Minerva chirurgica最新文献

{"title":"Bottom-up suprapubic approach for robotic right colectomy: technical aspects and preliminary outcomes.","authors":"P. Bianchi, G. Giuliani, A. Salaj, L. Ferraro, E. Opocher, F. Toti, G. Formisano","doi":"10.23736/S0026-4733.20.08664-2","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08664-2","url":null,"abstract":"BACKGROUND\u0000Complete mesocolic excision (CME) for right colectomy increase the technical complexity of a laparoscopic approach especially when an intracorporeal anastomosis (IA) is associated. The robotic platform, with its intrinsic technical advantages, could potentially overcome the limitations of conventional laparoscopy. This study aimed to describe the robotic bottom-up technique and to evaluate short-terms outcomes of robotic right colectomy (RRC) with CME and IA.\u0000\u0000\u0000METHODS\u0000Data from patients who underwent RRC for cancer with bottom-up suprapubic approach from October 2016 to April 2020 were prospectively collected and retrospectively analyzed. Intraoperative outcomes and complications, conversion rate, 30-day postoperative outcomes, incisional hernia rate and pathological outcomes were the variables assessed.\u0000\u0000\u0000RESULTS\u0000A total of 109 patients were submitted to bottom-up suprapubic approach for RRC with CME and IA during the study period. Mean operative time was 179 min, no intraoperative complications were observed, and the conversion rate was 3.6%. Mean postoperative stay was 4.6 days and the overall 30-day complication rate was 15.6%. Thirteen patients (12%) had minor complications, while major postoperative complications occurred in 4 patients (3.6%). Anastomotic leak was recorded in 1 patient (0.9%) and the 30-day re-admission rate was 0.9%. Mean number of harvested lymph nodes was 22.6. Incisional hernia rate at the specimen extraction site was 0.9%.\u0000\u0000\u0000CONCLUSIONS\u0000Bottom-up approach for RRC with CME and IA carries a low rate of conversions, intraoperative and short-term postoperative complications.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45777380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of clinical efficacy of suture-fixation mucopexy in the treatment of prolapsed hemorrhoid.","authors":"M. Zhai, Yizhen Wu, Rui-sheng Xu, Zhijun Zhang","doi":"10.23736/S0026-4733.20.08526-0","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08526-0","url":null,"abstract":"BACHGROUND\u0000To evaluate the clinical efficacy of suture-fixation mucopexy in the treatment of prolapsed hemorrhoids.\u0000\u0000\u0000METHODS\u0000A total of 123 patients with grade II, III, and IV hemorrhoids were admitted to The TCM Hospital of Pu Dong New District between 2018 and 2019. They were randomly divided into the suture-fixation group (SF, n=60) and the Milligan-Morgan hemorrhoidectomy group (MM, n=63). Clinical efficacy, postoperative pain, average operation time, hospital stay, complications, and patient satisfaction were prospectively evaluated.\u0000\u0000\u0000RESULTS\u0000No significant differences were identified in clinical efficacy, operation time and hospital stay between the two groups (P>0.05). However, VAS score in the SF group was lower than that in the MM group. And the SF group was also more advantageous in anal function protection (P<0.05). In addition, the results of the follow-up survey revealed no significant difference in postoperative recurrence rate and patient satisfaction (P>0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Compared with Milligan-Morgan hemorrhoidectomy, suture-fixation mucopexy is as effective in the treatment of prolapsed hemorrhoid, but it has more advantages in reducing postoperative pain and protecting the anal function.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42278527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthotopic liver transplantation for patients with end-stage alcohol-related liver disease and severe acute alcohol-related hepatitis: a concise review.","authors":"F. Caputo, G. Testino","doi":"10.23736/S0026-4733.20.08685-X","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08685-X","url":null,"abstract":"Worldwide, cirrhosis due to alcohol-related liver disease (ALD) is responsible for 0.9% of global deaths and 47.9% of cirrhosis-related deaths. End-stage ALD (ESALD) is the final condition of alcohol-related cirrhosis, and severe acute alcohol-related hepatitis (SAAH) is a distinct clinical syndrome associated with the consumption of large amounts of alcohol. In some cases, ESALD, and SAAH may need liver transplantation (LT). The severity of ESALD can improve after a few months (three months) of abstinence from alcohol, avoiding or delaying the need for LT. Conversely, patients with ESALD with a poor prognosis (MELD≥15) may be candidates for LT after three months of abstinence; in these patients, the 6 months rule needs to be revised. In addition, in non-responders to steroid therapy, the indication for early LT in patients with SAAH and acute on chronic liver failure (ACLF) due to alcohol use find indication in carefully selected patients (those with good insight into their alcohol problems and good social support). Thus, the role of a multi-disciplinary team of experts in the management of alcohol use disorder, ESALD and SAAH working in the same institution, the support of the patient's family and self-help groups represent a crucial approach in the reinforcement of motivation to abstain from alcohol, and in helping patients to avoid relapses in heavy drinking when entered in an LT programme.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42056233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results.","authors":"U. Bracale, R. Peltrini, M. D. Di Nuzzo, G. Altieri, V. Silvestri, P. Dolce, M. D’ambra, R. Lionetti, F. Corcione","doi":"10.23736/S0026-4733.20.08645-9","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08645-9","url":null,"abstract":"BACKGROUND\u0000The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The purpose of this study is to investigate the risk of colorectal anastomosis bleeding, when IMA is resected or preserved during left colectomy.\u0000\u0000\u0000METHODS\u0000A retrospective review of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020, were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two group: IMA resected (IMAR) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared.\u0000\u0000\u0000RESULTS\u0000Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; p=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group.\u0000\u0000\u0000CONCLUSIONS\u0000IMA preserving left colectomy seems to be associated with a higher risk of mostly selflimited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46176507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of intra- and post-operative complications during TEM/TAMIS procedures. A systematic review.","authors":"X. Serra‐Aracil, J. Badia-Closa, A. Pallisera-Lloveras, L. Mora-López, S. Serra-Pla, A. Garcia-Nalda, S. Navarro-Soto","doi":"10.23736/S0026-4733.20.08405-9","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08405-9","url":null,"abstract":"INTRODUCTION\u0000Transanal endoscopic microsurgery (TEM) is a safe procedure and the rates of intra- and post-operative complications are low. The information in the literature on the management of these complications is limited, and so their importance may be either under- or overestimated (which may in turn lead to under- or overtreatment). The present article reviews the most relevant series of TEM procedures and their complications and describes various approaches to their management.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A systematic review of the literature, including TEM series of more than 150 cases each. We analyzed the population characteristics, surgical variables and intraoperative and postoperative complications.\u0000\u0000\u0000EVIDENCE GATHERING\u0000A total of 1043 records were found. After review, 1031 were excluded. The review therefore includes 12 independent cohorts of TEM procedures with a total of 4395 patients. The rate of perforation into the peritoneal cavity was 5.1%, and conversion to abdominal approach was required in 0.8% of cases. The most frequent complications were acute urinary retention (AUR, 4.9%) and rectal bleeding (2.2%). Less common complications included abscesses (0.99%) and rectovaginal fistula (0.62%). Mortality rates were low, with a mean value of 0.29%.\u0000\u0000\u0000CONCLUSIONS\u0000Awareness and knowledge of TEM complications and their management can play an important role in their treatment and patient safety. Here, we present a review of the most important TEM series and their complication rates and describe various approaches to their management.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47573344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of different anesthesia and analgesia on cellular immunity and cognitive function of patients after surgery for esophageal cancer.","authors":"Rongyu Zhu,&nbsp;Jun Xiang,&nbsp;Ming Tan","doi":"10.23736/S0026-4733.20.08283-8","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08283-8","url":null,"abstract":"<p><strong>Background: </strong>The study intends to analyze influences of different anesthesia and analgesia on cellular immune and cognitive functions of patients undergoing thoracotomy for esophageal cancer (EsC).</p><p><strong>Methods: </strong>Patients undergoing thoracotomy for EsC were divided into four groups: Group A (received general anesthesia [GA]) and postoperative intravenous analgesia); B (received GA and postoperative epidural analgesia); C (received GA combined with thoracic epidural anesthesia [TEA]) and postoperative intravenous analgesia); D (received GA combined with TEA and postoperative epidural analgesia). The T-lymphocyte subsets were determined at 30 min before anesthesia induction (T<inf>0</inf>), 2 h after skin incision (T<inf>1</inf>), and at 4 h (T<inf>2</inf>), 24 h (T<inf>3</inf>), and 48 h (T<inf>4</inf>) after operation. Besides, visual analogue scale (VAS) and mini-mental state examination (MMSE) were assessed.</p><p><strong>Results: </strong>The percentage of CD3⁺ and CD4⁺ cells in groups B and C were higher than group A from T<inf>1</inf> to T<inf>3</inf>. The ratio of CD4⁺/CD8⁺ in group B and C were higher than in group A at T<inf>3</inf>. Compared with group A, group D had increased percentages of CD3⁺ and CD4⁺ from T<inf>1</inf> to T<inf>4</inf>, and elevated ratio of CD4⁺/CD8⁺ from T<inf>2</inf> to T<inf>4</inf> VAS scores were lower and MMSE scores were higher in groups B, C, and D than in group A, and group D had relatively lower VAS and higher MMSE scores as compared to group B.</p><p><strong>Conclusions: </strong>The intraoperative general anesthesia combined with thoracic epidural anesthesia and postoperative epidural analgesia may reduce adverse effect on cellular immune and cognitive functions of patients undergoing thoracotomy for EsC.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38245414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axillary observation alone versus sentinel node biopsy: past, present and future perspectives.","authors":"Rosa Di Micco,&nbsp;Oreste D Gentilini","doi":"10.23736/S0026-4733.20.08528-4","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08528-4","url":null,"abstract":"<p><p>The evolution of axillary surgery in breast cancer has led from complete axillary dissection (AD) to sentinel node biopsy (SNB). It has not stopped yet but continues with a progressive de-escalation of surgical procedures aiming at axillary conservation. In parallel, the meaning of axillary surgery has changed as well. Over time, the dual role of both a therapeutic and a staging procedure has decreased leaving room to other modalities to treat and stage breast cancer. Although, the gold standard for axillary staging in early breast cancer remains SNB, the idea that axillary surgery could be even omitted has been proposed. The concept of abandoning axillary surgery is revolutionary but not new. Historical literature provides interesting data on patients who did not receive any axillary treatment at all with no impact on their survival. Starting from this, several ongoing trials are working to demonstrate that in selected breast cancer cohorts the information deriving from axillary surgery is superfluous and \"axillary observation\" alone is as effective as SNB. Whilst surgery has been de-escalated to less invasive procedures, systemic treatment, radiotherapy, multigene assays and advanced imaging modalities have gained ground in the management of breast cancer. New research is expected to help select the subgroups of patients for whom axillary surgery is not necessary anymore. This is a qualitative review reporting the most relevant literature data from historical trials on the omission of axillary surgery to the most recent and ongoing ones.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38395448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing clinical trials on axillary management.","authors":"Andriana Kouloura,&nbsp;Sophocles Lanitis,&nbsp;Evangelos Filopoulos,&nbsp;Michail-Periklis Angelopoulos,&nbsp;Sofia P Kosmidis,&nbsp;Nikolaos Arkadopoulos","doi":"10.23736/S0026-4733.20.08490-4","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08490-4","url":null,"abstract":"<p><strong>Introduction: </strong>Within the last 50 years the management of patients with breast cancer has changed dramatically with a significant de-escalation of the role and magnitude of surgery, both for the management of the primary tumor and for the management of the axilla. In the management of the axilla of patients with early stage breast cancer (EBC) and clinically uninvolved axilla (cN0), axillary lymph node dissection (ALND) was gradually replaced by sentinel lymph node biopsy (SLNB) saving more than 60-70% of patients from an unnecessary dissection. Further studies confirmed that isolated tumor cells or micrometastases found on the SLN had no further benefit from ALND sparing even more patients from an unnecessary ALND. Eventually, the Z0011 and other studies showed that even patients with 1-2 positive SLN can be spared from ALND provided they fulfill certain criteria. Still though there were many flaws in these studies and further research was necessary to generalize the results of these studies to a wider target group. Meanwhile, there is a clear view that many low risk patients if they have their axilla evaluated via US and are not found to have suspicious nodes, it is highly unlikely to have involved axilla. This let to studies evaluating the non-surgical management of the axilla. Finally, in the post neoadjuvant setting 3 randomized controlled trials showed that under certain circumstances SLNB can be done after the NAC even in patients who initially had involved axilla and was converted to clinically uninvolved (cN1→cN0).</p><p><strong>Evidence acquisition: </strong>PubMed, Medline, the Cochrane Library Controlled Trials Register as well as National Institutes of Health ClinicalTrials.Gov database have been consulted up to May 2020.</p><p><strong>Evidence synthesis: </strong>We studied and described the ongoing trials on patients not undergoing neoadjuvant chemotherapy and we discussed the eligibility criteria, the comparison arms and the expected outcomes. We further examined the ongoing trials on patients undergoing neoadjuvant chemotherapy in the same manner.</p><p><strong>Conclusions: </strong>Although we have covered a long way in the journey of eliminating axillary surgery, there are still lots of questions to be answered and trials to be conducted. We anticipate the results of the ongoing trials to provide the necessary evidence to safely de-escalate more the axillary surgery, both in the non-neoadjuvant as well as in the neoadjuvant setting, hoping that in the not so far future the axillary surgery will eventually perish.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38735854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramesorectal or total mesorectal excision for ulcerative colitis: what is better for the patient?","authors":"Filippo Carannante,&nbsp;Erica Mazzotta,&nbsp;Gianluca Mascianà,&nbsp;Marco Caricato,&nbsp;Gabriella Capolupo","doi":"10.23736/S0026-4733.20.08479-5","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08479-5","url":null,"abstract":"","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38418010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sentinel node biopsy in conservative surgery for breast cancer: a changing role in clinical practice.","authors":"Francesca Magnoni,&nbsp;Paolo Veronesi","doi":"10.23736/S0026-4733.20.08481-3","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08481-3","url":null,"abstract":"<p><p>Recent studies have demonstrated that the extent of surgical treatment in both breast and axilla can be minimized through a multimodal and personalized management, based on assessment of breast cancer (BC) molecular subtypes, genetics and on the prevailing relevance of systemic therapies. Axillary lymph-nodes dissection (ALND) represents the older surgical modality for appropriate staging and for adjuvant systemic and radiation therapies planning. Thanks to findings from extensive and crucial clinical trials, sentinel lymph node biopsy (SLNB) replaced this approach, obviating the need for ALND in node-negative disease patients, both in mastectomy and conservative surgery, and becoming a crucial turning point in BC managing. Furthermore, recent clinical trials have established that ALND can be avoided in those patients with low axillary disease burden in the sentinel nodes who are undergoing breast-conserving surgery (BCS) with radiotherapy. Several studies also proved that neoadjuvant chemotherapy (NAC) increases the BCS rates, as well reducing the extent of axillary surgery. The potential oncological safety of axillary observation choice in early BC patients undergoing BCS, in the recent perspective of the prevailing value of BC biology, is also under scientific evaluation. This study explores the current role of SLNB in BC patients eligible for BCS, providing a view into future directions in BC care.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38418011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}