Publications by authors named "Gianluca Pellino"

160 Publications

Anal squamous cell carcinoma in a high HIV prevalence population.

Discov Oncol 2021 11;12(1). Epub 2021 Feb 11.

Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.

Anal Squamous Cell Carcinoma (ASCC) is a rare cancer that has a rapidly increasing incidence in areas with highly developed economies. ASCC is strongly associated with HIV and there appears to be increasing numbers of younger male persons living with HIV (PLWH) diagnosed with ASCC. This is a retrospective cohort study of HIV positive and HIV negative patients diagnosed with primary ASCC between January 2000 and January 2020 in a demographic group with high prevalence rates of HIV. One Hundred and seventy six patients were included, and clinical data was retrieved from multiple, prospective databases. A clinical subgroup was identified in this cohort of younger HIV positive males who were more likely to have had a prior diagnosis of Anal Intraepithelial Neoplasia (AIN). Gender and HIV status had no effect on staging or disease-free survival. PLWH were more likely to develop a recurrence (p < 0.000) but had a longer time to recurrence than HIV negative patients, however this was not statistically significant (46.1 months vs. 17.5 months; p = 0.077). Patients known to have a previous diagnosis of AIN were more likely to have earlier staging and local tumour excision. Five-year Disease-Free Survival was associated with tumour size and the absence of nodal or metastatic disease (p < 0.000).
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http://dx.doi.org/10.1007/s12672-021-00397-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878215PMC
February 2021

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature.

BMC Endocr Disord 2021 Apr 7;21(1):60. Epub 2021 Apr 7.

General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.

Background: Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review.

Case Presentation: We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma.

Conclusions: Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.
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http://dx.doi.org/10.1186/s12902-021-00724-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028146PMC
April 2021

Patient-Reported Outcome Measures in Colorectal Surgery: Construction of Core Measures Using Open-Source Research Method.

Surg Innov 2021 Jan 1:1553350621998871. Epub 2021 Jan 1.

Digestive Disease Center, Clevland Clinisk, Florida, USA.

. The primary aim of the study was to review the existing literature about patient-reported outcome measures (PROMs) in colorectal cancer and IBD. The secondary aim was to present a road map to develop a core outcome set via opinion gathering using social media. . This study is the first step of a three-step project aimed at constructing simple, applicable PROMs in colorectal surgery. This article was written in a collaborative manner with authors invited both through Twitter via the #OpenSourceResearch hashtag. The 5 most used PROMs were presented and discussed as slides/images on Twitter. Inputs from a wide spectrum of participants including researchers, surgeons, physicians, nurses, patients, and patients' organizations were collected and analyzed. The final draft was emailed to all contributors and 6 patients' representatives for proofreading and approval. . Five PROM sets were identified and discussed: EORTC QLQ-CR29, IBDQ short health questionnaire, EORTC QLQ-C30, ED-Q5-5L, and Short Form-36. There were 315 tweets posted by 50 tweeters with 1458 retweets. Awareness about PROMs was generally limited. The general psycho-physical well-being score (GPP) was suggested and discussed, and then a survey was conducted in which more than 2/3 of voters agreed that GPP covers the most important aspects in PROMs. . Despite the limitations of this exploratory study, it offered a new method to conduct clinical research with opportunity to engage patients. The general psycho-physical well-being score suggested as simple, applicable PROMs to be eventually combined procedure-specific, disease-specific, or symptom-specific PROMs if needed.
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http://dx.doi.org/10.1177/1553350621998871DOI Listing
January 2021

D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis.

Eur J Surg Oncol 2021 Feb 26. Epub 2021 Feb 26.

Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain. Electronic address:

Background: D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3.

Material And Methods: A systematic review with meta-analysis was conducted, according to PRISMA methodology.

Results: 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases.

Conclusions: CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.
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http://dx.doi.org/10.1016/j.ejso.2021.02.020DOI Listing
February 2021

Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique.

Updates Surg 2021 Mar 3. Epub 2021 Mar 3.

Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.

The aim of this study is to evaluate the cost-effectiveness of different modifications of the trans-abdominal pre-peritoneal (TAPP) repair of groin hernia. Data were collected prospectively for all consecutive patients who underwent TAPP unilateral inguinal hernia repair between November 2017 and March 2019, and who completed a minimum of 1 year of follow-up. Costs and quality adjusted life year (QALY) gained were collected. Three TAPP variations were assessed: mesh fixation and peritoneal closure with staples (group 1); mesh fixation with fibrin glue and peritoneal closure with sutures (group 2); and mesh fixation and peritoneal closure with fibrin glue (group 3). A matched group of open repairs was established. The incremental cost-effectiveness ratio (ICER) and main intra-operative and post-operative outcomes were assessed. Overall 120 patients were included (group 1 n = 31; group 2 n = 27; group 3 n = 33; open group: 29). Operative time was shorter for groups 2 and 3, and the main post-operative outcomes were similar. The overall mean total cost of the open group (1185.95€) was lower compared with the laparoscopic group (group 1: 1682.39; group 2: 1538.54€; group 3: 1510.1€) (p = 0.026). However, the mean ICERs of groups 2 and 3 were significantly higher compared with group 1 (p = 0.021) and the open group (p = 0.032). At simulations analysis, the probability of cost-effectiveness was 33.32%, 36.26%, and 36.7% in TAPP groups 1, 2, and 3. In the long term, laparoscopic repair of groin hernia is cost-effective compared with open surgery. The use of fibrin glue for mesh fixation and/or for closing the peritoneum is the most cost-effective option and shortens operative times.
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http://dx.doi.org/10.1007/s13304-021-01005-7DOI Listing
March 2021

Correction to: Surgical treatment of colonic Crohn's disease: a national snapshot study.

Langenbecks Arch Surg 2021 Mar 2. Epub 2021 Mar 2.

Department of Advanced Medical and Surgical Science, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy.

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http://dx.doi.org/10.1007/s00423-021-02119-7DOI Listing
March 2021

Urgent and elective proctologic/anorectal interventions in the COVID-19 pandemic: A practical guideline for treatment safety.

Ulus Travma Acil Cerrahi Derg 2021 Mar;27(2):180-186

Department of Colorectal Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona-Spain.

Background: This article aims to give practical information and concrete suggestions on what should be considered in emergency, semi-urgent and elective settings for common anorectal diseases in the hectic period of the COVID-19 pandemic, based on early results of a series of anorectal interventions.

Methods: Referring to other related guidelines, general considerations specific to the diagnosis and treatment of highly prevalent anorectal diseases were developed to target the correct patients, evaluate and orientate by telemedicine, adapt the Proctology Unit to the new pandemic, and control contamination and infection. Specific considerations for common anorectal diseases were cited, and our initial results were retrospectively documented.

Results: From March 1 to April 10, 2020, we contacted 240 patients with anorectal diseases in two centers. We evaluated the results retrospectively on 16-17 April. At the end of this survey, 14 patients (5.8%) were lost for further contact and follow-up. Thirty-one patients (12.9%) were evaluated as nondeferrable cases and invited to the Proctology Unit. Twenty-eight patients required interventions at the same session. Adhering to the principles described here, more than 90 percent of benign anorectal disorders could be treated successfully, with 2.1 percent of suspected contamination and no confirmed cases. None of the Proctology personnel or their close contacts developed COVID-19, either.

Conclusion: By adhering to the principles outlined in this practical guide, it was possible to treat most of the benign anorectal diseases safely in the initial, hectic period of the COVID-19 pandemic.
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http://dx.doi.org/10.14744/tjtes.2020.02446DOI Listing
March 2021

How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score.

J Gastrointest Surg 2021 Feb 24. Epub 2021 Feb 24.

HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain.

Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them.

Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis.

Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001).

Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.
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http://dx.doi.org/10.1007/s11605-021-04956-9DOI Listing
February 2021

Surgical anatomy applied to transperitoneal approaches of the abdominal aorta and visceral trunks. Dynamic article.

Cir Esp 2021 Feb 2. Epub 2021 Feb 2.

Servicio de Cirugía Cardiovascular, Hospital Universitario del Vinalopó, Elche, Alicante, España.

Access to the abdominal aorta and its visceral trunks is possible through several approaches. Dissections of five cadavers performed during three National Surgical Anatomy courses applied to Aorta, Hepatobiliopancreatic and Digestive Surgery. Videos and pictures were taken throughout the dissections and showed different abdominal aorta approaches. Abdominal aorta and visceral trunks approaches: longitudinal inframesocolic access, supraceliac clamping, celiac trunk dissection, superior mesenteric artery approaches (retroperitoneal after Kocher menoeuvre, supramesocolic or inframesocolic), Cattell-Braasch manoeuvre and mattox manoeuvre: retrorenal and prerenal. Correct knowledge of the intraabdominal anatomy is necessary to perform all the abdominal aorta surgical approaches. Cadaveric dissection could help to achieve this objective. Cardiovascular and digestive surgeons need to know the possible strategies in order to choose the one which is best suited for each patient.
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http://dx.doi.org/10.1016/j.ciresp.2020.12.016DOI Listing
February 2021

Psychological Health of Surgeons in a Time of COVID-19: A Global Survey.

Ann Surg 2021 Jan 22. Epub 2021 Jan 22.

Department of Urology, National University Hospital, National University Health System, Singapore Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore Department of Psychological Medicine, National University of Singapore Department of Urology, CiptoMangunkusumo Hospital, Jakarta, Indonesia General Surgery and Digestive System Service, Alfredo Espinosa Hospital, Urduliz, Vizcaya, Spain Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Italy Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom Hospital Israelita Albert Einstein, Sao Paulo, Brazil; BP-a Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, India Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR Eastern Health and Monash University Eastern Health Clinical School, Box Hill, VIC, Australia Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China Department of Urology, Marmara University Research and Training Hospital, Turkey Conselleria de Sanidad Universal y salud Publica, Spain Hospital Universitario Parc Taulí Sabadell, Spain Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Malaysia Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy Department of Urology, Campus Biomedico University of Rome, Italy Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain Division of Urology, University Health Network, Department of Surgery, University of Toronto, Canada Macquarie University Hospital and Royal North Shore Hospital, Department of Urology, Sydney, New South Wales, Australia Department of Urology- Luzerner Kantonsspital- Luzern, CH, Switzerland Instituto de Investigación Sanitaria San Carlos, Hospital Clinico San Carlos, Madrid, Spain Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS).

Objective: To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic.

Summary Background Data: The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19.

Methods: We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the Depression Anxiety Stress Scale-21 (DASS-21) and Impact of Event Scale-Revised (IES-R) scores.

Results: 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9% and 24.0% screened positive for depression, anxiety, stress and Post-Traumatic Stress Disorder (PTSD) respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress and PTSD (OR 1.3, 1,6, 1.4, 1.7 respectively, all p < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress and PTSD (OR 1.2, 1.2 and 1.3 respectively, all p < 0.05). Surgical specialities that operated in the Head and Neck region had higher psychological distress among its surgeons. Deployment for COVID-19-related work was not associated with increased psychological distress.

Conclusions: The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.
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http://dx.doi.org/10.1097/SLA.0000000000004775DOI Listing
January 2021

Ischemic colitis. Does right colon location mean worst prognosis?

Cir Esp 2021 Jan 20. Epub 2021 Jan 20.

Unidad de Cirugía Colorrectal, Hospital Álvaro Cunqueiro, Vigo, España.

Introduction: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC).

Methods: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P <0.05.

Results: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P <0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P <0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD.

Conclusions: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.
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http://dx.doi.org/10.1016/j.ciresp.2020.12.002DOI Listing
January 2021

ECCO Topical Review Optimising reporting in surgery, endoscopy, and histopathology.

J Crohns Colitis 2021 Jan 11. Epub 2021 Jan 11.

Department of Pathology, Sorbonne Université, AP-HP, Saint-Antoine hospital, Paris, France.

Background And Aims: Diagnosis and management of inflammatory bowel diseases (IBD) requires a lifelong multidisciplinary approach. The quality of medical reporting is essential in this context. The present topical review addresses the need for optimised reporting in endoscopy, surgery, and histopathology.

Methods: A consensus expert panel consisting of gastroenterologists, surgeons, and pathologists convened by the European Crohn's and Colitis Organisation performed a systematic literature review. Following topics were covered: In endoscopy: (i) general IBD endoscopy; (ii) disease activity and surveillance; (iii) endoscopy treatment in IBD. In surgery: (iv) medical history with surgical relevance, surgical indication and strategy; (v) operative approach; (vi) intraoperative disease description; (vii) operative steps. In pathology: (viii) macroscopic assessment and interpretation of resection specimens; (ix) IBD histology, including biopsies, surgical resections, and neoplasia; (x) IBD histology conclusion and report. Statements were developed using a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when >80% of participants agreed on a recommendation.

Results: Thirty practice positions established a standard terminology for optimal reporting in endoscopy, surgery, and histopathology. Assessment of disease activity, surveillance recommendations, advice to surgeons for operative indication and strategies, including margins and extent of resection, and diagnostic criteria of IBD, as well as guidance for the interpretation of dysplasia and cancer were handled. A standardized report including a core set of items to include in each speciality report, was defined.

Conclusions: Interdisciplinary high-quality care requires thorough and standardised reporting across specialities. This topical review offers an actionable framework and practice recommendations to optimise reporting in endoscopy, surgery, and histopathology.
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http://dx.doi.org/10.1093/ecco-jcc/jjab011DOI Listing
January 2021

Correction to: Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn's disease: a propensity score-matched analysis.

Int J Colorectal Dis 2021 Mar;36(3):609

Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy.

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http://dx.doi.org/10.1007/s00384-020-03832-3DOI Listing
March 2021

Management guidelines for low anterior resection syndrome - the MANUEL project.

Colorectal Dis 2021 Feb 24;23(2):461-475. Epub 2021 Jan 24.

Department of Surgical Oncology, Sigmund Freud University, Vienna, Austria.

Aim: Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS.

Method: The 'Management guidelines for low anterior resection syndrome' (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face-to-face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project.

Results: The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts.

Conclusions: The MANUEL project provides an up-to-date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.
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http://dx.doi.org/10.1111/codi.15517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986060PMC
February 2021

Anastomosis configuration and technique following ileocaecal resection for Crohn's disease: a multicentre study.

Updates Surg 2021 Feb 6;73(1):149-156. Epub 2021 Jan 6.

Department of Advanced Medical and Surgical Science, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy.

A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD.
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http://dx.doi.org/10.1007/s13304-020-00918-zDOI Listing
February 2021

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn's disease: a propensity score-matched analysis.

Int J Colorectal Dis 2021 Mar 23;36(3):605-608. Epub 2020 Dec 23.

Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy.

Introduction: Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn's disease (CD) to conventional laparoscopy and open surgery using a propensity score-matched analysis in a retrospective national multicentre study.

Methods: All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint.

Results: Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% (p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery (p < 0.0001).

Conclusions: SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.
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http://dx.doi.org/10.1007/s00384-020-03821-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895768PMC
March 2021

A Risk-Based Screening Approach to Patients Needing Surgery During the De-Escalation Phase of COVID-19 Pandemic.

Surg Innov 2020 Dec 20:1553350620975886. Epub 2020 Dec 20.

General Surgery Department, Universitary Hospital Vall d'Hebron, Spain.

Since the outbreak of COVID-19 pandemic, many national and international surgical societies have produced guidelines regarding the management of surgical patients. During the mitigation phase of the pandemic, most documents suggested to consider postponing elective procedures, unless this might have impacted the life expectancy of patients. As awareness and knowledge about COVID-19 are gradually increasing, and as we enter a phase when surgical services are resuming their activities, surgical strategies have to adapt to this rapidly evolving scenario. This is particularly relevant when considering screening policies and the associated findings. We herein describe a risk-based approach to the management of patients with surgical diseases, which might be useful in order to limit the risks for healthcare workers and patients, while allowing for resuming elective surgical practice safely.
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http://dx.doi.org/10.1177/1553350620975886DOI Listing
December 2020

Uncovering the Veils of Maya on defensive medicine, litigation risk and second victims in surgery: care for the carers to protect the patients.

Colorectal Dis 2021 Feb 4;23(2):548-549. Epub 2020 Dec 4.

General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.

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http://dx.doi.org/10.1111/codi.15451DOI Listing
February 2021

The Authors Reply.

Dis Colon Rectum 2020 12;63(12):e596-e597

Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy, Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.

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http://dx.doi.org/10.1097/DCR.0000000000001848DOI Listing
December 2020

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices.

J Glob Health 2020 Dec;10(2):020507

Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy.

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.

Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100).

Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%;  < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries.

Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions.

Study Registration: Registered in ClinicalTrials.gov: NCT04344197.
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http://dx.doi.org/10.7189/jogh.10.020507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567431PMC
December 2020

Colonic J-Pouch or Straight Colorectal Reconstruction After Low Anterior Resection For Rectal Cancer: Impact on Quality of Life and Bowel Function: A Multicenter Prospective Randomized Study.

Dis Colon Rectum 2020 11;63(11):1511-1523

Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.

Background: Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate.

Objective: This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection.

Design: Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery.

Settings: Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798).

Patients: Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected.

Main Outcome Measures: The primary outcomes measured were quality of life and bowel function.

Results: Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study.

Limitations: Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation.

Conclusion: The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate.Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja.La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía.Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798).Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta.calidad de vida y función intestinal.De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio.Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento.Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen en http://links.lww.com/DCR/B328. (Traducción-Dr. Yesenia Rojas-Khalil).
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http://dx.doi.org/10.1097/DCR.0000000000001745DOI Listing
November 2020

Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review.

Int J Colorectal Dis 2021 Feb 26;36(2):213-226. Epub 2020 Sep 26.

Chelsea and Westminster Hospitals, NHS Foundation Trust and Imperial College, London, UK.

Purpose: Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN.

Methods: MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included.

Results: Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison.

Conclusions: Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.
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http://dx.doi.org/10.1007/s00384-020-03740-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801290PMC
February 2021

Incidence, features, outcome and impact on health system of de-novo abdominal surgical diseases in patients admitted with COVID-19.

Surgeon 2020 Aug 28. Epub 2020 Aug 28.

Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address:

Objective: to assess the epidemiology and features of de novo surgical diseases in patients admitted with COVID-19, and their impact on patients and healthcare system.

Summary Background Data: Gastrointestinal involvement has been described in COVID-19; however, no clear figures of incidence, epidemiology and economic impact exist for de-novo surgical diseases in hospitalized patients.

Methods: This is a prospective study including all patients admitted with confirmed SARS-CoV-2 rT-PCR, between 1 March and 15 May 2020 at two Tertiary Hospitals. Patients with known surgical disease at admission were excluded. Sub-analyses were performed with a consecutive group of COVID-19 patients admitted during the study period, who did not require surgical consultation.

Results: Ten out of 3089 COVID-19 positive patients (0.32%) required surgical consultation. Among those admitted in intensive care unit (ICU) incidence was 1.9%. Mortality was 40% in patients requiring immediate surgery and 20% in those suitable for conservative management. The overall median length of stay (LOS) of patients admitted to ICU was longer in those requiring surgical consultation compared with those who did not (51.5 vs 25 days, p = 0.0042). Patients requiring surgical consultation and treatment for de-novo surgical disease had longer median ICU-LOS (31.5 vs 12 days, p = 0.0004). A median of two post-surgical complications were registered for each patient undergoing surgery. Complication-associated costs were as high as 38,962 USD per patient.

Conclusions: Incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery.
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http://dx.doi.org/10.1016/j.surge.2020.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455107PMC
August 2020

The Authors Reply.

Dis Colon Rectum 2020 10;63(10):e538

Hospital Universitario y Politecnico la Fe, Valencia, Spain.

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http://dx.doi.org/10.1097/DCR.0000000000001771DOI Listing
October 2020

Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project.

Eur J Surg Oncol 2021 02 18;47(2):276-284. Epub 2020 Aug 18.

Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain. Electronic address:

Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons.

Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II.

Results: Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers.

Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
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http://dx.doi.org/10.1016/j.ejso.2020.04.056DOI Listing
February 2021

Preoperative oral antibiotics in colon surgery - Authors' reply.

Lancet Gastroenterol Hepatol 2020 09;5(9):802-803

Infectious Diseases Department, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain.

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http://dx.doi.org/10.1016/S2468-1253(20)30241-7DOI Listing
September 2020

Surgeons' fear of getting infected by COVID19: A global survey.

Br J Surg 2020 10 18;107(11):e543-e544. Epub 2020 Aug 18.

Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy.

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http://dx.doi.org/10.1002/bjs.11833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461173PMC
October 2020

Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study.

Int J Colorectal Dis 2020 Dec 30;35(12):2227-2238. Epub 2020 Jul 30.

Department of General Surgery, Colorectal Unit, La Fe University Hospital, University of Valencia, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain.

Purpose: Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer.

Methods: Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality.

Results: Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications.

Conclusions: Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
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http://dx.doi.org/10.1007/s00384-020-03692-xDOI Listing
December 2020

The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review.

J Invest Surg 2020 Jul 7:1-8. Epub 2020 Jul 7.

Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.

Background: Colorectal surgery is associated with significant pain often requiring opioid and non-opioid analgesics. Pudendal nerve blocks (PNBs) can be administered with the aim to reduce pain and improve patient satisfaction. However, there are no current accepted guidelines for the use of PNB in colorectal surgery.

Method: We evaluated the available literature on the role of PNB in colorectal surgery to determine which technique and anesthetic agent may provide optimal pain relief and safety. Studies from January 1970 to December 2019 assessing PNB in colorectal surgery were retrieved from MEDLINE and EMBASE databases. Indication for PNB, technique, anesthetic agent, postoperative pain outcomes, patient satisfaction and complications were extracted.

Results: We initially identified 339 studies of which 17 (nine randomized controlled trials, three cohort studies, one case-control study and four reviews) specifically met the inclusion criteria. The most common indication found for PNB is hemorrhoidectomy using either bupivacaine or lidocaine. The anatomical landmark and neurostimulation are the most favorable techniques being applied. The majority of studies reported better pain scores, less analgesia requirement and higher patient satisfaction when performing a bilateral PNB, with no major complications.

Conclusions: The current evidence, though limited, supports the use of bilateral PNBs in colorectal surgical procedures in particular hemorrhoidectomies. PNBs can be safe and effective in improving patient outcomes particularly when using bupivacaine or lidocaine with either the anatomical landmark or neurostimulation technique.
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http://dx.doi.org/10.1080/08941939.2020.1786611DOI Listing
July 2020

Surgical Training During and After COVID-19: A Joint Trainee and Trainers Manifesto.

Ann Surg 2020 07;272(1):e24-e26

Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.

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http://dx.doi.org/10.1097/SLA.0000000000003929DOI Listing
July 2020