. The use of standard-definition colonoscopes was associated to lower PDR (adjusted OR 1.59, 95%CI: 1.22-2.08, P < 0.001), ADR (adjusted OR 1.71, 95%CI: 1.26-2.30, P < 0.001) and AADR (adjusted OR 1.97, 95%CI: 1.09-3.56, P = 0.025) in patients receiving LV preparation. Mean Visual Analogue Scale tolerability scored equally (7, P = 0.627) but a ≥ 75% dose intake was more frequent with LV (94.6% vs 92.1%, P = 0.003)., Conclusion: In a real-life setting, PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation. However, with higher PDR and ADR, HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy, especially when colonoscopy is performed with standard resolution imaging., Competing Interests: Conflict-of-interest statement: The authors declare that there is no conflict of interest., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2021
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18. Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients.

Author

Anania G, Davies RJ, Arezzo A, Bagolini F, D'Andrea V, Graziosi L, Di Saverio S, Popivanov G, Cheruiyot I, Cirocchi R, and Donini A

Subjects
Humans, Lymph Node Excision, Neoadjuvant Therapy, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Treatment Outcome, Quality of Life, Rectal Neoplasms pathology, Rectal Neoplasms surgery
Abstract

The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer., Methods: A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer., Results: Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND., Conclusion: Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND., (© 2021. The Author(s).)

Published
2021
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19. Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives.

Author

Romeo L, Bagolini F, Ferro S, Chiozza M, Marino S, Resta G, and Anania G

Subjects
Abdominal Injuries diagnostic imaging, Abdominal Injuries physiopathology, Conservative Treatment methods, Embolization, Therapeutic methods, Female, Hemodynamics, Humans, Laparoscopy trends, Male, Organ Sparing Treatments trends, Spleen diagnostic imaging, Spleen immunology, Splenectomy trends, Trauma Severity Indices, Treatment Failure, Treatment Outcome, Wounds, Nonpenetrating diagnostic imaging, Wounds, Nonpenetrating physiopathology, Abdominal Injuries surgery, Laparoscopy methods, Organ Sparing Treatments methods, Spleen injuries, Splenectomy methods, Wounds, Nonpenetrating surgery
Abstract

The spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

Published
2021
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20. Mechanical hepaticojejunostomy: can we use a circular stapler as a viable and safe alternative? -a retrospective study of a single center.

Author

Fabbri N, Ferro S, Bagolini F, Romeo L, Carcoforo P, Giorgio C, and Pansini G

Abstract

Background: Since the first years of the 1980s, some authors described the use of mechanical stapler for the creation of anastomosis in biliary surgery. However, the use of these devices has not spread during the following decades, and nowadays most centers usually craft hand-sewn anastomosis., Methods: We retrospectively collected data from medical records, surgical registries and computerized databases about the use of mechanical circular staplers for the creation of hepaticojejunostomy at our institution., Results: From 2012 to 2020, 11 stapled hepaticojejunostomy for both neoplastic and non-neoplastic diseases were performed at our institution. The mean age of the patient was 74, with a sex distribution of 5 men and 6 women. The mean preoperative common bile duct diameter was 19 mm. Preoperative blood samples showed mean total bilirubin of 6.95 mg/dL. No intraoperative complications were reported. Two patients (18%) had minor postoperative complications (1 wound dehiscence and 1 episode of melena that required blood transfusions), while no major complications occurred. No patients developed biliary fistula or anastomotic dehiscence. No one dies within 30 days from surgery. The mean postoperative length of stay was 13 days., Conclusions: According to our limited experience, stapled hepaticojejunostomy seems to be a safe and effective technique in selected patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-387). The authors have no conflicts of interest to declare., (2020 Gland Surgery. All rights reserved.)

Published
2020
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