Minerva chirurgica最新文献

{"title":"Surgical treatment for severe liver injuries: a single-center experience.","authors":"Bianca Mitricof,&nbsp;Vladislav Brasoveanu,&nbsp;Doina Hrehoret,&nbsp;Alexandru Barcu,&nbsp;Nausica Picu,&nbsp;Elena Flutur,&nbsp;Dana Tomescu,&nbsp;Gabriela Droc,&nbsp;Ioana Lupescu,&nbsp;Irinel Popescu,&nbsp;Florin Botea","doi":"10.23736/S0026-4733.20.08193-6","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08193-6","url":null,"abstract":"<p><strong>Background: </strong>The liver is one of the most frequently injured organs in abdominal trauma. The advancements in diagnosis and interventional therapy shifted the management of liver trauma towards a non-operative management (NOM). Nevertheless, in severe liver injuries (LI), surgical treatment often involving liver resection (LR) and rarely liver transplantation (LT) remains the main option. The present paper analyses a single center experience in a referral HPB center on a series of patients with high-grade liver trauma.</p><p><strong>Methods: </strong>Forty-five patients with severe LI, that benefitted from NOM (6 pts), LRs (38 pts), and LT (1 pt) performed in our center between June 2000 and June 2019, were included in a combined prospective and retrospective study. The median age of the patients was 29 years (median 33, range 10-76), and the male/female ratio of 33/12. Almost all cases had blunt trauma, except 2 with stab wound (4.4%).</p><p><strong>Results: </strong>LIs classified according to the American Association for the Surgery of Trauma (AAST) system were 13.3% (grade III), 44.2% (grade IV), and 42.2% (grade V); none were grade I, II or VI. The rate of major LR was 56.4% (22 LRs). The median operative time was 200 minutes (mean 236; range 150-420). The median blood loss was 750 ml (mean 940; range 500-6500). Overall and major complication rates were 100% (45 pts) and 33.3% (15 pts), respectively. Overall mortality rate was 15.6% (7 pts).</p><p><strong>Conclusions: </strong>Severe liver trauma, often involving complex liver resections, should be managed in a referral HPB center, thus obtaining the best results in terms of morbidity and mortality.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37603059","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":"Reduction of postoperative lymphorrhoea in patients undergoing radical lymphadenectomy for stage III melanoma: prospective study using collagen-fibrin patches.","authors":"Piero Covarelli,&nbsp;Francesco Barberini,&nbsp;Daniele Cannavicci,&nbsp;Roberto Cirocchi,&nbsp;Antonio Rulli,&nbsp;Carlo Boselli,&nbsp;Vincenzo De Giorgi","doi":"10.23736/S0026-4733.19.08114-8","DOIUrl":"https://doi.org/10.23736/S0026-4733.19.08114-8","url":null,"abstract":"<p><strong>Background: </strong>Radical lymph nodes dissection (RLND) is the standard procedure for regional control of disease in patients with metastatic melanoma (stage III). Because of its aggressiveness, lymphorrhoea is a constant problem in postoperative.</p><p><strong>Methods: </strong>In this prospective nonrandomized study with a retrospective analysis of data, patients undergoing surgical treatment of axillary or iliac-inguinal RLND received standard treatment plus a collagen-fibrin sealant patch (TachoSil) (N.=50) or standard treatment alone (N.=50). The first endpoint was the comparison between the treated population and the control group, in terms of persistence of drainage and average daily volume of lymphorrhoea. The second aim was to relate patients' BMI, volume of lymphorrhoea and time of drainage in the two groups.</p><p><strong>Results: </strong>In the comparison between the two groups receiving or not the treatment with collagen-fibrin patch, we found an average difference both in the volume of daily lymphorrhoea (42.91±6.61 cc) and in the persistence of drainage (9.292±1.644 days) with P value <0.0001. Besides, the collagen-fibrin patch was actually effective in reducing lymphorrhoea and time of drainage, regardless of patients' BMI.</p><p><strong>Conclusions: </strong>The results of this study confirm and support the starting thesis: TachoSil is an effective tissue sealant able to reduce lymphorrhoea and drainage removal times following a radical lymphadenectomy, independently from the BMI.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37443276","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":"External hemorrhoidal thrombosis in the elderly patients: conservative and surgical management.","authors":"Chiara Eberspacher,&nbsp;Domenico Mascagni,&nbsp;Pavlos Antypas,&nbsp;Gianmarco Grimaldi,&nbsp;Lisa Fralleone,&nbsp;Stefano Pontone,&nbsp;Salvatore Sorrenti,&nbsp;Daniele Pironi","doi":"10.23736/S0026-4733.18.07724-6","DOIUrl":"https://doi.org/10.23736/S0026-4733.18.07724-6","url":null,"abstract":"<p><strong>Background: </strong>External hemorrhoidal thrombosis is a common disease with an acute anal pain as the major symptom. It is astonishing the lack of studies which investigates the most effective treatment and there are not guidelines. Furthermore, nobody has ever evaluated this peculiar condition in an elderly population.</p><p><strong>Methods: </strong>We have considered 87 patients aged >75 years who were visited and treated for this condition in our clinic, dividing them in three groups according the curative option chosen together with them after anamnesis and an interview: a conservative medical treatment (Group A), an immediate incision and evacuation of the thrombus (Group B) and the excision of hemorrhoid with the thrombus, with hemorrhoidectomy technique (Group C). The mean follow-up was 12.3 months. We analyzed immediate pain relief and time of remission of symptoms, bleeding, recurrences and major complications.</p><p><strong>Results: </strong>The Group A presented a remission of symptoms in 11.8 days, Group B in 1.58 ad Group C in 7.8 days. The recurrence rate was very similar for the first two options (19.4% and 16.1%) and lower in the excision group (no recurrence during follow-up). Bleeding is the common adverse event observed with a high frequency in the immediate incision and evacuation of thrombus, less common in hemorrhoidectomy, that did not present major complication. Surgical option is often refused by elderly patient evaluating comorbidities in the fear of adverse events.</p><p><strong>Conclusions: </strong>The surgical treatment for EHT in elderly is safe and effective, but not the most common choice for fear of complications. Medical treatment or immediate incision of thrombus can be preferred and well accepted by elderly even if followed by a higher rate of recurrences.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.23736/S0026-4733.18.07724-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36827468","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":"Transversostomy versus sigmoidostomy.","authors":"Nicolás J Leclerc,&nbsp;Antonio Giuliani,&nbsp;Lucia Romano,&nbsp;Pablo J Morejón,&nbsp;Claudia C Santana","doi":"10.23736/S0026-4733.19.08206-3","DOIUrl":"https://doi.org/10.23736/S0026-4733.19.08206-3","url":null,"abstract":"","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37603060","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":"Quality of recovery after major emergency abdominal surgery: a prospective observational cohort study.","authors":"Jakob O Oreskov,&nbsp;Jakob Burcharth,&nbsp;Andreas F Nielsen,&nbsp;Sarah Ekeloef,&nbsp;Jakob Kleif,&nbsp;Ismail Gögenur","doi":"10.23736/S0026-4733.20.08226-7","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08226-7","url":null,"abstract":"BACKGROUND Major emergency abdominal surgery results in high morbidity and mortality. We aimed to describe patient-reported quality of recovery after major emergency abdominal surgery. METHODS A prospective observational cohort study of patients undergoing major emergency abdominal surgery at a University Hospital was conducted in the period between November 2016 and February 2017. Patients were interviewed using the 15-item questionnaire Quality of Recovery (QoR- 15) six times over the first 30 postoperative days. Patients' maximum score of QoR-15 ranging from 0- 150 were divided into four groups depending on recovery status going from poor (score of 0-89), moderate (score of 90-121), good (score of 122-135) to excellent (score of 136-150) recovery. RESULTS A total of 37 patients were included in the trial. At postoperative day (POD) 1 the recovery status of the patients was mainly poor to moderate (poor n=8 (22%), moderate n=23 (62%), good n=4 (11%) and excellent n=2 (5%)). 16 (55%) of the patients reported a poor or moderate recovery within the first 7 days after surgery, which advanced to good or excellent recovery (n=19 (68%)) from POD 14. The patients were not fully recovered at POD 30 (n=18 (62%) had an excellent recovery). CONCLUSIONS Recovery measured by QoR-15 is substantially affected after major emergency abdominal surgery even after 14- and 30 days postoperatively. The patients were poor or only moderately recovered within the first seven postoperative days and only 62% of the patients were fully recovered at postoperative day 30.","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37602474","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":"Standard stapled transanal rectal resection versus stapled transanal rectal resection with one high-volume stapler to prevent complications in the elderly.","authors":"Domenico Mascagni,&nbsp;Alessandra Panarese,&nbsp;Chiara Eberspacher,&nbsp;Gianmarco Grimaldi,&nbsp;Stefano Pontone,&nbsp;Salvatore Sorrenti,&nbsp;Daniele Pironi","doi":"10.23736/S0026-4733.18.07725-8","DOIUrl":"https://doi.org/10.23736/S0026-4733.18.07725-8","url":null,"abstract":"<p><strong>Background: </strong>The causes of obstructed defecation syndrome (ODS) can actually be either functional or mechanical (primary or secondary deficit of the sensitivity, slow bowel transit, pelvic floor dyssynergia, internal and external rectal prolapse, recto-anal intussusceptions, anterior or posterior rectocele and pelvic prolapse of the bladder, uterus, bowel or sigma). The aim of our study was to evaluate the safety, efficacy and feasibility of stapled transanal rectal resection (STARR) procedure performed by a single or double stapler through clinical and functional outcomes for transanal stapled surgery.</p><p><strong>Methods: </strong>From January 2016 to October 2017, ninety patients with ODS secondary to rectal prolapse, anal-rectal intussusception and anterior rectocele, that underwent to a STARR procedure were enrolled. Thirty of these underwent a STARR procedure with double circular stapler PPH-01 (Group A); 30 with single circular stapler CPH34HV with a purse string suture (Group B); and 30 with single circular stapler CPH34HV with a \"parachute technique\" (Group C). All patients were selected with clinical examination, Wexner score for fecal incontinence and ODS score for constipation. Patients also underwent a Defeco RMN for an anatomical and dynamic evaluation of the pelvic floor.</p><p><strong>Results: </strong>No recurrence rates were observed in the three groups. The mean operative time was 46.3 minutes in group A; 34.5 minutes in group B; and 37.6 minutes in Group C. The volume of the resected specimen was 17 mL in group A; 15 mL in group B; and 16 mL in Group C. Complications were bleeding (3.3% in group A); fecal urgency (6.6% in group A, 10% in group B and 3.3% in group C); rectal hematoma (3.3% in group A). all symptoms significantly improved after the operation without differences between groups.</p><p><strong>Conclusions: </strong>The STARR technique performed with a single stapler CPH34HV is safe, faster and less expensive than the STARR performed by a double PPH01. Besides, with the parachute technique, it is possible to resect asymmetric prolapses.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.23736/S0026-4733.18.07725-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36844097","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":"Effect of miR-1266 on proliferation, invasion and migration of laryngeal squamous cell carcinoma by targeting CCL18.","authors":"Qijun Wang,&nbsp;Baifang Su,&nbsp;Qinggang Li,&nbsp;Qingjuan He,&nbsp;Dongmei Li,&nbsp;Qingyan Li","doi":"10.23736/S0026-4733.19.08202-6","DOIUrl":"https://doi.org/10.23736/S0026-4733.19.08202-6","url":null,"abstract":"","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37443622","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":"Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience.","authors":"Nunzio Velotti,&nbsp;Paolo Bianco,&nbsp;Alessio Bocchetti,&nbsp;Marco Milone,&nbsp;Domenico Manzolillo,&nbsp;Paola Maietta,&nbsp;Maurizio Amato,&nbsp;Oreste Buonomo,&nbsp;Giuseppe Petrella,&nbsp;Mario Musella","doi":"10.23736/S0026-4733.18.07712-X","DOIUrl":"https://doi.org/10.23736/S0026-4733.18.07712-X","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities.</p><p><strong>Methods: </strong>Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients.</p><p><strong>Results: </strong>For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001).</p><p><strong>Conclusions: </strong>Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.23736/S0026-4733.18.07712-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36012304","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":"Robotic resection of a large ovarian leiomyoma.","authors":"Alberto Mangano,&nbsp;Valentina Valle,&nbsp;Roberto Bustos,&nbsp;Stephan Gruessner,&nbsp;Mario Masrur,&nbsp;Gabriela Aguiluz,&nbsp;Francesco Bianco,&nbsp;Pier C Giulianotti","doi":"10.23736/S0026-4733.20.08253-X","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08253-X","url":null,"abstract":"<p><p>Uterine leiomyomata are the most frequent leiomyomata. However, this benign tumor can also arise in unusual locations (e.g. ovaries, urethra, bladder and vulva). The diagnostic process of ovarian leiomyomata can be difficult, and it is mostly incidental: the lesions are usually small and the clinical presentation is mainly asymptomatic. Since the first case described in 1862, less than 100 cases have been described. Some of these lesions have been treated laparoscopically. To our knowledge, this is the first worldwide case of an ovarian leiomyoma treated with a robotic approach (surgeon: Prof. P.C. Giulianotti, M.D., F.A.C.S.). Moreover, we provide an overview of the recent literature, and an intraoperative video of the intervention.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37814139","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":"Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse.","authors":"Fabio Gaj,&nbsp;Ivano Biviano,&nbsp;Antonello Trecca,&nbsp;Quirino Lai,&nbsp;Jacopo Andreuccetti","doi":"10.23736/S0026-4733.20.08175-4","DOIUrl":"https://doi.org/10.23736/S0026-4733.20.08175-4","url":null,"abstract":"<p><strong>Background: </strong>Different surgical techniques have been proposed for rectocele repair. However, controversial aspects exist on the best approach to use. The study aims to report the early and late outcomes of the sequential transfixed stich technique (STST) for the treatment of rectocele in the absence of mucosal prolapse.</p><p><strong>Methods: </strong>One hundred patients presenting a symptomatic rectocele were treated with STST from January 2010 through August 2015. Patients with mucosal prolapse were not considered eligible for STST. After a period of 24 months from surgery, all the patients were clinically evaluated with the intent to investigate the risk of recurrence of the preoperative symptoms.</p><p><strong>Results: </strong>All the patients were women (median age=54.7 years; ranges=37-75). Median discharge time was 1.5 days. One-month severe complications were: hemorrhoid thrombosis (6.0%), self-solved bleeding (6.0%), urinary retention (4.0%), anal secretion (4.0%) and urinary incontinence (1.0%). No post-operative cases of fecal incontinence were observed. Two years after surgery, 76.0% of patients reported a global improvement of the preoperative symptoms, with 73 and 35% of cases showing a reduced difficulty in the evacuation and need for digitation. Only 8.0% of patients showed a recurrence of the initial symptoms.</p><p><strong>Conclusions: </strong>The STST is a feasible, safe, and cost-effective technique for the treatment of the rectocele without rectal mucosal prolapse. The method does not increase the risk of postoperative anal incontinence and presents a short hospital stay. STST presents long-term results in line with other transvaginal and transanal approaches.</p>","PeriodicalId":18714,"journal":{"name":"Minerva chirurgica","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37603058","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}