Annali italiani di chirurgia最新文献

{"title":"Correlation between Preoperative Blood Pressure Variability and Carotid Sinus Reaction after Internal Carotid Artery Stenting.","authors":"Xinxiu Zhao, Zhengyu Tong, Liang Yin, Song Luo, Yuyu Li, Peng Shi, Weidong Qian","doi":"10.62713/aic.3730","DOIUrl":"10.62713/aic.3730","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the relationship between blood pressure variability (BPV) 24 hours before internal carotid artery stenting and post-procedural carotid sinus reaction (CSR), with an emphasis on identifying BPV indexes that predict the implementation of carotid artery stenting (CAS) and the subtype of CSR.</p><p><strong>Methods: </strong>A total of 105 patients who completed 24-hour ambulatory blood pressure monitoring and underwent CAS from August 2019 to February 2024 in the First Affiliated Hospital of Bengbu Medical College were included in this study. Patients were divided into CSR and non-CSR groups. The CSR group was further divided into three subgroups according to the type of CSR that occurred: namely hypotensive, bradycardic, and mixed types. Prior to stent placement, changes in ambulatory blood pressure were monitored using a fully automated non-invasive portable blood pressure monitor for 24 hours before the procedure, and the individual metrics in BPV were compared.</p><p><strong>Results: </strong>CSR occurred in 69 patients (65.71%) and the remaining 36 patients did not experience CSR (34.29%). Among the patients with CSR, 46 (66.67%) experienced hypotensive CSR, 9 (13.04%) had bradycardic CSR, and 14 (20.29%) mixed-type CSR. The age, history of hypertension, coronary artery disease, and history of smoking were significantly higher in the CSR group than in the non-CSR group (p = 0.007, p = 0.002, p = 0.046, p = 0.007, respectively). Age, hypertension, and history of smoking were the risk factors for CSR. A statistically significant difference in triglyceride levels was found between the three subgroups of CSR (p < 0.05); however, triglycerides had no significant effect on the type of CSR subgroups (all p > 0.05). A series of preoperative BPV indexes, like the maximum systolic blood pressure (SBP), SBP's max-min difference, mean, standard deviation (SD), coefficient of variation (CV), and degree of variability (SV) of the 24-hour SBP, were significantly correlated with the occurrence of CSR (p < 0.05). Further analysis revealed that SBP's max-min difference, SD, CV, and SV of 24-hour SBP were independent predictors of CSR. The bradycardic CSR was significantly correlated with the maximum diastolic blood pressure (DBP), minimum DBP, and 24-hour mean DBP, when compared to the hypotensive CSR (p < 0.05). The mixed-type CSR was significantly correlated with the maximum DBP and minimum DBP, when compared to the bradycardic CSR (p < 0.05).</p><p><strong>Conclusions: </strong>The indexes of BPV 24 hours before internal carotid artery stenting correlate with the occurrence and types of CSR. Therefore, BPV can be used as a predictor of the occurrence and specific type of CSR after internal carotid artery stenting.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"179-187"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors and Preventive Measures for Perioperative Incision Infection in Patients Receiving Rigid Internal Fixation of Maxillofacial Fractures.","authors":"Fengxing Xu, Fan Wang","doi":"10.62713/aic.3853","DOIUrl":"10.62713/aic.3853","url":null,"abstract":"<p><strong>Aim: </strong>To analyze the risk factors for perioperative incision infection in patients undergoing rigid internal fixation for maxillofacial fractures and the prevention and control measures formulated to enhance the effect of surgical treatment.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of 342 maxillofacial fracture patients who received rigid internal fixation treatment at the Department of Stomatological Surgery of The First People's Hospital of Yongkang (Yongkang First People's Hospital) from May 2018 to April 2023, and divided them into the uninfected group (n = 308) and the infected group (n = 34) according to their history of perioperative incision infections. Data from the subjects on age, type of fracture trauma and length of hospitalization were collected and analyzed. Multifactorial logistic regression analysis was employed to explore the risk factors for perioperative incision infections in these patients and to develop preventive measures for these risk factors.</p><p><strong>Results: </strong>The study found that the incidence of incision infections was 9.94% (34/342) in 342 patients. Multifactorial logistic regression analysis showed that the incidence of incision infections was significantly higher in patients with comorbid diabetes mellitus versus those without comorbid diabetes mellitus (odds ratio [OR] = 9.543, 95% confidence interval [CI]: 1.818-50.095, p = 0.008); patients undergoing surgery in summer versus those in other seasons (OR = 8.483, 95% CI: 1.476-48.744, p = 0.017); and malnourished patients versus those with good nutritional status (OR = 5.163, 95% CI: 1.016-26.231, p = 0.048). In addition, the analysis also revealed that incision size was also a risk factor for incision infections during the postoperative period (OR = 2.882, 95% CI: 1.567-5.304, p = 0.001), whereas a higher preoperative albumin level was a protective factor (OR = 0.755, 95% CI: 0.639-0.891, p = 0.001).</p><p><strong>Conclusions: </strong>A plethora of risk factors can lead to incision infection in patients with maxillofacial fracture during perioperative period. Therefore, preventive measures should be implemented in the hospitals to control these factors in order to reduce the occurrence of complications and enhance the effectiveness of surgical treatment.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"213-220"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Neurological Function and Prognosis After Stereotactic Aspiration and Neuroendoscopic Surgery for Hypertensive Intracerebral Hemorrhage.","authors":"Ting Guo, Qianqian Zhu, Congying Zhu, Zhixin Zhao, Haifei Chai, Xufeng Pan, Danjiang Lin","doi":"10.62713/aic.3950","DOIUrl":"https://doi.org/10.62713/aic.3950","url":null,"abstract":"<p><strong>Aim: </strong>In recent years, minimally invasive surgery has become a preferred treatment for hypertensive intracerebral hemorrhage (HICH). This study aims to comprehensively compare the neurological function and prognosis of neuroendoscopic surgery (NS) and stereotactic aspiration (SA) in patients with HICH.</p><p><strong>Methods: </strong>A total of 247 patients with HICH admitted to Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University from April 2020 to December 2023 were included. Patients were divided into the NS group (65 cases) and the SA group (182 cases). The perioperative indicators, serum neurological function, complications, and functional prognosis were compared between the two groups.</p><p><strong>Results: </strong>The SA group demonstrated higher hematoma clearance rate with lower hematoma residual volumes and intraoperative blood loss than the NS group (p < 0.05). Compared with these before surgery, serum brain-derived neurotrophic factor (BDNF) levels increased, neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) levels decreased in both groups at 1 and 3 months post-surgery (p < 0.05). The SA group showed higher BDNF and lower NSE and GFAP levels at 1 and 3 months post-surgery than the NS group (p < 0.05). Compared with these before surgery, both groups showed lower National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) score and higher Glasgow Outcome Scale (GOS) scores at 1 and 3 months post-surgery, with the SA group performing better than the NS group post-surgery (p < 0.05). There was no difference in the complications rates between the two groups (p > 0.05). At 3- and 6-months post-surgery, the SA group showed higher Mini-Mental State Examination (MMSE) scores than the NS group (p < 0.05). At 3 months post-surgery, the SA group showed higher activities of daily living (ADL) scores than the NS group (p < 0.05), but no difference at 6 months post-surgery (p > 0.05).</p><p><strong>Conclusions: </strong>In the treatment of HICH, compared to NS, SA offers advantages in hematoma clearance and intraoperative bleeding reduction. Additionally, SA more effectively improves neurological function, quality of life, and cognitive ability in HICH patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"514-522"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Laparoscopic Sleeve Gastrectomy Without Staple Reinforcement Safer? Analysis of 426 Consecutive Cases.","authors":"Nail Omarov, Elnur Huseynov, Gulcan Coban, Mushviq Hasanov","doi":"10.62713/aic.3774","DOIUrl":"https://doi.org/10.62713/aic.3774","url":null,"abstract":"<p><strong>Aim: </strong>Laparoscopic Sleeve Gastrectomy (LSG) is an accepted safe procedure and the most common surgical method used in the treatment of morbid obesity. Leakage and staple line bleeding are significant postoperative complications that can cause concern due to the long staple line. The purpose of this study to examine the risk of complications that may arise due to the lack of staple line reinforcement during the surgery.</p><p><strong>Methods: </strong>Between March 2021 and May 2023, 426 consecutive patients who underwent LSG in Avrupa Safak Hospital were identified through a retrospective database. The patients included in the study were divided into two groups according to the staple line reinforcement. Group A (n = 210) received staple line reinforcement (SLR) and Group B (n = 204) received non-staple line reinforcement (NSLR). Twelve patients who did not meet the inclusion criteria were excluded from the study. Patient demographics, operative time, postoperative and perioperative complications such as staple line leak, bleeding, conversion to open surgery, length of hospital stay, abdominal pain, morbidity and mortality-related data were analyzed.</p><p><strong>Results: </strong>The mean age, body mass index (BMI), and ASA scores were similar in both groups. Operative time was longer in SLR group (p < 0.001). Postoperative complications occurred in 6 (2.9%) and 9 (4.4%) patients in Groups A and B respectively (p = 0.397). There was no staple line leak in either group. There were two strictures in Group A. Mean length of postoperative hospital stay was 2.17 and 2.16 days in Groups A and B respectively (p = 0.830). There was no in patient death.</p><p><strong>Conclusions: </strong>Reinforcing the staple line after LSG is not necessary to reduce the risk of staple line leaks and bleeding.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"562-567"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Gallbladder Perforation in a Patient With Osteogenesis Imperfecta Type III: A Rare Case Report.","authors":"Huseyin Esin","doi":"10.62713/aic.3768","DOIUrl":"https://doi.org/10.62713/aic.3768","url":null,"abstract":"<p><strong>Aim: </strong>Osteogenesis imperfecta (OI), also known as brittle bone disease, is an inherited connective tissue disorder (CTD) characterized by recurrent fractures, low bone mass, skeletal deformity, and variable short stature. Gallbladder perforation (GBP) is a rare but serious complication of acute cholecystitis, associated with high morbidity and mortality due to diagnostic delays in both calculous and acalculous cases. This case highlights the importance of maintaining a high index of suspicion for spontaneous ischemic GBP in patients with CTDs such as OI Type III.</p><p><strong>Case presentation: </strong>A 20-year-old woman with severe OI type III presented to the emergency department with a two-day history of abdominal pain and distension. Abdominal computed tomography revealed free intraperitoneal air anterior to the liver and adjacent to the falciform ligament, which was suggestive of GBP. No gallstones or sludge were identified within the gallbladder lumen. An emergent open cholecystectomy was performed. Intraoperative findings revealed a concealed perforation at the gallbladder fundus. Due to dense adhesions and the inability to achieve the critical view of safety, a partial cholecystectomy was performed to reduce the risk of biliary and vascular injury.</p><p><strong>Results: </strong>OI poses significant clinical challenges, including abnormal coagulation, airway obstruction, cardiovascular complications, and delayed wound healing. The patient recovered without complications and was discharged on the seventh postoperative day, remaining asymptomatic during the three-month follow-up period.</p><p><strong>Conclusions: </strong>This case demonstrates that GBP, though rare, should be considered a potential complication in patients with CTDs such as OI Type III. Early recognition and appropriate management are crucial for improving clinical outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"465-469"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Application of a New Model for Disease Classification in Minimally Invasive Treatment of Concomitant Cholecystolithiasis and Choledocholithiasis.","authors":"Yiwei Liu, Yusha Xiao, Pengpeng Liu, Jianwei Lan, Dekun Song, Longhui Xie, Quanyan Liu","doi":"10.62713/aic.3771","DOIUrl":"10.62713/aic.3771","url":null,"abstract":"<p><strong>Aim: </strong>There is no consensus regarding the minimally invasive treatment method for concomitant cholecystolithiasis and choledocholithiasis. Therefore, this study aimed to develop a universal classification system for minimally invasive surgeries, thereby supporting development of consensus in guidelines for diagnosing choledocholithiasis.</p><p><strong>Methods: </strong>This retrospective study included 1044 consecutive patients with concomitant cholecystolithiasis and choledocholithiasis who underwent different minimally invasive surgical treatments at the Zhongnan Hospital of Wuhan University, China, between January 2014 and April 2021. To identify the key factors influencing the choice of different minimally invasive surgical procedures, clinical data for all hospitalized patients were analyzed. The patients were followed up through outpatient visits or telephonic calls at 1 week, 6 weeks, 3 months, 6 months, and 1 year or immediately if symptoms developed following discharge from the hospital. This information was integrated in the form of a new disease classification model, and the optimal treatment approaches were screened.</p><p><strong>Results: </strong>A significant correlation was observed between the choice of minimally invasive surgical procedures and the concomitant common bile duct (CBD) (p < 0.001), stone size (p < 0.001), or stone number (p < 0.001). A new clinical classification model was developed for patients with concomitant gallbladder (GB) and CBD stones based on the CBD diameter, stone sizes, and stone numbers, and the patients were sorted into Type I, II, III, and Ⅳ, respectively. Three invasive surgical methods were performed in patients with type I patients, revealing the laparoscopic cholecystectomy + Laparoscopic Transcystic Common Bile Duct Exploration (LC + LTCBDE) method as a preferred option for these patients. Furthermore, five surgical methods were performed on patients with type II CBD stones, demonstrating LC + LTCBDE as the viable option for these patients. Additionally, among the four minimally invasive surgical methods applied in patients with type III, the LC + laparoscopic choledochotomy for common bile duct exploration (LCCBDE) + Duodenoscope or LC + LCCBDE + primary closure demonstrated favorable results in this group of patients. Among the three methods applied in type IV patients, LC + laparoscopic choledocholithotomy and T-tube drainage (LCTD) were found to be more favorable.</p><p><strong>Conclusions: </strong>In summary, this novel and simple clinical classification system, which is based on CBD diameter, stone sizes, and stone numbers, can assist clinicians in selecting a minimally invasive treatment approach for managing concomitant GB and CBD stones.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"244-260"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Systemic Immune-Inflammation Index Combined with Distal Ureteral Diameter Ratio for Early Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux.","authors":"Xiangxiang Chen, Weihua Zheng, Xiaoyu Tang, Yan Chen, Fang Chen, Xiujun Yang","doi":"10.62713/aic.3916","DOIUrl":"10.62713/aic.3916","url":null,"abstract":"<p><strong>Aim: </strong>To investigate predictive value of the systemic immune-inflammation index (SII) combined with the distal ureteral diameter ratio (UDR) for early breakthrough urinary tract infection (BT-UTI) in children with primary vesicoureteral reflux (VUR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 150 VUR patients admitted to ShangHai Children's Hospital from January 2021 to December 2023. Patients were divided into the early BT-UTI group (n = 52) and the non-earlyBT-UTI group (n = 98) based on whether early BT-UTI occurred. Univariate and binary logistics regression analyses were performed to identify factors influencing early BT-UTI in VUR children. Pearson correlation analysis was used to assess the relationship between variables, and receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of SII combined with UDR for early BT-UTI in VUR children.</p><p><strong>Results: </strong>Comparisons of age, gender, body mass index (BMI), neutrophils (NEU), lymphocytes (LYM), red blood cells (RBC), white blood cells (WBC), comorbidities, length of hospital stay, and caregiver education level showed no statistically significant differences (p > 0.05). Differences in reflux grade, UDR, SII, and platelets (PLT) between the groups were statistically significant (p < 0.05). According to Pearson linear correlation analysis, SII was negatively correlated with LYM, and positively correlated with PLT and NEU (r = 0.366 and 0.839, respectively; p < 0.05). UDR was unrelated to NEU and LYM, and positively correlated with PLT (r = 0.280, p < 0.05), and SII was positively correlated with UDR (r = 0.162, p < 0.05). Binary logistic regression analysis indicated that UDR and SII were factors influencing early BT-UTI in VUR children (OR = 1.171 and 5.306, respectively; 95% confidence interval (CI) = 1.099-1.249 and 2.841-9.912, respectively; p < 0.05). The combined variables had an area under the curve (AUC) of 0.832 with a standard error of 0.032 (95% CI: 0.768-0.895), Youden index = 0.53, sensitivity of 90.4%, and specificity of 62.2%. The combined index had an AUC closest to 1, indicating the highest predictive value.</p><p><strong>Conclusions: </strong>UDR combined with SII boasts a high predictive value for early BT-UTI in VUR children.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"345-351"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review.","authors":"Shannon Baker, Subham Jaiswal, Valentin Butnari, Aashlesha Sardesai, Ahmer Mansuri, Dixon Osilli, Francesco Di Nubila, Robert Buhain, Sayed Haschmat Sarwary, Sandeep Kaul","doi":"10.62713/aic.3806","DOIUrl":"https://doi.org/10.62713/aic.3806","url":null,"abstract":"<p><strong>Aim: </strong>Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings.</p><p><strong>Methods: </strong>A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist.</p><p><strong>Results: </strong>A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection.</p><p><strong>Conclusions: </strong>The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence.</p><p><strong>Systematic review registration: </strong>PROSPERO: CRD42024503724.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"421-436"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Gastric Twist and Leak Post Band Removal and Sleeve Gastrectomy.","authors":"Mohammad N Nofal, Ali J Yousef, Mohammad Salah, Saad H Samarah","doi":"10.62713/aic.3742","DOIUrl":"10.62713/aic.3742","url":null,"abstract":"<p><strong>Aim: </strong>Gastric twist is a rare, however, troublesome complication of laparoscopic sleeve gastrectomy. This report describes a case complicated by perforation and leak in addition to twist. The patient was managed conservatively and successfully.</p><p><strong>Case presentation: </strong>A 29-year-old female patient with a body mass index (BMI) of 41.3 kg/m2 (111 kg/1.64 m), who underwent gastric band insertion six years ago, recently experienced postprandial vomiting. Endoscopic examination revealed grade A esophagitis, minor antral gastropathy, and mild bulbar duodenitis. Her BMI was calculated at 33.1 kg/m2 (89 kg/1.64 m). One week later, she had a laparoscopic band removal and sleeve gastrectomy using an endo GIA Tri-stapler. Both the surgical and postoperative periods proceeded without complications, and she was discharged home the next day after surgery. The patient was readmitted after two weeks due to an organo-axial gastric volvulus, which was managed with stent placement. Six weeks following, a stomach leak and peri splenic fluid collection were diagnosed. A 12 mm Ovesco clip was employed to seal a perforation situated 35 cm from the incisors. Subsequently, a MEGA bariatric stent was placed.</p><p><strong>Results: </strong>Two months after the removal of the MEGA stent, the patient had recovered completely and was in good health.</p><p><strong>Conclusions: </strong>Gastric twist after sleeve gastrectomy is a rare condition; a high index of suspicion is required for diagnosis. Prioritize conservative treatment to prevent the risk of revisional surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"14-18"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Retrieval of Disconnected Tip From an Iliac Branch Device Stent Graft: A Case Report.","authors":"Ilaria Calicchio, Antonia Rinaldi, Nicola Cantile, Michele Vollono, Luca Del Guercio, Umberto Marcello Bracale, Davide Turchino","doi":"10.62713/aic.3784","DOIUrl":"https://doi.org/10.62713/aic.3784","url":null,"abstract":"<p><p>Endovascular repair of aneurysmal pathology in the aorto-iliac district presents one of the significant challenges in contemporary vascular surgery. Advances in techniques, materials, and devices have enhanced the ability of vascular surgeons in endovascular procedures, leading to the management of increasingly complex cases, with applications sometimes extending beyond the Instructions for Use (IFUs) of specific devices. In our case report, we describe the successful endovascular retrieval of a disconnected tip from an iliac branch device (IBD), preventing conversion to open surgery in a 73-year-old patient with a complex aortoiliac aneurysm. The case highlights the importance of exercising caution when treating patients with complex anatomy not in conformance with a device's IFU, even in high-volume centers with extensive endovascular expertise.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"572-578"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}