Publications by authors named "Bianca Cudia"

10 Publications

  • Page 1 of 1

Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia.

J Clin Med 2021 Jun 28;10(13). Epub 2021 Jun 28.

Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported.

Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months.

Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively.

Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.
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http://dx.doi.org/10.3390/jcm10132865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268200PMC
June 2021

Long term outcomes of fissurectomy and anoplasty for chronic anterior anal fissure without hypertonia: low recurrences and continence conservation.

Ann Ital Chir 2020 Dec 21;9. Epub 2020 Dec 21.

Introduction: Aetiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.

Methods: We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluation of anal continence, short and long term post-operative complications, recurrence rate.

Results: At 5 years follow up we did not record any new case of anal incontinence and the pre-existing ones haven't worsened. We observed 2 recurrences, which occurred within 2 years after surgery and healed after medical therapy. The manometric values were similar than those recorded prior to surgery.

Conclusion: Our study suggests that the procedure performed allows us to preserve anal continence and avoid worsening of its pre-existing alteration.

Key Words: Anal canal, Anoplasty, Fissure, Fissurectomy, Proctology, Sphincterotomy.
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December 2020

Lymphatic Mesenteric Cyst, a Rare Cause of Surgical Abdominal Pain: Case Report and Review of the Literature.

Cureus 2020 Nov 29;12(11):e11766. Epub 2020 Nov 29.

General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA.

A lymphatic mesenteric cyst (LMC) is a rare clinical entity, of unclear etiopathogenesis, which can arise in the abdominal cavity or retroperitoneum without a clear origin. We describe a case of a 74-year-old male presenting with abdominal pain that was non-specific and non-responsive to medical therapy. Laboratory tests clinical examination were inconclusive while the abdominal computed tomography (CT) scan showed a cystic lesion of the ileal mesentery. We performed an open surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted to be an LMC at the histological examination. At the five-year CT scan follow-up, we did not record any recurrences. LMCs present without specific symptoms and imaging diagnostic techniques, such as ultrasound (US) or CT scan may define its features, location, or size. The preoperative diagnosis remains difficult, which is why the complete surgical excision is the gold standard treatment, aiming to prevent malignant transformation, complications, and recurrences.
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http://dx.doi.org/10.7759/cureus.11766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779134PMC
November 2020

Effect of Fibrin Sealant on Seroma Formation Post-Incisional Hernia Repair.

Chirurgia (Bucur) 2020 Nov-Dec;115(6):767-774

Development of seroma after incisional hernia repair is a common complication. Our study aims to compare the outcomes of sublay incisional hernia repairs with or without spray instillation of fibrin glue. We enrolled fifty patients undergoing incisional hernia repair. In all patients a suction drain was placed in the subcutaneous space. In one group (FG) 4 ml fibrin glue was instilled in the subcutaneous space. In the control group (C) patients did not receive any prevention measure. Wounds fluids were collected on post-operative day 1 (POD) and once daily until drain removal. All patients were followed up by ultrasound on POD 15, 20, 40, 60. Drain fluid production, even if in significantly greater amount in the C group (p 0.01) as compared with the FG group, decreased after POD 1 in both groups. Drain was removed on POD-5 in 80% of FG patients and in 36% of C patients (p 0.01). No infective or bleeding complications were detected. In group FG average hospital stay was of 5.5 ÃÂ+- 2 days versus 7.1 +- 1.5 days in group C (p 0.01). At ultrasounds examination, seroma development was similar among two groups. Spray instillation of fibrin glue during the surgical repair reduces amount of drained fluid and hospital stay without increasing surgical complications. However, seroma occurrence was not significantly reduced.
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http://dx.doi.org/10.21614/chirurgia.115.6.767DOI Listing
January 2021

Recurrent sacrococcygeal pilonidal disease: the efficacy of minimal subcutaneous excision of the sinus and unroofing of pseudocystic cavity.

Ann Ital Chir 2020 ;91:437-441

Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present prospective analysis was performed to evaluate the outcome for recurrent pilonidal disease treatment with a technique that provides a minimal subcutaneous excision of fistula and of the skin above the cyst, with secondary healing of wounds.

Methods: 48 consecutive patients with previous surgical excision and recurrent pilonidal disease underwent surgery from January 2009 to December 2016, under local anaesthesia. The age of the patients (42 males and 6 females) at the time of our observation was 28.5 ± 10.2 years, the BMI of 26.3 ± 6.8. The average number of interventions prior to our was 2.02 ± 1.14.

Results: The mean operative time was 18.2 ± 5.5 minutes. All patients were discharged 2 to 4 hours after surgery, with an average healing time of 22.8 ± 15.3 days. We recorded, in the follow-up period, only 4 relapses (8.32%), all retreated with the same surgical procedure and brought to complete healing. The results of the cosmetic questionnaire, which assessed patient satisfaction and contentment, showed that 96% of patients were completely satisfied and all patients recommended surgery to others. Kaplan-Meier analysis showed that in 7 years of follow-up, 85% of patients healed without recurrence.

Conclusions: Our simple procedure appears to be safe and easily reproducible, allowing a high surgical success in the treatment of recurrent pilonidal disease.

Key Eords: Excision, Healing, Recurrent sacrococcygeal pilonidal disease.
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August 2021

Conservative Treatment of Splenic Haematoma After Colonoscopy: A Case Report.

Cureus 2020 Sep 18;12(9):e10531. Epub 2020 Sep 18.

Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA.

Colonoscopy is a routine procedure performed worldwide, nevertheless, a small risk of splenic injury, often under-estimated, is still present. As a matter of fact, the diagnosis may be delayed, leading to a rising risk of morbidity and mortality. This paper describes a case of conservative treatment of colonoscopy-associated splenic injury. A 57-year-old woman presented with worsening pain in the upper left abdominal quadrant; she had radiation therapy to the ipsilateral subscapular region, and a diagnostic colonoscopy 18 hours earlier. The computed tomography (CT) scan revealed splenic laceration without signs of hemoperitoneum. Because of the hemodynamic stability of the patient, successful conservative treatment and serial controls of the blood and hemodynamic parameters were adopted. Even if rare splenic injury during colonoscopy is associated with significant morbidity and mortality. A high degree of clinical suspicion is essential to achieve a prompt diagnosis as well as an early surgical evaluation. The nonoperative approach is usually taken in patients with no intraperitoneal bleeding, a closed subcapsular haematoma and a stable hemodynamic status.
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http://dx.doi.org/10.7759/cureus.10531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574971PMC
September 2020

Stump appendicitis. A case report.

Int J Surg Case Rep 2016 7;20:21-3. Epub 2016 Jan 7.

School of Medicine, University Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and Thoracic Surgery, Service of Diagnostic and Operative Digestive Endoscopy, Italy.

Introduction: Today, the diagnosis of SA is usually not considered as the etiology for right lower quadrant pain in patient with history of appendectomy, resulting in delaying making the correct diagnosis and treatment. Obviously, other more common causes should be excluded first.

Discussion: Stump appendicitis (SA) was first described by Rose in 1945. The commonest presenting symptom are abdominal pain (right lower quadrant pain 59%, non specific abdominal pain 16%, and central abdominal pain radiating to the right lower quadrant 14%).

Presentation Of Case: A 54-year-old appendectomized woman presented with recent history of abdominal pain with periumbilical pain radiating to the right side and in the right iliac fossa, in the absence of fever, vomiting or other symptoms. Elective colonoscopy revealed appendicular orifice clogged by big fecalith, with hyperemic surrounding mucosa and CT confirmed "stump appendicitis". After 30 days of therapy with metronidazole 500mg/day and mesalazine 1000mg×2/day, the patient was submitted to surgery and appendectomy was performed, with a specimen of 24mm stump appendicitis.

Conclusion: SA may well be considered as one of the differential diagnoses of acute right lower abdominal pain even in patients with history of appendicectomy.
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http://dx.doi.org/10.1016/j.ijscr.2015.12.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818281PMC
March 2016

The improvement of quality of life a indication for elective surgery in elderly patients with minimally symptomatic inguinal hernia.

Ann Ital Chir 2014 Mar-Apr;85(2):136-42

Aim: Effectiveness of surgery on quality of life in elderly affected by minimally symptomatic inguinal hernia.

Material Of Study: Forty male patients aging over 75 years affected by minimally symptomatic inguinal hernia were included. In the first group were allocated 15 patients who refused hernioplasty; in the second were included 25 patients who underwent early elective hernioplasty using an high density polypropylene mesh under local anesthesia. The SF-36 questionnaire was administered to all patients at the time of enrollment and 6 months after.

Results: All 8 domains of SF-36 and his related two comprhensive index, Mental Component Summary and Physical Component Summary scores, improved 6 months after surgery in patients of the second group. No significant differences were detected in the first group.

Discussion: There is no scientific evidence concerning early repair or watchful waiting strategy for elderly with minimally symptomatic inguinal hernia. in the last years, the evaluation of quality of life have a central role in the decision making of disease.

Conclusion: Improvement of quality of life in elderly with minimally symptomatic inguinal hernia underwent to early hernia repair hernioplasty could represents a further indication for elective hernia repair.
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August 2015

Contribution of large genomic rearrangements in Italian Lynch syndrome patients: characterization of a novel alu-mediated deletion.

Biomed Res Int 2013 30;2013:219897. Epub 2012 Dec 30.

Dipartmento di Biochimica e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Via Pansini, 5 80131 Napoli, Italy.

Lynch syndrome is associated with germ-line mutations in the DNA mismatch repair (MMR) genes, mainly MLH1 and MSH2. Most of the mutations reported in these genes to date are point mutations, small deletions, and insertions. Large genomic rearrangements in the MMR genes predisposing to Lynch syndrome also occur, but the frequency varies depending on the population studied on average from 5 to 20%. The aim of this study was to examine the contribution of large rearrangements in the MLH1 and MSH2 genes in a well-characterised series of 63 unrelated Southern Italian Lynch syndrome patients who were negative for pathogenic point mutations in the MLH1, MSH2, and MSH6 genes. We identified a large novel deletion in the MSH2 gene, including exon 6 in one of the patients analysed (1.6% frequency). This deletion was confirmed and localised by long-range PCR. The breakpoints of this rearrangement were characterised by sequencing. Further analysis of the breakpoints revealed that this rearrangement was a product of Alu-mediated recombination. Our findings identified a novel Alu-mediated rearrangement within MSH2 gene and showed that large deletions or duplications in MLH1 and MSH2 genes are low-frequency mutational events in Southern Italian patients with an inherited predisposition to colon cancer.
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http://dx.doi.org/10.1155/2013/219897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591251PMC
September 2013

Internal sphincterotomy reduces postoperative pain after Milligan Morgan haemorrhoidectomy.

BMC Surg 2009 Oct 24;9:16. Epub 2009 Oct 24.

Università degli Studi di Palermo- Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti d'Organo- Via Liborio Giuffrè n degrees 5- 90100- Palermo- Italy.

Background: Over the last few years, there has been increasing attention on surgical procedures to treat haemorrhoids. The Milligan-Morgan haemorrhoidectomy is still one of the most popular surgical treatments of haemorrhoids. The aim of the present work is to assess postoperative pain, together with other early and late complications, after Milligan-Morgan haemorrhoidectomy as we could observe in our experience before and after performing an internal sphincterotomy.

Methods: from January 1980 to May 2007, we operated 850 patients, but only 699 patients (median age 53) were included in the present study because they satisfied our inclusion criteria. The patients were divided into two groups: all the patients operated on before 1995 (group A); all the patients operated on after 1995 (group B). Since 1995 an internal sphincterotomy of about 1 cm has been performed at the end of the procedure. The data concerning the complications of these two groups were compared. All the patients received a check-up at one and six months after operation and a telephone questionnaire three years after operation to evalue medium and long term results.

Results: after one month 507 patients (72.5%) did not have any postoperative complication. Only 192 patients (27.46%) out of 699 presented postoperative complication and the most frequent one (23.03%) was pain. The number of patients who suffered from postoperative pain decreased significantly when performing internal sphincterotomy, going from 28.8% down to 10.45% (chi(2): 10,880; p = 0,0001); 95% Confidence Interval (CI) 24.7 to 28.9 (group A) and 10.17 to 10.72 (group B). In 51 cases (7.29%) urinary retention was registered. Six cases of bleeding (0.85%) were registered. Medium and long term follow up did not show any difference among the two groups.

Conclusion: internal sphincterotomy: reduces significantly pain only in the first postoperative period, but not in the medium-long term follow up; does not increase the incidence of continence impairment when performed; does not influence the incidence of the other postoperative complications especially as regard medium and long term results.
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http://dx.doi.org/10.1186/1471-2482-9-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774293PMC
October 2009
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