Publications by authors named "G Clerico"

61 Publications

Transanal Transection and Single-Stapled Anastomosis (TTSS): A comparison of anastomotic leak rates with the double-stapled technique and with transanal total mesorectal excision (TaTME) for rectal cancer.

Eur J Surg Oncol 2021 Aug 6. Epub 2021 Aug 6.

Champalimaud Institute for the Unknown, Lisboa, Portugal.

Background: in the literature on rectal cancer (RC) surgery many studies have focused on the quality of total mesorectal excision (TME) dissection, while there is a scarcity of comparative data on transection and anastomosis. No anastomosis has so far proved to be superior to any other. The aim of this study was to compare anastomotic leak (AL) rates between conventional laparoscopic double-stapled (DS), transanal total mesorectal excision (TaTME) and Transanal Transection and Single-Stapled anastomosis (TTSS) techniques.

Methods: consecutive mid-low RC patients undergoing elective laparoscopic TME with stapled anastomosis and protective stoma, by either DS, TaTME or TTSS techniques were retrieved from a prospectively collected database.

Results: 127 DS; 100 TaTME and 50 TTSS were included. Demographics, distance of the tumor from anal verge and neoadjuvant therapy were comparable. Operative time was longer in TaTME over DS and TTSS (p < 0.0001). More 90-days complications occurred in DS group vs TTSS (p = 0.029). The AL rate was 17.5% in DS, 6% in TaTME and 2% in TTSS group (p = 0.005). AL grade was: one B (2%) in TTSS; 2 grade B (2%) and 4 grade C (4%) in TaTME; 6 grade A (4.7%), 7 grade B (5.5%) and 9 grade C (7.1%) in DS group. Reintervention rate after AL was higher in DS group over TTSS (12.6% vs 2%; p = 0.003). The rate of stoma closure, pathology data and margin positivity did not differ.

Conclusions: TTSS strategy is feasible, safe and leads to very low AL rates after TME for RC.
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http://dx.doi.org/10.1016/j.ejso.2021.08.002DOI Listing
August 2021

Anatomo-functional outcomes of the laparoscopic Frykman-Goldberg procedure for rectal prolapse in a tertiary referral centre.

Updates Surg 2021 Jun 17. Epub 2021 Jun 17.

Department of Health Sciences, University of Catanzaro, 88100, Catanzaro, Italy.

Rectal prolapse is a common disorder that represents a burden for patients due to the associated symptoms that may include both incontinence and constipation. Currently, a huge variation in techniques exist. The aim of this study was to evaluate the anatomo-functional results of the laparoscopic Frykman-Goldberg procedure (LFGP) for the treatment of both internal (IRP) and complete rectal prolapse (CRP). Between July 2004 and October 2019, 45 patients with IRP and CRP underwent a LFGP. The Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Syndrome Score (ODSS) and Vaizey Score (VS) were assessed preoperatively, 3 months before the procedure, 12 months after the procedures and at the final follow-up visit. The patients' mean age was 51.4 ± 17.9 (15-93) years, and the mean follow-up was 9.24 ± 4.57 (1.6-16.3) years. The VS, CCCS and ODSS significantly improved (p = 0.008; p < 0.001; p < 0.001) from median preoperative values of 3, 20 and 18 to 2, 6 and 5, respectively. Furthermore, the improvements in scores during follow-up remained constant and significant over time when considering the two groups separately (time effect for ODSS p < 0.001, for VS p = 0.026, for CCCS p < 0.001) and when the patients were divided by age (< 40, 41-60 and > 60; p < 0.001). The overall complication rate was 8.9% (4/45), and no intraoperative complications or anastomotic leakage occurred. Conversion to the open approach was not necessary in any case. The overall success rate was 97.7%, and only one recurrence in the IRP group occurred after 14 months. LRGP can be considered a safe, effective and long-lasting procedure in young patients with IRP or CRP, a history of ODS and a redundant sigmoid colon.
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http://dx.doi.org/10.1007/s13304-021-01114-3DOI Listing
June 2021

A step-by-step approach to endorectal proctopexy (ERPP): how we do it.

Tech Coloproctol 2021 07 28;25(7):879-886. Epub 2021 May 28.

Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.

There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12-58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.
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http://dx.doi.org/10.1007/s10151-021-02467-yDOI Listing
July 2021

Laparoscopic Intracorporeal Double Pursestring Ileorectal Anastomosis With Transanal Natural Orifice Specimen Extraction.

Dis Colon Rectum 2021 Jun;64(6):e367

Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.

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http://dx.doi.org/10.1097/DCR.0000000000002021DOI Listing
June 2021

Short-Term Outcomes of Polycarbophil and Lysate Gel after Open Hemorrhoidectomy: A Prospective Cohort Study.

J Clin Med 2020 Dec 10;9(12). Epub 2020 Dec 10.

Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.

Background: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and lysate gel (EmorsanGel) on pain control after OEH.

Research Design And Methods: Fifty consecutive patients undergoing OEH were included. All patients received stool softeners and oral analgesia in the post-operative period. EmorsanGel was also used topically by the last 25 patients (EmorsanGel group (EG)) until Post-Operative Day 20 (POD 20). The primary outcome was the effectiveness of EmorsanGel on pain relief using an 11-point visual analogue scale (VAS). Morbidity, wound healing (WH), and time to work were documented at POD 1, POD 10, POD 20, and POD 40.

Results: Of the 50 patients enrolled, twenty-eight (56%) were males; median age, 49 (range, 28-73) years. The VAS score decreased over time in all patients, with significantly lower scores at POD 20 in the EG (1.44 (SD, 1.16) vs. 2.12 (0.93) in the control group (CG); = 0.045). All patients in the EG achieved complete WH at last follow-up, compared to only 17 (68%) in the CG ( = 0.004). The likelihood of WH was 66% higher in the EG (OR, 1.66 [95%CI, 0.80-3.44; = 0.172).

Conclusions: EmorsanGel is safe and effective at reducing pain after EOH, promoting earlier WH compared to standard care treatment.
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http://dx.doi.org/10.3390/jcm9123996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763882PMC
December 2020
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