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The Coronavirus (COVID-19) pandemic activated a global health crisis. The best practice in operating room (OR) is a discussed argument. This review was performed to clarify the importance and effectiveness of standardized clinical practice (procedure, organization, guidance), identifying contemporary evidence deduced from some international experience. We decided to make a narrative review that analyses the most current shared guidelines and procedures in management of COVID-19 patients in perioperative theatre.Medline was searched using PubMed (from 1 April 2020 to 22 December 2020) for relevant study according with Prisma Guidelines. The studies were assessed and classified for levels of evidence and recommendation. Three factors were extracted: OR organization, personnel safety and procedures.44 articles were identified: eleven met eligibility criteria: of these, four articles are expert opinion/experience/descriptive study, one is a multicenter/descriptive study and six are review/systematic review. 33 articles were excluded because did not meet inclusion criteria. The studies selection is focused on clinical processes in the operating theatre, guidelines for the OR safety, correct procedures for personal protective equipment use, experience and recommendations related to COVID-19 context.Despite the modest number of studies and high evidence, all the publications show agreement about many aspects of OR practice. Global experiences selection confirms the role and the importance of a standardized practice in operating theatre instead personal interpretation; this study aims to provide a guidelines qualitative synthesis for all surgical staff, enclosing basic behaviors for the staff and patient safety in a complex assistant approach on a pandemic time.

To present the University of Genoa Advanced Simulation Center (SimAv) and the project of a trainer (eLap4D) that would achieve the equivalent goals of the fundamentals of laparoscopic surgery trainer at an economical cost. The validation process is going to be shown too. METHODS. The laparoscopic trainer is a physical low-cost laparoscopic training platform that reproduces the tactile feedback (eLaparo4d) integrated with a software for virtual anatomical realistic scenarios (Unity3D V 4.1). A sample of 20 students was selected, divided into 2 homogeneous groups with respect to the level of confidence with the use of video games, consoles, smartphones (this has been possible thanks to the use of a questionnaire, administered before the practical phase of training). The groups participated in a training program based on 5 basic laparoscopic skills (laparoscopic focusing and navigation, hand – eye – coordination and grasp coordination). So, a second and a third study sample was chosen, consisting of 20 post graduate students (intermediate group) and 20 experienced surgeons; for these groups a training program was provided, identical to the previous group as well as their subdivision into 2 group. The face validity was used for an ergonomic analysis of the simulator, the construct to test the system's ability to differentiate potential expert users (experienced surgeons) from non-experts (student without experience in laparoscopic surgery). The authors analyzed the results of the three samples obtained by comparing variables such as score, % of fulfillment, panality and time. At the same time, the students' improvements have been monitored, developing a customized learning curve for each user. To evaluate the structural characteristics of the simulator a specific questionnaire has been used. The results were encouraging. The simulator is ergonomically satisfactory and its structural features are adapted to the training. The system was able to differentiate the level of experience and also has therefore met the requirements of “construct validity”. laparoscopic simulators can be constructed at an economical cost.

Background Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter. Case presentation We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years. Conclusions The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication.

The aim of this study is to investigate the importance of acquiring basic and advanced laparoscopic skills using a virtual reality low cost simulator in laparoscopic surgery. The authors have considered six basic and five advanced skills. The training exercises are related to the acquisition of tasks which allow students to reach basic gestures competences. In the second phase the students will perform complex drills to acquire a correct gesture. The authors have developed a standardized, graduated and evidence-based training course. A software able to handle the training task has been created through a virtual interface based on the concept “student - exercise – evaluation”. The results are expected because data analysis will be possible only after a period of simulator testing on different samples of students. Referring to the experience reported by other authors, they expect significant results in terms of: reduction of learning time, better dexterity, ability to recognize and correct procedural errors, positive economic impact in term of better patients outcome, analyzed by codified clinical indicators.

Considering the extensive experience developed in 28 years of medical practice in a specialist facility dedicated to proctological surgery and the treatment of 2.467 patients presenting with an anal fistula, the authors review problems associated with this disease from an aetiopathogenic, classifying, diagnostic, and therapeutic viewpoint.The surgical treatment of Arnous's French School was adopted. The method envisions slow sectioning of the sphincter by means of elastic constriction, even dividing surgical sessions.Results were excellent, recording 99.5% of complete healings, while failures and complications numbered 0.3% of incomplete healings, 0.2% of relapses, 2.8% of soiling, and 1.4% of transitory gas incontinence.Correct diagnosis of the type of fistula, the choice of a perfect surgical technique, and thorough long-term follow-up of the postoperative progress of surgical wounds are the basic premises to achieve the patient's healing.

Fecal incontinence can seriously affect quality of life. The treatment of fecal incontinence starts conservatively, but, in case of failure, different surgical approaches may be proposed to the patient. Recently several noninvasive approaches have been developed: one of these is the radiofrequency energy application to the internal anal sphincter.

The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). Data were collected over a 3-year period (2004–2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,. Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 ± 4.5 days. Patients were followed for a mean of 24.7 ± 10.9 months (range: 6–42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p

Aim The SECCA system is a treatment option for patients with faecal incontinence and was introduced into clinical practice in 2002. Clinical studies of radiofrequency energy to treat patients with faecal incontinence have been published. This article aimed to review all published series to assess the results of this treatment. Method Twelve studies were included. Outcomes analysed included quality of life, the Wexner incontinence score, anorectal manometry and endoanal ultrasound findings. Results A total of 220 patients from 10 studies were included. In the majority of clinical studies, the SECCA procedure has been shown to be an effective treatment of mild-to-moderate faecal incontinence. Conclusion When patient selection is appropriate, this treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statistically significant reductions in the Wexner incontinence and quality of life scores.

The aim of the study is to detect the presence of esophageal motor disorders in type I and II diabetic patients, and to establish whether there is any difference between patients with and without neuropathy. 118 diabetics patients (34 type I and 84 type II) were investigated by water-perfused stationary esophageal manometry. Data were correlated with the presence of peripheral neurophaty. As a result 71% of patients affected by peripheral neuropathy showed manometric abnormalities against the 37% of the patients without neuropathy. Our experience has shown that patients with diabetes mellitus frequently present esophageal symptoms and manometric abnormalities. Manometric study of the esophagus has to be considered a useful investigative tool to manage and monitorize the gastrointestinal abnormalities in patients affected by diabetes mellitus.

Energy deficit is a common and serious problem in major surgical patients and is associated with increased rates of complications, length of stay, and mortality. Parental nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to this kind of patients. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes. In this article, we review the role of parenteral lipid emulsions (LEs) in the management of patients undergone to major surgical procedures and highlight important biologic activities associated with lipids. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the surgical setting. More recently developed parenteral LEs employ partial subsostitution of soybean oil with oils providing medium-chain triglycerides, omega-9 monounsaturated fatty acids or omega-3 PUFA. Manyof these LEs have demostrated reduced effects on oxidative stress, immune responses, and inflammation. Ongoing research using adequately designed and well-controlled studies that characterize the biological properties of LEs should assist clinicians in selecting LEs within the surgical setting.

The patients with Crohn's disease (CD) have a greater risk of gastrointestinal and hemopoietic cancers compared with background population. Identify groups of people affected by CD with exposition to factors that play a role in the development of cancer could be useful to plan correct diagnostic and therapeutic methods.A reaserch on "pubmed" with "Risk factors for cancer in patients with Crohn's disease", "Cancer and Crohn's disease" Crohn's disease and cancer risk" as key-words was conducted. We identified 35 studies and analized also references reported inside each single work.Patients with CD have a higher risk of colorectal cancer (CRC). The risk of colon cancer alone was found to be increased, with no significant increase in the risk of rectal cancer. Factors that play a role in the development of CRC are: diagnosis of CD before 25-years-old, duration of disease, severity of inflammation, habit to cigarette's smoke, a familial history of CRC and immunosuppressive therapies. The risk of small bowel cancer was found to be increased, even if overall risk remains low. Although the role of immunosuppressive therapies remain to clarify yet, patients with CD have a higher risk of development lymphoma compared with background population.Patients with CD are at high risk of large bowel, small bowel, extraintestinal and hemopoietic cancers. Selected patients with extensive colonic disease, which has been present from a young age, are at high risk of cancer and should be candidates for colonscopic surveillance.

Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.

Aims and background Carcinoids of the appendix continue to be of interest, despite their low incidence. There is still considerable controversy surrounding these tumors, especially with regard to the role of right hemicolectomy in the surgical management. The aim of this work was to explicate the current therapeutic knowledge and to review the criteria for the indications of appendectomy or hemicolectomy. Methods The records of patients who underwent appendectomies from 1990 to 2000 were analyzed. Seven patients were included in the study. The clinical data were reviewed for demographic details, tumor size, localization in the appendix, histological patterns and surgical procedures. All patients underwent appendectomy including removal of the mesenteriolum, and in one of them a right hemicolectomy was performed 3 weeks later. The mean follow-up was 7 years (range, 4–14). Follow-up data included symptoms, urinary 5-hydroxyin-doleacetic acid, ultrasound examination, computerized tomography, and octreotide scanning. Results Seven patients (0.9% of all appendectomies) were reported to have carcinoid tumors of the appendix. They were 3 men and 4 women with a mean age of 29 years. All patients were admitted for appendicitis. None suffered from the carcinoid syndrome. The site of the tumor was the apex of the appendix in 4 cases, the body in 2 cases and the base in 1 case. Mean tumor diameter was 8 mm (range, 5–29 mm); in 6 patients it was Conclusions According to current guidelines, an appendectomy may be performed for small carcinoid tumors (2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. The criteria that direct us towards major (hemicolectomy) or minor surgery (appendectomy) are controversial. Tumor size is still considered the most important prognostic factor, with a presumed increase in the risk of metastasis for tumors greater than 2.0 cm. The accepted treatment of such tumors is a right hemicolectomy. However, there is no evidence demonstrating a survival benefit for right hemicolectomy over simple appendectomy in patients with carcinoids greater than 2.0 cm in diameter.

Geriatric patients and their relative fragility with respect to younger patients represent a surgical dilemma for the general surgeon. This has led surgeons to adopt "tailored" techniques and strategies to treat them. The rapid increase of this aged population has given the clinician the chance to push forward the knowledge on this subset of patients and challenge previous concepts; thus changing behaviour and strategies when treating them.