Publications by authors named "Giovanni Domenico De Palma"

96 Publications

Robotic versus laparoscopic colorectal surgery in elderly patients in terms of recovery time: a monocentric experience.

J Robot Surg 2021 Nov 7. Epub 2021 Nov 7.

Department of Clinical Medicine and Surgery, Federico II University of Naples, Sergio Pansini 5, 80131, Naples, Italy.

Colorectal cancer has a great socio-sanitary relevance. It represents the third cancer by incidence and mortality. Ageing plays a major role in the development of colorectal cancer and this tumour, in patients aged 65 and older, has gradually increased over the past decade. The robotic technique is considered the evolution of conventional laparoscopy. Few studies evaluate the effects of robotic surgery in elderly patient, and even fewer are those that compare it with laparoscopic surgery in this population. The aim of this study was to evaluate the perioperative outcomes of robotic colorectal surgery compared to laparoscopic colorectal surgery in patients older than 65 years. We conducted a retrospective study enrolling 83 elderly patients (age > 65) undergoing robotic and laparoscopic colectomy (32 and 51, respectively) between January 2019 and January 2021. For statistical analysis, p values were calculated using t test and chi-square test. p < 0.05 is the criterion for statistical significance. Statistical analyses were performed with the Number Cruncher Statistical System (NCSS) 2020 data analysis version 20.0.1 (Utah, USA). The operation time was higher in robotic left (p = 0.003, mean time 249.6 vs 211.7 min) and right (p = 0.004, mean time 238.5 vs 183.5 min) hemicolectomy and similar for procedures on rectosigmoid and rectum when compared to laparoscopic technique. In terms of length of hospital stay and recovery of bowel function, these values were significantly lower for robotic group in left hemicolectomy (p = 0.004), rectum (p = 0.003) and rectosigmoid (p = 0.003), while right hemicolectomy was similar in two groups (p = 0.26). There was no statistically significant difference between the groups regarding conversion rate, postoperative complications, length of specimen, number of lymph nodes encountered and oncological results. Colorectal robotic surgery in elderly patients appears as a feasible and safe surgical approach when compared to the laparoscopic one, showing a shorter recovery and a reduction of length of stay with similar oncological outcomes even if with an increase of operating times.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11701-021-01332-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572529PMC
November 2021

16S rRNA of Mucosal Colon Microbiome and CCL2 Circulating Levels Are Potential Biomarkers in Colorectal Cancer.

Int J Mol Sci 2021 Oct 4;22(19). Epub 2021 Oct 4.

CEINGE Biotecnologie Avanzate S.C.a R.L., 80131 Naples, Italy.

Colorectal cancer (CRC) is one of the most common malignancies in the Western world and intestinal dysbiosis might contribute to its pathogenesis. The mucosal colon microbiome and C-C motif chemokine 2 (CCL2) were investigated in 20 healthy controls (HC) and 20 CRC patients using 16S rRNA sequencing and immunoluminescent assay, respectively. A total of 10 HC subjects were classified as overweight/obese (OW/OB_HC) and 10 subjects were normal weight (NW_HC); 15 CRC patients were classified as OW/OB_CRC and 5 patients were NW_CRC. Results: and were more abundant in OW/OB_HC than in NW_HC microbiomes. Globally, , , , and were significantly increased in CRC patient tumor/lesioned tissue (CRC_LT) and CRC patient unlesioned tissue (CRC_ULT) microbiomes compared to HC microbiomes. CCL2 circulating levels were associated with tumor presence and with the abundance of , and . Our data suggest that mucosal colon dysbiosis might contribute to CRC pathogenesis by inducing inflammation. Notably, , which was more abundant in the OW/OB_HC than in the NW_HC microbiomes, might represent a putative link between obesity and increased CRC risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms221910747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509685PMC
October 2021

Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis.

Am J Surg 2021 Oct 1. Epub 2021 Oct 1.

Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy.

Background: To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy.

Methods: A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients' number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results.

Results: 12 articles were included in the final analysis. A significant difference was observed in terms of "overall anastomotic complications" in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies.

Conclusion: Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2021.09.024DOI Listing
October 2021

Preoperative Localization in Colonic Surgery (PLoCoS Study): a multicentric experience on behalf of the Italian Society of Colorectal Surgery (SICCR).

Updates Surg 2021 Oct 5. Epub 2021 Oct 5.

Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.

The aim of this prospective multicentric study was to compare the accurate colonic lesion localization ratio between CT and colonoscopy in comparison with surgery. All consecutive patients from 1st January to 31st December 2019 with a histologically confirmed diagnosis of dysplastic adenoma or adenocarcinoma with planned elective, curative colonic resection who underwent both colonoscopy and CT scans were included. Each patient underwent conventional colonoscopy and CT to stage the tumour, and the localization results of each procedure were registered. CT and colonoscopic localization were compared with surgical localization, adopted as the reference. Our analysis included 745 patients from 23 centres. After comparing the accuracy of colonoscopy and CT (for visible lesions) in localizing colonic lesions, no significant differences were found between the two preoperative tools (510/661 vs 499/661 correctly localized lesions, p = 0.518). Furthermore, after analysing only the patients who underwent complete colonoscopy and had a visible lesion on CT, no significant difference was observed between conventional colonoscopy and CT (331/427 vs 340/427, p = 0.505). Considering the intraoperative localization results as a reference, a comparison between colonoscopy and CT showed that colonoscopy significantly failed to correctly locate the lesions localized in the descending colon (17/32 vs 26/32, p = 0.031). We did not identify an advantage in using CT to localize colonic tumours. In this setting, colonoscopy should be considered the reference to properly localize lesions; however, to better identify lesions in the descending colon, CT could be considered a valuable tool to improve the accuracy of lesion localization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13304-021-01180-7DOI Listing
October 2021

Segmental transverse colectomy. Minimally invasive versus open approach: results from a multicenter collaborative study.

Updates Surg 2021 Sep 14. Epub 2021 Sep 14.

Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.

The role of minimally invasive surgery in the treatment of transverse colon cancer is still controversial. The aim of this study is to investigate the advantages of a totally laparoscopic technique comparing open versus laparoscopic/robotic approach. Three hundred and eighty-eight patients with transverse colon cancer, treated with a segmental colon resection, were retrospectively analyzed. Demographic data, tumor stage, operative time, intraoperative complications, number of harvested lymph nodes and recovery outcomes were recorded. Recurrences and death were also evaluated during the follow-up. No differences were found between conventional and minimally invasive surgery, both for oncological long-term outcomes (recurrence rate p = 0.28; mortality p = 0.62) and postoperative complications (overall rate p = 0.43; anemia p = 0.78; nausea p = 0.68; infections p = 0.91; bleeding p = 0.62; anastomotic leak p = 0.55; ileus p = 0.75). Nevertheless, recovery outcomes showed statistically significant differences in favor of minimally invasive surgery in terms of time to first flatus (p = 0.001), tolerance to solid diet (p = 0.017), time to first mobilization (p = 0.001) and hospital stay (p = 0.004). Compared with laparoscopic approach, robotic surgery showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.005) and tolerance to solid diet (p = 0.001). Finally, anastomosis evaluation confirmed the superiority of intracorporeal approach which showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.003) and tolerance to solid diet (p = 0.001); moreover, we recorded a statistical difference in favor of intracorporeal approach for infection rate (p = 0.04), bleeding (p = 0.001) and anastomotic leak (p = 0.03). Minimally invasive approach is safe and effective as the conventional open surgery, with comparable oncological results but not negligible advantages in terms of recovery outcomes. Moreover, we demonstrated that robotic approach may be considered a valid option and an intracorporeal anastomosis should always be preferred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13304-021-01159-4DOI Listing
September 2021

Laparoscopic left colic artery preserving sigmoidectomy for diverticulitis in a patient with urinary tract malformation - a video vignette.

Colorectal Dis 2021 Nov 3;23(11):3036-3037. Epub 2021 Sep 3.

Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/codi.15892DOI Listing
November 2021

Endoscopic resection of a large polypoid gastric heterotopia of duodenum: a case report.

Clin Case Rep 2021 Aug 16;9(8):e04633. Epub 2021 Aug 16.

Department of Clinical Medicine and Surgery "Federico II" University of Naples Naples Italy.

This report shows a rare case of gastric heterotopia in the duodenum presented as a large polypoid lesion, differently from data reported in literature, which enters into differential diagnosis with other duodenal lesions that are not always benign.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccr3.4633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365857PMC
August 2021

Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes.

J Pers Med 2021 Jul 6;11(7). Epub 2021 Jul 6.

Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy.

Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. a search of the studies comparing robotic and laparoscopic or open esophagectomy was performed trough the medical libraries, with the search string "robotic and (oesophagus OR esophagus OR esophagectomy OR oesophagectomy)". Outcomes were: postoperative complications rate (anastomotic leakage, bleeding, wound infection, pneumonia, recurrent laryngeal nerves paralysis, chylotorax, mortality), intraoperative outcomes (mean blood loss, operative time and conversion), oncologic outcomes (harvested nodes, R0 resection, recurrence) and recovery outcomes (length of hospital stay). Robotic approach is superior to open surgery in terms of blood loss = 0.001, wound infection rate, = 0.002, pneumonia rate, = 0.030 and mean number of harvested nodes, < 0.0001 and R0 resection rate, = 0.043. Similarly, robotic approach is superior to conventional laparoscopy in terms of mean number of harvested nodes, = 0.001 pneumonia rate, = 0.003. robotic surgery could be considered superior to both open surgery and conventional laparoscopy. These encouraging results should promote the diffusion of the robotic surgery, with the creation of randomized trials to overcome selection bias.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jpm11070640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306060PMC
July 2021

Effect of bariatric surgery on in vitro fertilization in infertile men with obesity.

Surg Obes Relat Dis 2021 10 9;17(10):1752-1759. Epub 2021 Jul 9.

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy. Electronic address:

Background: Obesity has previously been related to reduced female fertility, with prolonged waiting time to pregnancy among women with a body mass index (BMI) >35 kg/m but there are few studies investigating the relationship between high BMI, bariatric surgery, and male fertility.

Objectives: The primary objective of this article was to investigate the effect of bariatric surgery on in vitro fertilization (IVF) outcomes in a cohort of men with morbid obesity who underwent sleeve gastrectomy (SG).

Setting: University hospital, bariatric surgery unit.

Methods: Pre- and postsurgery data on patient age, body mass index (BMI), and variables related to male fertility (semen volume, concentration, progressively motile sperm count, and sperm morphology) were collected; assisted reproductive technology outcomes before and after bariatric surgery were measured by the number of metaphase II oocytes; the number of top-quality oocytes and embryos; the number of fertilized oocytes; the number of transferred embryo; the implantation rate; the pregnancy rate; the live birth rate and the miscarriage rate.

Results: Thirty-five men with obesity and idiopathic infertility were included in this study. We found a significant increase, after bariatric surgery, in semen volume, total sperm concentration, progressively motile sperm count, and sperm morphology. Considering IVF outcomes, mean number of top-quality oocytes, mean number of fertilized oocytes, mean number of embryos obtained, and top-quality embryos were significantly increased after bariatric procedure.

Conclusion: Bariatric surgery is confirmed to be safe and effective in increasing the outcomes of assisted reproductive technology treatment also in case of infertile men with obesity, both in terms of pregnancy and live birth rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.soard.2021.07.007DOI Listing
October 2021

Management of pheochromocytoma during pregnancy from diagnosis to laparoscopic adrenalectomy. A case report and review of literature.

Ann Ital Chir 2021 ;92:254-259

Introduction: Pheochromocytoma is an endocrine tumour of chromaffin cells. It can be diagnosed either sporadically or in the context of hereditary syndromes (e.g. Von Hippel Lindau, Neurofibromatosis type 1 and multiple neuroendocrine neoplasia type 2). During pregnancy, its frequency is very low (about 0,007%). This tumour causes paroxysmal hypertension in 0,1-0,6% pregnant women, because of an overproduction of catecholamines. If undiagnosed and nontreated, it's associated with high maternal and fetal mortality (40-50%). We report the case of a 30-year-old female diagnosed with pheochromocytoma during pregnancy at week 31 of gestation. In a multidisciplinary team made of surgeons, gynaecologists, anaesthetists, geneticists and endocrinologists we evaluated the case and according to literature, we choose a surgical approach after childbirth: performing a laparoscopic right adrenalectomy.

Discussion: In pregnancy, pheochromocytoma is a rare clinical condition. Gold standard treatment is laparoscopic adrenalectomy. However, the optimum timing of surgery is a challenge.

Conclusion: Timely diagnosis of pheochromocytoma in pregnant women with hypertension and appropriate therapeutic management can lead to improve maternal, fetal and neonatal outcomes. The multidisciplinary team is necessary to recognize the symptoms and to adopt the right pre - and post - operative treatment. Laparoscopic adrenalectomy after delivery is safe and feasible even though the surgical procedure should be performed by an experienced surgeon.

Key Words: Pheochromocytoma, Pregnancy, Laparoscopic adrenalectomy and pregnancy, Management of pheochromocytoma, Laparoscopic adrenalectomy, Adrenalectomy, Pregnancy and pheochromocytoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2021

Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience.

J Pers Med 2021 Jun 30;11(7). Epub 2021 Jun 30.

Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy.

The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases ( = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases ( = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups ( = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jpm11070621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307843PMC
June 2021

Laparoscopic completion proctectomy and pouch with lengthening techniques - a video vignette.

Colorectal Dis 2021 Aug 14;23(8):1990-1991. Epub 2021 Jul 14.

Endoscopic Surgery Unit, Department of Surgical and Medical Gastrointestinal Disease, University of Naples Federico II, Napoli, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/codi.15782DOI Listing
August 2021

Surgical stress and metabolic response after totally laparoscopic right colectomy.

Sci Rep 2021 05 6;11(1):9652. Epub 2021 May 6.

Department Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.

No clear consensus on the need to perform an intracorporeal anastomosis (IA) after laparoscopic right colectomy is currently available. One of the potential benefits of intracorporeal anastomosis may be a reduction in surgical stress. Herein, we evaluated the surgical stress response and the metabolic response in patients who underwent right colonic resection for colon cancer. Fifty-nine patients who underwent laparoscopic resection for right colon cancer were randomized to receive an intracorporeal or an extracorporeal anastomosis (EA). Data including demographics (age, sex, BMI and ASA score), pathological (AJCC tumour stage and tumour localization) and surgical results were recorded. Moreover, to determine the levels of the inflammatory response, mediators, such as C-reactive protein (CRP), tumour necrosis factor (TNF), interleukin 1β (IL-1β), IL-6, IL-10, and IL-13, were evaluated. Similarly, cortisol and insulin levels were evaluated as hormonal responses to surgical stress. We found that the proinflammatory mediator IL-6, CRP, TNF and IL-1β levels, were significantly reduced in IA compared to EA. Concurrently, an improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Relative to the hormone response to surgical stress, cortisol was increased in patients who underwent EA, while insulin was reduced in the EA group. Based on these results, surgical stress and metabolic response to IA justify advocating the adoption of a totally laparoscopic approach when performing a right colectomy for cancer.This trial is registered on ClinicalTrials.gov (ID: NCT03422588).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-89183-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102592PMC
May 2021

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs).

Diagnostics (Basel) 2021 Apr 25;11(5). Epub 2021 Apr 25.

Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.

Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. The biological behavior of rectal NETs may be different: factors predicting the risk of metastases have been identified, such as size and grade of differentiation. The tendency for metastatic diffusion generally depends on the tumor size, muscular and lymphovascular infiltration, and histopathological differentiation. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. Rectal NETs larger than 20 mm have a higher risk of involvement of muscularis propria and high metastatic risk and are candidates for surgical resection. There is controversy over rectal NETs of intermediate size, 10-19 mm, where the metastatic risk is considered to be 10-15%: assessment of tumors endoscopically and by endoanal ultrasound should guide treatment in these cases towards endoscopic, transanal, or surgical resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11050771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145857PMC
April 2021

Barbed suture in gastro-intestinal surgery: A review with a meta-analysis.

Surgeon 2021 Apr 2. Epub 2021 Apr 2.

Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.

Background: The laparoscopic approach is a very popular technique for many gastrointestinal operations and barbed sutures may improve the difficulties of intracorporeal anastomosis by eliminating the need for knot tying. The aim of this systematic review with a meta-analysis is to explore literature to establish the security profile of barbed suture compared with conventional laparoscopic sutures.

Materials And Methods: A systematic search was performed in all electronic databases (PubMed, Web of Science, Scopus, EMBASE) and 12 studies were included in the analysis, involving 27,133 patients, whereof 3372 cases (patients undergone barbed suture usage) and 23,761 controls (patients undergone conventional suture usage). We found 3 studies discussing differences between barbed and conventional sutures in colorectal surgery and 8 studies presenting results in bariatric surgery, both in Roux-en-y gastric bypass and Mini Gastric/One Anastomosis Gastric Bypass.

Results: We found comparable rate of leaks, bleedings and stenosis. The meta-regression analysis demonstrated that, both in case of bariatric and colorectal surgery, the demographic characteristic of patients and the oncological features of neoplasms did not impact of these findings. As expected, operative time is significantly shorter when barbed suture is used.

Conclusion: Our analysis on current literature define an acceptable security profile for barbed suture with effective results particularly in terms of shorter operative time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surge.2021.02.011DOI Listing
April 2021

Portal venous gas after a failed endoscopic retrograde cholangiopancreatography attempt in a patient with a large hepatocellular carcinoma: A case report.

Clin Case Rep 2021 Mar 9;9(3):1339-1343. Epub 2021 Jan 9.

Department of Clinical Medicine and Surgery University of Naples "Federico II" Napoli Italy.

The cause of hepatic portal vein gas (HPVG) is variable. Good knowledge of the possible causes, combined with the clinical assessment of the patient and a good quality imaging, is required to correctly identify the underlying cause of HPVG and to best predict the prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccr3.3766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981622PMC
March 2021

Transanal minimally invasive approach for early giant rectal tumour - a video-vignette.

Colorectal Dis 2021 06 5;23(6):1603-1604. Epub 2021 Apr 5.

Endoscopic Surgery Unit, Department of Surgical and Medical Gastrointestinal Disease, University of Naples Federico II, Via pansini 5, Naples, Napoli, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/codi.15647DOI Listing
June 2021

A giant inguinal hernia in a patient with Ehlers-Danlos syndrome.

Ann Ital Chir 2021 Feb 5;10. Epub 2021 Feb 5.

Background: Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally invasive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications.

Aim: Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure).

Material And Methods: We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins.

Results: During the robotic procedure no intraoperative complications were recorded and no drains were applied. The postoperative period was uneventful and the patient was discharged in the first postoperative day.

Discussion: Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative effect on the clinical outcome of hernioplasty because of postoperative complication and recurrence rates. Our strategy has been robotic technology to facilitate the surgical approach.

Conclusion: Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. The endowrist movement of the robotic arms allows wide instrument articulation in a confined space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications.

Key Words: Ehlers-Danlos syndrome, Inguinal hernia, TAPP.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2021

Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease.

Gastroenterol Res Pract 2021 11;2021:8940682. Epub 2021 Jan 11.

Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131 Naples, Italy.

A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2021/8940682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814944PMC
January 2021

Telemedicine in Patients With an Ostomy During the COVID-19 Pandemic: A Retrospective Observational Study.

Wound Manag Prev 2021 01;67(1):12-17

University of Naples, Federico II, Naples, Italy.

Background: Italy instituted a lockdown from March 10 to May 3, 2020, due to the coronavirus disease-19 pandemic. All nonessential businesses were closed during this time, and health care services were reorganized. On March 11, the Stoma Care Center started providing telehealth services for patients with a stoma.

Purpose: This retrospective observational study describes the experience of the Stoma Care Center of the University Hospital Federico II, Naples, Italy, before and during the lockdown.

Methods: Consultation records from January 1 through April 29 were retrieved, patient demographics and reasons for consultation abstracted, and pre-lockdown (January 1 to February 29) and lockdown (March 1 to April 29) information was compared. Patients who used telehealth services were also asked to rate their satisfaction with these services on a scale of 0 (extremely dissatisfied) to 4 (extremely satisfied). The authors analyzed all consultations provided from January to April 2020 and evaluated the use of telemedicine services for patients with an ostomy. Consultations were divided into 2 groups. Group A included consultations provided from January 1 to February 29. Group B included consultations provided from March 1 to April 29, which included the lockdown period. Group B included both in-person and telemedicine consultations.

Results: During the pre-lockdown period, 240 in-person consultations were provided. During the lockdown period, 181 in-person and 99 telemedicine consultations were provided. The number of in-person consultations for mechanical bowel preparation and transanal irrigation system training was lower (12.5% vs 6.6% [P = .046] and 3.3% vs 0% [P = .03]), whereas the number of consults for stoma care follow-up and stoma complications was higher (202 [84.1%] vs 266 [95%]). Of the 65 patients who completed the questionnaire, 82% indicated being extremely satisfied.

Conclusions: The reorganization of stoma care services, including the availability of telemedicine, did not result in a decrease in the number of consultations provided. The results suggest that stoma care services using telemedicine may provide valid support for patients with an ostomy in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2021

Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways.

Open Med (Wars) 2020 9;15(1):1087-1095. Epub 2020 Nov 9.

Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 - 80131, Naples, Italy.

In 2010, serrated polyps (SP) of the colon have been included in the WHO classification of digestive tumors. Since then a large corpus of evidence focusing on these lesions are available in the literature. This review aims to analyze the present data on the epidemiological and molecular aspects of SP. Hyperplastic polyps (HPs) are the most common subtype of SP (70-90%), with a minimal or null risk of malignant transformation, contrarily to sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs), which represent 10-20% and 1% of adenomas, respectively. The malignant transformation, when occurs, is supported by a specific genetic pathway, known as the serrated-neoplasia pathway. The time needed for malignant transformation is not known, but it may occur rapidly in some lesions. Current evidence suggests that a detection rate of SP ≥15% should be expected in a population undergoing screening colonoscopy. There are no differences between primary colonoscopies and those carried out after positive occult fecal blood tests, as this screening test fails to identify SP, which rarely bleed. Genetic similarities between SP and interval cancers suggest that these cancers could arise from missed SP. Hence, the detection rate of serrated-lesions should be evaluated as a quality indicator of colonoscopy. There is a lack of high-quality longitudinal studies analyzing the long-term risk of developing colorectal cancer (CRC), as well as the cancer risk factors and molecular tissue biomarkers. Further studies are needed to define an evidence-based surveillance program after the removal of SP, which is currently suggested based on experts' opinions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/med-2020-0226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718641PMC
November 2020

Hepatocellular carcinoma in patients with chronic renal disease: Challenges of interventional treatment.

Surg Oncol 2021 Mar 20;36:42-50. Epub 2020 Nov 20.

Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Naples, Italy; Oxford University Hospitals NHS Foundation Trust, UK; Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium.

Hepatocellular carcinoma (HCC) is a common malignancy worldwide, recognized as the fourth most common cause of cancer related death. Many risk factors, leading to liver cirrhosis and associated HCC, have been recognized, among them viral hepatitis infections play an important role worldwide. Patients suffering from chronic kidney disease (CKD), especially those on maintenance dialysis, show a higher prevalence of viral hepatitis than the general population what increases the risk of HCC onset. In addition, renal dysfunction may have a negative prognostic impact on both immediate and long-term outcomes after malignancy treatment. Several interventional procedures for the treatment of HCC are currently available: thermal ablation, transcatheter arterial chemoembolization, liver surgery or even liver transplantation. The Barcelona Clinic Liver Cancer system provides an evidence-based treatment algorithm to address different categories of patients to the most-effective treatment in consideration of the extension of disease, liver function and performance status. Liver resection and transplantation are usually reserved to patients with early stage HCC and acceptable performance status, while the other treatments are more indicated in case of impaired liver function or locally advanced or unresectable tumors. However, there is no validated treatment algorithm for HCC in CKD patients, mainly due to the rarity of reports in this cohort of patients. Hereby we discuss the available evidences on interventional HCC treatments in CKD patients, and briefly report up-to-date pharmacological therapy for HCC patients affected by viral hepatitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.suronc.2020.11.007DOI Listing
March 2021

Surgical treatment in late-stage gastric cancer. A retrospective analysis of 26 cases.

Ann Ital Chir 2021 ;92:20-27

Background: Gastric cancer represents the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Italy. Therefore, this study aimed to determine the survival rate of patients with advanced gastric cancer and its affecting factors in our experience at AOU Federico II.

Methods: 26 patients with late-stage T4N2M0 and T4N2M1 gastric cancer that were diagnosed and registered during 2008 to 2018 in Federico II Surgical department, were studied. All patients were followed to the end of 2019. Kaplan-Meier method was used to draw survival curves and to determine the effective factors on the survival rate of surveyed patients. Moreover, Log-rank test was used to evaluate whether or not survival curves for different patients, related to residual tumor, are statistically equivalent (p<0.05).

Results: The mean age of the study population was 49±29, and most of them were males (57,8% (15 patients). After diagnosis, the survival rates for 1, 2, 3 and 4 years, were 26,9%, 11,5 %, 3,8%, 19,2 %; 11,5% of patients with residual tumors survived 6 months respectively. Overall average survival was of 20.61 sd 17.52 months with a median of 12. No statistical difference was detected in terms of survival among M0 and M1 sub-groups.

Conclusion: Based on the findings of the present study, T4 gastric cancer has a poor prognosis. Survival rate was decreased over time after diagnosis. Tumoral stage at the time of diagnosis is the most important factor affecting the survival of surveyed patients. This shows that there is a crucial need to diagnose the gastric cancer in early stages.

Key Words: Advanced gastric cancer, Surgical techniques, Therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2021

Robotic repair of iatrogenic left diaphragmatic hernia. A case report.

Int J Surg Case Rep 2020 12;76:488-491. Epub 2020 Oct 12.

Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Via S. Pansini 5, 80131, Naples, Italy. Electronic address:

Introduction: Iatrogenic diaphragmatic hernia after laparoscopic left adrenalectomy has been rarely reported in adults. Surgery is the preferred treatment because of the risks of incarceration, strangulation and pulmonary complications.

Presentation Of Case: An elderly woman with parasternal diaphragmatic hernia has been successfully treated by robotic repair with mesh placement. The short-term follow-up showed that there was no recurrence or any symptoms after the intervention.

Discussion: Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery. The diagnosis could be challenging because of the presence of chronic symptoms. Computed tomography can be considered the gold standard technique to assess the correct diagnosis of diaphragmatic hernias in the majority of cases. Patients with chronic symptomatic hernia should undergo surgical repair of defect. Robotic technology because of its enhanced precision and the endowrist movement of the robotic arms, facilitates the dissection near the esophago-gastric junction and the other important adjacent structures.

Conclusion: Robotic technology seems to be a valid approach for the repair of diaphragmatic defects, even if this remains a high cost-related procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2020.10.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588745PMC
October 2020

Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: A multicentre cohort study.

Int J Med Robot 2021 Apr 16;17(2):e2198. Epub 2020 Nov 16.

Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

Purpose: To present the outcomes of gastric gastrointestinal stromal tumour (GIST) resection from five Italian centres, focussing the analysis on the comparison among open (OG), laparoscopic (LG) and robotic (RG) approaches.

Methods: All consecutive gastric wedge resections for GIST between 2009 and 2019 were included.

Results: In total 101 (OG = 14, LG = 63 and RG = 24) were included. No differences were seen in the preoperative characteristics among the groups. Robotic procedures were longer (RG 180 min vs. LG 100 vs. OG 110; p < 0.0001). Time-to-first flatus and length of hospital stay were significantly longer in the OG group. Complication rates were similar among the groups. A sub-analysis on minimally invasive (RG = 19 vs. LG = 20) wedge resections and hand/robot-sewn suture showed that operative time was longer in the RGs (p = 0.007). No conversions were recorded in the RG group versus three in the LG group (p = 0.231). Safety-related factors were similar.

Conclusions: Gastric GIST can be safely treated with a minimally invasive approach which is also associated with improved postoperative outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rcs.2198DOI Listing
April 2021

Conversions related to adhesions in abdominal surgery. Robotic versus laparoscopic approach: A multicentre experience.

Int J Med Robot 2021 Apr 16;17(2):e2186. Epub 2020 Nov 16.

Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.

Background: An advantage of robotic surgery over laparoscopy is the lower rate of unplanned conversion. One of the implicated reasons for conversion is adhesions from previous abdominal surgeries (PASs).

Methods: A comparative analysis of 98 patients with history of open PAS treated by laparoscopic or robotic surgery was performed. Primary endpoint was the rate of conversion to open surgery related to adhesiolysis. Secondary endpoints were short-term outcomes and complications.

Results: Conversion rate specifically related to adhesiolysis was significantly lower in robotic group (13 for laparoscopic group vs. 2 for robotic group; p = 0.046). Conversions occurred during adhesiolysis were significantly related to severity of adhesions expressed by peritoneal adhesion index (PAI) score (p < 0.001), number of abdominal areas involved by adhesions (p < 0.001) and severity of PAI into the target area of surgical intervention (p = 0.021).

Conclusions: Benefits of robotic surgery are more noticeable in performing procedures with increasing technical difficulties.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rcs.2186DOI Listing
April 2021

Outpatient vascular clinic management in COVID-19 pandemic.

Ann Ital Chir 2020 ;91:345-351

Introduction: The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures.

Methods: Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected.

Conclusion: The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff.

Key Words: COVID-19, Management, vascular, Outpatient clinic.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2020

Male breast cancer: an update.

Ann Ital Chir 2020 ;91:359-365

Purpose: To summarize and compare the most recent data from the literature to clarify the management of male breast cancer.

Methods: A review article.

Results: Diagnosis and Treatment of Male Breast Cancer have been derivative for years. Nowadays MBC is a nosological entity in its own right with biological, molecular and clinical features that require a multidisciplinary approach and the involvement of specific skills. Multimodal treatment involves surgery, radiotherapy and chemotherapy. It is evident that the outcome of the MBC is worse than the female one. MBC is often diagnosed in advanced stages. Screening programs in the male population need to be strengthened to obtain an earlier diagnosis. It is necessary to know even more in depth the endocrine-metabolic and behavioral risk factors related to the neoplasm. Finally in the coming years it is reasonable to expect an improvement in multigenic tests: the sensitivity of these methods could predict the risk of recurrence even more precisely. This could lead to substantial changes in the choice and duration of treatment with results that could be surprising.

Key Words: Male breast cancer, Management, Review, Update.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2021

The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer.

Int J Mol Sci 2020 Sep 24;21(19). Epub 2020 Sep 24.

Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80138 Naples, Italy.

The response to neoadjuvant chemoradiation (nCRT) is a critical step in the management of locally advanced rectal cancer (LARC) patients. Only a minority of LARC patients responds completely to neoadjuvant treatments, thus avoiding invasive radical surgical resection. Moreover, toxic side effects can adversely affect patients' survival. The difficulty in separating in advances responder from non-responder patients affected by LARC highlights the need for valid biomarkers that guide clinical decision-making. In this context, microRNAs (miRNAs) seem to be promising candidates for predicting LARC prognosis and/or therapy response, particularly due to their stability, facile detection, and disease-specific expression in human tissues, blood, serum, or urine. Although a considerable number of studies involving potential miRNA predictors to nCRT have been conducted over the years, to date, the identification of the perfect miRNA signatures or single miRNA, as well as their use in the clinical practice, is still representing a challenge for the management of LARC patients. In this review, we will first introduce LARC and its difficult management. Then, we will trace the scientific history and the key obstacles for the identification of specific miRNAs that predict responsiveness to nCRT. There is a high potential to identify non-invasive biomarkers that circulate in the human bloodstream and that might indicate the LARC patients who benefit from the watch-and-wait approach. For this, we will critically evaluate recent advances dealing with cell-free nucleic acids including miRNAs and circulating tumor cells as prognostic or predictive biomarkers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms21197040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582560PMC
September 2020

Small bowel obstruction secondary to adipose tissue herniation through gastric band tubing loop. An unusual case presentation.

Ann Ital Chir 2020 Sep 14;9. Epub 2020 Sep 14.

Background: Laparoscopic adjustable gastric band complications like oesophageal dilatation, intractable nausea and vomiting, band migration, late slippages, and port problems with a cumulative rate of 19.2%. Rarely, LAGB complications may be related to the connection tube system and in this case the clinical presentation and the effects of the problem can generate difficulties in diagnosis.

Methods: A 47 years old woman who had a LAGB placed 2 years before the symptoms was admitted in our centre with nausea, vomit, leukocytosis and distended abdomen with a generalized tenderness. Computed tomography images showed an anomalous course of banding tube and a contemporary compression of a small bowel tract secondary to the traction exerted by an adipose tissue band attracted by the tube.

Results: A laparoscopic exploration of the abdominal cavity showed a tight loop of LAGB tubing causing a small bowel obstruction with an ischemic damage, so surgeons provided to LAGB removal and a 50 cm ileum resection CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account.

Key Words: Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2020
-->