An evaluation score of the difficulty of thyroidectomy considering operating time and preservation of recurrent laryngeal nerve
AbstractThe purpose of this study was to edit a renovated thyroidectomy difficulty scale (rTDS) in order to identify underlying thyroid diseases with a longer operative time and higher technical difficulty, also considering preservation of recurrent laryngeal nerve. We developed a renovated scale with a maximum score of 20 points by creating a form in which five variables were considered: vascularity, friability, mobility/fibrosis, gland size and difficulty in preservation of the recurrent laryngeal nerve. Two surgeons separately evaluated each of these. Through a simple linear regression analysis, we have analyzed the rel...
Source: Updates in Surgery - August 7, 2019 Category: Surgery Source Type: research

Analysis of risk factors for hemorrhage and related outcome after pancreatoduodenectomy in an intermediate-volume center
AbstractPrecise risk factors for bleeding after pancreatoduodenectomy (PD) need to be further explored. We aimed to identify which variables were associated with the risk of post-pancreatectomy hemorrhage (PPH) and benchmark the PPH rate and related outcome in our intermediate-volume center with the current literature. We retrospectively analyzed 183 PD records. We investigated the association between PPH and a number of pre-surgical (age, body mass index, bilirubin plasma level, gender, American Society of Anesthesiologists classification (ASA) and smoking status, vascular hypertension), surgical (technique, additional or...
Source: Updates in Surgery - August 2, 2019 Category: Surgery Source Type: research

The General Surgery Residency Program in Italy: a changing scenario
(Source: Updates in Surgery)
Source: Updates in Surgery - July 6, 2019 Category: Surgery Source Type: research

Short-term outcomes after duodenal surgery for mesenchymal tumors: a retrospective analysis from a single tertiary referral center
AbstractDuodenal resections are sometimes necessary for radical surgery. We analyzed technical aspects and post-operative outcomes in patients with RPS and GIST involving duodenum. We identified patients who underwent duodenal resection for RPS and GIST at our Institute between 2000 and 2016. Clinical, pathological and treatment variables were analyzed. Thirty patients were treated: 15 for GIST, 15 for RPS. Sixteen duodenal wedge resections (WR) and 14 segmental resections (SR) were performed. Multi-organ resection was frequently performed (63.4%). Median time to flatus was 3  days (range 1–6), to oral refeeding...
Source: Updates in Surgery - July 3, 2019 Category: Surgery Source Type: research

Message from the Editors in Chief
(Source: Updates in Surgery)
Source: Updates in Surgery - July 2, 2019 Category: Surgery Source Type: research

Selecting treatment sequence for patients with incidental gallbladder cancer: a neoadjuvant approach versus upfront surgery
AbstractAt MSKCC, over 50% of the patients presenting with gallbladder cancer have been diagnosed incidentally following elective cholecystectomy for presumed benign disease. While traditional management of incidental gallbladder cancer (IGBC) dictates re-resection with the ultimate goal of achieving cure, surgical decision-making must take into account that this malignancy is characterized by poor tumor biology with frequent distant recurrence. Since early and frequent distant recurrence is the most common cause of surgical failure, the surgical oncologist ’s goal should be to selectively re-resect only those patien...
Source: Updates in Surgery - June 28, 2019 Category: Surgery Source Type: research

Intraoperative ultrasonography in patients undergoing surgery for Crohn ’s disease. Prospective evaluation of an innovative approach to optimize staging and treatment planning
AbstractPercutaneous ultrasonography (perc-US) and magnetic resonance enterography (e-MR) are the present standards for staging patients with Crohn ’s disease (CD). However, intraoperative data still have some discrepancies with preoperative ones. The contribution of intraoperative ultrasonography (IOUS) has never been evaluated. Sixty-five consecutive patients scheduled for ileal/colonic resection for CD between 2010 and 2014 were prospectiv ely enrolled. All patients had perc-US, e-MR and IOUS. Data from different imaging modalities were compared. The reference standard was the final pathology. Surgery was schedule...
Source: Updates in Surgery - June 28, 2019 Category: Surgery Source Type: research

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer
AbstractUnplanned readmissions heavily affect the cost of health care and are used as an indicator of performance. No clear data are available regarding beyond-total mesorectal excision (bTME) procedure. Aim of the study is to identify patient-related and surgery-related factors influencing the 30-day readmissions after bTME. Retrospective data were collected from 220 patients who underwent bTME procedures at single centre between 2006 and 2016. Patient-related and operative factors were assessed, including body mass index (BMI), age, gender, American Society of Anaesthesiologists ’ (ASA) score, preoperative stage, n...
Source: Updates in Surgery - June 27, 2019 Category: Surgery Source Type: research

Outcomes of end-to-side oblique anastomosis as a surgical technique for jejuno-ileal atresia
AbstractAll of the anastomotic techniques used for jejuno-ileal atresia aim to overcome the size discrepancy between the resected bowel ends, lessen anastomotic complication and prevent development of short bowel syndrome. Aim of study was to evaluate the outcomes of end-to-side oblique anastomosis for jejuno-ileal atresia and verifying the risk factors for complications. A prospective study was conducted on patients with jejuno-ileal atresia managed by end-to-side oblique anastomotic technique over a 7-year period. Data were collected and analyzed to evaluate the outcomes of this surgical technique as morbidity and mortal...
Source: Updates in Surgery - June 26, 2019 Category: Surgery Source Type: research

Minimal length of proximal resection margin in adenocarcinoma of the esophagogastric junction: a systematic review of the literature
In conclusion, available retrospective studi es did not allow a conclusion for a minimal length of PM and showed no clear evidence for an impact of PM length on survival. Taking into consideration available data and the shrinkage phenomen, a PM >  2 cm might be necessary to obtain a sufficient PM. (Source: Updates in Surgery)
Source: Updates in Surgery - June 26, 2019 Category: Surgery Source Type: research

Surgery 2019: an existential crisis
(Source: Updates in Surgery)
Source: Updates in Surgery - June 21, 2019 Category: Surgery Source Type: research

Reform in the training of digestive surgeons in France: a revolution for a renaissance!
(Source: Updates in Surgery)
Source: Updates in Surgery - June 17, 2019 Category: Surgery Source Type: research

Bowel preparation in colorectal surgery: back to the future?
(Source: Updates in Surgery)
Source: Updates in Surgery - June 14, 2019 Category: Surgery Source Type: research

Net survival of patients with colorectal cancer: a comparison of two periods
ConclusionA comparison of the 5-year net survival rate for R0-resected patients with colorectal cancer increased in the last period from 1995 to 2000 compared with the period from 1991 to 1995. In multivariate analysis, early stage at diagnosis and adjuvant chemotherapy was both associated with better net survival after surgery with curative intent. The improvement of net survival is potentially the result of combination of better surgical and adjuvant therapy. (Source: Updates in Surgery)
Source: Updates in Surgery - June 12, 2019 Category: Surgery Source Type: research

The diagnosis and management of intraductal papillary mucinous neoplasms of the pancreas: has progress been made?
AbstractIntraductal papillary mucinous neoplasms (IPMN) of the pancreas are premalignant mucin-producing epithelial tumors that arise from the pancreatic ductal system. These cystic tumors represent 15 –30% of cystic lesions of the pancreas [Basturk et al. in Am J Surg Pathol 39(12):1730–1741,1; Ferrone et al. in Arch Surg (Chicago, Ill: 1960) 144(5):448 –454,2, Kosmahl et al. in Virchows Arch Int J Pathol 445(2):168 –178,3; Spinelli et al. in Ann Surg. 239(5):651 –657,4]. It is believed that IPMN can progress from low-grade dysplasia to high-grade dysplasia to invasive cancer, and this pathwa...
Source: Updates in Surgery - June 7, 2019 Category: Surgery Source Type: research

Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy
This study aimed to assess EJF regarding its incidence, risk factors, management and the impact on overall survival. We retrospectively analyzed 258 consecutive patients who underwent total or completion gastrectomy for GC from 2009 and 2017. Clinicopathological characteristics analysis was performed comparing patients who developed EJF with patients with other clinical or surgical complications, as well as patients without any postoperative complications. Fifteen (5.8%) patients had EJF and 81 (31.4%) had other complications (including other surgical fistulas). The median time of EJF diagnosis was on the eighth postoperat...
Source: Updates in Surgery - June 3, 2019 Category: Surgery Source Type: research

A remark on: do all the European surgeons perform the same D2? The need for D2 audit in Europe
(Source: Updates in Surgery)
Source: Updates in Surgery - June 1, 2019 Category: Surgery Source Type: research

A stepwise learning curve to define the standard for technical improvement in laparoscopic liver resections: complexity-based analysis in 1032 procedures
The objective of this study is to define the learning curve in a series of procedures grouped according to their complexity calculated by difficulty index to define a standard for technical improvement. 1032 laparoscopic liver resections performed in a single tertiary referral center were stratified by difficulty scores: low difficulty (LD,n = 362); intermediate difficulty (ID,n = 332), and high difficulty (HD,n = 338). The learning curve effect was analyzed using the cumulative sum (CUSUM) method taking into consideration the expected risk of conversion. The ratio of laparoscopic/...
Source: Updates in Surgery - May 22, 2019 Category: Surgery Source Type: research

Retraction Note to: Contrast-enhanced ultrasound appearances of enhancement patterns of intrahepatic cholangiocarcinoma: correlation with pathological findings
While Prof. Dott. Di Carlo gave verbal consent to the corresponding author. (Source: Updates in Surgery)
Source: Updates in Surgery - May 8, 2019 Category: Surgery Source Type: research

TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique —cumulative experience in a single centre
AbstractFrom January 2011 to December 2015, 70 consecutive patients underwent either laparoscopic surgery (LS) or robotic surgery (RS) total mesorectal excision (TME) for malignancy. Data were prospectically recorded in a dedicated local database including ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results. We enrolled 70 consecutive patients, 35 treated with LS (18  M, 17 F), 35 treated with RS (23 M, 12 F). Median total operative time was 225 min in LS group (IQR 194–255) and 252.5 min for RS group (IQR 214–300)...
Source: Updates in Surgery - April 26, 2019 Category: Surgery Source Type: research

Patients with gunshot wounds to the torso differ in risk of mortality depending on treating hospital
AbstractPrevious studies have had conflicting results when comparing risk of mortality in patients with gunshot wounds (GSWs) treated at Level-I and II trauma centers. However, the populations studied were restricted geographically. We hypothesized that patients presenting after a GSW to the torso at Level-I centers would have a shorter time to surgical intervention (exploratory laparotomy or thoracotomy) and a lower risk of mortality, compared to Level-IIs in a national database. The Trauma Quality Improvement Program (2010 –2016) was queried for patients presenting to Level-I or II trauma center after a GSW to the ...
Source: Updates in Surgery - April 22, 2019 Category: Surgery Source Type: research

Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience
We described our experience in the diagnosis and management of chylous ascites. Five hundred and forty-six patients were submitted to surgery for ovarian cancer and 298 patients received pelvic and/or para-aortic lymphadenectomy. Chylous ascites occurred in 8 patients with an incidence of 1.4% in the overall population and a 2.68% among patients receiving lymphadenectomy. All patients received total parenteral nutrition (TPN) with Olimel N4E 2000  mL (Baxter®) and somatostatin therapy with 0.2  mL per 3 times/day for a median of 9 days (range 7–11). Median hospital stay was 15 days (range 7&nd...
Source: Updates in Surgery - April 20, 2019 Category: Surgery Source Type: research

Appendectomy in Switzerland: how is it done?
AbstractMore than 10,000 appendectomies are performed every year in Switzerland. The aim of this study was to investigate the treatment strategy for appendicitis among Swiss surgeons with particular interest in laparoscopic technique, method of appendiceal stump closure, and abdominal lavage. We performed an anonymous survey among 540 members of the Swiss Surgical Society. Technical details and differences between the surgical procedures in adults and children as well as in complicated and non-complicated appendicitis were investigated. The overall response rate was 45% (n = 243). 78% of the surgeons perform ...
Source: Updates in Surgery - April 13, 2019 Category: Surgery Source Type: research

Surgical approach and geriatric evaluation for elderly patients with colorectal cancer
AbstractThis review aims to define the most appropriate surgical approach and geriatric evaluation for elderly patients with colorectal cancer (CRC). Surgery represents the main treatment for CRC, but elderly cancer patients still represent a challenge for the surgeon due to frequent comorbidities such as cardiovascular and pulmonary diseases, which increase operative risk as well as the risk of postoperative morbidity and mortality. Cancer patients with comorbidities show lower survival rates and quality of life, together with higher healthcare costs. There is also evidence that patients with comorbidities sometimes recei...
Source: Updates in Surgery - April 5, 2019 Category: Surgery Source Type: research

Intraoperative verification of parathyroid glands in primary and secondary hyperparathyroidism using near-infrared autofluorescence (IOPA)
AbstractIntraoperative verification of parathyroid glands relies on visual identification by the surgeon and, with some time delay, on serum parathormon measurements and frozen section. Fluorescence imaging, however, is an instant on-table method for direct visualization of parathyroid tissue which is known to exhibit increased autofluorescence intensity when exposed to near-infrared light. In this retrospective observational study, we evaluate the clinical use of this method in a series of patients with primary and secondary hyperparathyroidism. A total of 66 adenomatous and hyperplastic parathyroid glands were examined w...
Source: Updates in Surgery - April 3, 2019 Category: Surgery Source Type: research

Prophylactic drainage after laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis
AbstractIn the literature, there is a large evidence against the use of drains in laparoscopic cholecystectomy (LC) in elective surgery. However, evidence is lacking in the setting of acute cholecystitis (AC). The present meta-analysis was performed to assess the role of drains to reduce complications and improve recovery in LC for AC. An electronic search of the MEDLINE, Science Citation Index Expanded, SpringerLink, Scopus, and Cochrane Library database from January 1990 to July 2018 was performed to identify randomized clinical trials (RCTs) that compare prophylactic drainage with no drainage in LC for AC. Odds ratio (O...
Source: Updates in Surgery - April 3, 2019 Category: Surgery Source Type: research

Laparoscopic management of uncommon benign uterine tumors: a systematic review
The objective of the study was to review the reported cases of uncommon benign uterine tumors managed by laparoscopy. Medline database was searched using predefined search terms linked to atypical leiomyomas, leiomyoma variants, laparoscopy and morcellation. Quality of articles was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Due to heterogeneity in reporting characteristics of the patients, radiological findings, macroscopic findings, histological characteristics and follow-up, we performed a narrative synthesis. We included 109 cases of leiomyoma variants managed by laparoscopy. This stands for a...
Source: Updates in Surgery - April 2, 2019 Category: Surgery Source Type: research

Surgical and oncological outcomes of hepatic resection for BCLC-B hepatocellular carcinoma: a retrospective multicenter analysis among 474 consecutive cases
In this study, we focused on surgical and oncological outcomes of hepatic resection in BLCB-B patients. Patients who received hepatic resection for early- (BCLC-0/A) or intermediate-stage (BCLC-B) HCC in two tertiary hepatobiliary centers between January 2003 and December 2016 were included in study. Four-hundred and twenty-nine patients were included in the analysis. At the time of resection, 298 patients were classified as BCLC-A/0 and 131 as BCLC-B. Despite a higher complication rate in BCLC-B group (49.6% vs 32.9%;p = 0.001), the incidence of clinically relevant complications did not differ significantly ...
Source: Updates in Surgery - April 2, 2019 Category: Surgery Source Type: research

Burnout and psychological distress between surgical and non-surgical residents
AbstractSurgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), d...
Source: Updates in Surgery - April 2, 2019 Category: Surgery Source Type: research

Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases
AbstractReoperative thyroid surgery is an uncommon procedure that is indicated in recurrent benign or malignant disease. It is associated with a high complication rate, especially of hypoparathyroidism and recurrent nerve palsy. We retrospectively reviewed our series of patients on whom reoperative thyroid surgery was performed and we compared this group with patients who underwent primary thyroidectomies. From 2002 to 2015, 4572 thyroidectomies were performed at our institution; among these, 152 (3.3%) were for benign or malignant recurrent disease. We observed a higher rate of transient hypoparathyroidism in secondary vs...
Source: Updates in Surgery - April 1, 2019 Category: Surgery Source Type: research

Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity
AbstractIntraoperative liver ultrasound has a crucial role to guide open liver surgery. A 4-step ultrasound liver map technique for laparoscopic liver resection (LLR) has been standardized in our center. The aim of this study was to evaluate outcomes of our technique according to the hepatectomy technical complexity. A difficulty scale (DS) ranging from 1 to 10 was applied to each LLR. A cumulative sum control-chart analysis identified 3 periods of gradually increasing DS. Perioperative outcomes of the 3 periods were compared. 300 LLRs performed between 2006 and 2018 were analyzed. Median DS was 3 for first 100 cases (P1),...
Source: Updates in Surgery - March 27, 2019 Category: Surgery Source Type: research

The dilemma of surgical research between evidences and experience, impact factor and innovation
(Source: Updates in Surgery)
Source: Updates in Surgery - March 20, 2019 Category: Surgery Source Type: research

Message from the Editors-in-Chief
(Source: Updates in Surgery)
Source: Updates in Surgery - March 19, 2019 Category: Surgery Source Type: research

D-shape asymmetric excision in recurrent pilonidalis disease: an analytic longitudinal long-term evaluation
AbstractSacrococcigeal pilonidalis disease (SPD) recurrence is a major factor influencing surgical outcomes. Several different surgical treatments have been reported, however, there is a lack of long-term data on reoperation. Aim of this study was to analyze outcomes of a single center adopting a standardized off-midline asymmetric procedure (D-shape). Analytic longitudinal assessment of 83 patients (median age 35  years, range 23–59 years) with recurrent SPD that completed the 5-year study design following D-shape reoperation. Among a cohort of 607 patients, we enrolled 83 recurrent SPD. After D-shape reop...
Source: Updates in Surgery - March 18, 2019 Category: Surgery Source Type: research

Laparoscopic cholecystectomy: do risk factors for a prolonged length of stay exist?
AbstractGallstones are one of the most common morbidities in the world. Laparoscopic cholecystectomy is the gold standard for gallbladder stones ’ removal. Few studies focus on the existence of predictive factors aimed at facilitating cholecystectomy in a day surgery setting. The aim of this retrospective study was to identify clinical factors that could guide day-surgery laparoscopic cholecystectomy safety. The study included 985 consecut ive patients who underwent elective laparoscopic cholecystectomy for gallstone disease between May 2006 and February 2015. Patients were divided into two groups: group A with a len...
Source: Updates in Surgery - March 18, 2019 Category: Surgery Source Type: research

A novel patient-centered protocol to reduce hospital readmissions for dehydration after ileostomy
AbstractEarly hospital readmission for dehydration represents a relevant problem among patients with diverting or terminal ileostomy. The aim of the study was to evaluate the efficacy of a new multidisciplinary individualized multistep protocol in terms of reduction of hospital readmission for dehydration. Since January 2016, our institution adopted a new protocol for patients with ileostomy. Protocol key points were: preoperative personalized education in stoma management; early recognition of dehydration symptoms; multidisciplinary counseling; patient autonomy in stoma management through post-operative recall schedule. T...
Source: Updates in Surgery - March 18, 2019 Category: Surgery Source Type: research

Open versus minimally invasive surgery for rectal cancer: a single-center cohort study on 237 consecutive patients
AbstractMinimally invasive surgery (MIS) is gaining popularity in rectal tumor treatment. However, contrasting data are available regarding its safety and efficacy. Our aim is to compare the open and MIS approaches for rectal cancer treatment. Two-hundred-thirty-seven patients were included: 113 open and 124 MIS rectal resections. After the propensity score matching analysis (PS), the cases were matched into 42 open and 42 MIS. Short- and long-term outcomes, and pathological findings were analyzed before and after PS. A further comparison of the same outcomes and costs was conducted between the laparoscopic and the robotic...
Source: Updates in Surgery - March 13, 2019 Category: Surgery Source Type: research

Past, present, and future of donation after circulatory death in Italy
(Source: Updates in Surgery)
Source: Updates in Surgery - March 12, 2019 Category: Surgery Source Type: research

Dissecting the multinodular hepatocellular carcinoma subset: is there a survival benefit after hepatectomy?
AbstractWhether hepatic resection for multinodular hepatocellular carcinoma (HCC) is indicated remains to be demonstrated. We investigated the prognostic factors in a large series of patients treated with hepatic resection at a reference cancer center. All consecutive patients resected for multinodular HCC from January 2004 to April 2015 were reviewed. The study endpoints were the survival analysis and the definition of resection criteria. Among 380 patients resected for HCC, 116 (31%) were affected by multinodular HCC without macrovascular invasion. The median tumor number was 2 (range 2 –30), while the median tumor...
Source: Updates in Surgery - March 9, 2019 Category: Surgery Source Type: research

Duodeno-jejunal or gastro-enteric leakage after pancreatic resection: a case –control study
AbstractDuodeno-jejunal (DJ) and gastro-jejunal (GJ) anastomosis leakage represents a rare but life-threatening complication after pancreaticoduodenectomy or total pancreatectomy. The aim of this study was to assess its incidence, clinical presentation, and outcomes, and to identify perioperative risk factors for DJ/GJ leak. Prospectively collected perioperative data were reviewed, and a case –control study was performed. Patients who presented with a DJ/GJ leak (cases) were matched in a 1:5 ratio with patients who did not develop it. Match criteria included age, diagnosis, type of surgery, and anastomosis. Periopera...
Source: Updates in Surgery - March 2, 2019 Category: Surgery Source Type: research

Referees 2018
(Source: Updates in Surgery)
Source: Updates in Surgery - March 2, 2019 Category: Surgery Source Type: research

Use of 3D models for planning, simulation, and training in vascular surgery
(Source: Updates in Surgery)
Source: Updates in Surgery - February 25, 2019 Category: Surgery Source Type: research

Is taTME delivering?
(Source: Updates in Surgery)
Source: Updates in Surgery - February 22, 2019 Category: Surgery Source Type: research

The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer
The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5 –24.9), overwe...
Source: Updates in Surgery - February 21, 2019 Category: Surgery Source Type: research

The role of socioeconomic disparity in colorectal cancer stage at presentation
AbstractColorectal cancer, despite multiple screening measures being available, is the second leading cause of death due to cancer. Cancer stage at diagnosis is an important determinant of survival, where earlier stages have significantly increased rates of survival. By looking at various social health disparities (at a patient and geographic level) and their effect on stage at presentation, we will gain a better understanding of the effect they have on cancer outcomes. Data were collected from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database for the years  2007–2014. Cov...
Source: Updates in Surgery - February 20, 2019 Category: Surgery Source Type: research

Cholecystectomy-related malpractice litigation: predictive factors of case outcome
This study is a retrospective analysis utilizing the legal database Verdictsearch (ALM Media Properties, LLC, New York, NY). Medical malpractice cases between July 2004 and November 2017 were identified using the search term “gallbladder.” Case information was recorded, including patient information, medical details, trial outcome, and resulting payments. Of 46 cases examined, 39 went to trial with a favorable plaintiff (patient) verdict in 43% (20/46) and a favorable physician verdict in 41% (19/46) of the cases. O nly 7% (3/46) of the cases resulted in a settlement, with 4% (2/26) concluding in mixed verdicts...
Source: Updates in Surgery - February 19, 2019 Category: Surgery Source Type: research

Colorectal surgery in Italy: a snapshot from the iCral study group
This study offers a good snapshot of colorectal resections in Italy. There was a high rate of laparoscopic resections, reflec ting the special interest in this kind of surgery by the participating centers. AL, morbidity, mortality, readmission and reoperation rates are compared to those reported in previous population-based studies. Compared to series dealing with open colorectal resections, the time to diagnosis of AL was shortened by several days. (Source: Updates in Surgery)
Source: Updates in Surgery - February 11, 2019 Category: Surgery Source Type: research

Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature
AbstractAnastomotic leak (AL) is a serious post-operative complication in colorectal surgery. It can lead to devastating morbidity and mortality. Clinicians usually depend on a combination of clinical, biochemical and radiological findings to diagnose this problem. In our article, we tried to look if electrolyte disturbances could be indicators for intra-abdominal sepsis due to AL. Systematic review of the literature identifies a potential correlation between electrolyte alterations and AL in digestive surgery. The following databases were searched: PubMed, EMBASE and MIDLINE. The review adhered to the PRISMA statement for...
Source: Updates in Surgery - February 8, 2019 Category: Surgery Source Type: research

Transanal total mesorectal excision (TaTME): current status and future perspectives
AbstractTotal mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing t...
Source: Updates in Surgery - February 8, 2019 Category: Surgery Source Type: research

Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes
AbstractMinimally invasive liver surgery has evolved significantly during the last 2 decades. A growing number of published studies report outcomes from robotic liver resections (RLR). The aim of our meta-analysis was to evaluate short-term outcomes after RLR vs. open liver resection (OLR). A systematic search of Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases for articles published from January 2000 until November 2018 was performed. Ten non-randomized retrospective clinical studies comprising a total of 1248 patients were included in our meta-analysis. Four...
Source: Updates in Surgery - February 4, 2019 Category: Surgery Source Type: research