Clinical Study Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures

Towards a permanent deep sea observatory,: the GEOSTAR European Experiment.

GEOSTAR is the prototype of the first European long-term, multidisciplinary deep sea observatory for continuous monitoring of geophysical, geochemical and oceanographic parameters. Geostar is the example of a strong synergy between science and tecnology addressed to the development of new technological solutions for the observatory realisation and management. The GEOSTAR system is described outlining the enhancements introduced during five years of project activity. An example of data retrieved from the observatory being the deep sea mission running is also given.Published111-1202.5. Laboratorio per lo sviluppo di sistemi di rilevamento sottomarinireserve

GEOSTAR, an observatory for deep sea geophysical and oceanographic researches: characteristics, first scientific mission and future activity

GEOSTAR (GEophysical and Oceanographic STation for Abyssal Research) is a project funded by in the 4th Framework Programme of the European Commission, with the aim of developing an innovative deep sea benthic observatory capable of carrying out long-term (up to 1 year) scientific observations at abyssal depths. The configuration of the observatory, conceived to be a node of monitoring networks, is made up of two main subsystems: the Bottom Station, which in addition to the acquisition and power systems and all the sensors also hosts the communications systems; and the Mobile Docker, a dedicated tool for surface-assisted deployment and recovery. At present the Bottom Station is equipped with a triaxial broad-band seismometer, two magnetometers (fluxgate and scalar), CTD, transmissometer, ADCP, but it can easily host other sensors for different experiments. The first phase of the project, started in November 1995, was concluded with the demonstration mission in Adriatic Sea at shallow water depth (42 m) in August - September 1998. Some preliminary results of this first scientific experiment are presented and discussed. The second phase, started in 1999, will end with a long-term deep sea scientific mission, scheduled during 2000 for 6-8 months at 3400 m.w.d. in the southern Tyrrhenian bathyal plain.Published491-4973A. Ambiente MarinoN/A or not JCRrestricte

Mission results from the first GEOSTAR observatory (Adriatic Sea, 1998)

We assess the first mission of the GEOSTAR (GEophysical and Oceanographic STation for Abyssal Research) deep-sea multidisciplinary observatory for its technical capacity, performance and quality of recorded data. The functioning of the system was verified by analyzing oceanographic, seismological and geomagnetic measurements. Despite the mission’s short duration (21 days), its data demonstrated the observatory’s technological reliability and scientific value. After analyzing the oceanographic data, we found two different regimes of seawater circulation and a sharp and deepening pycnocline, linked to a down-welling phenomenon. The reliability of the magnetic and seismological measurements was evaluated by comparison with those made using on-land sensors. Such comparison of magnetic signals recorded by permanent land geomagnetic stations and GEOSTAR during a “quiet” day and one with a magnetic storm confirmed the correct functioning of the sensor and allowed us to estimate the seafloor observatory’s orientation. The magnitudes of regional seismic events recorded by our GEOSTAR seismometer agreed with those computed from land stations. GEOSTAR has thus proven itself reliable for integrating other deep-sea observation systems, such as modular observatories, arrays, and instrumented submarine cablesPublished361-373ope

European Seafloor Observatory Offers New Possibilities For Deep Sea Study

The Geophysical and Oceanographic Station for Abyssal Research (GEOSTAR), an autonomous seafloor observatory that collects measurements benefiting a number of disciplines during missions up to 1 year long, will begin the second phase of its first mission in 2000. The 6-8 month investigation will take place at a depth of 3400 m in the southern Tyrrhenian basin of the southern Tyrrhenian basin of the central Mediterranean. GEOSTAR was funded by the European Community (EC) for $2.4 million (U.S. dollars) in 1995 as a part of the Marine Science and Technology programme (MAST). The innovative deployment and recovery procedure GEOSTAR uses was derived from the "two-module" concept successfully applied by NASA in the Apollo and space shuttle missions, where one module performs tasks for the other, including deployment, switching on and off, performing checks and recovery. The observatory communication system, which takes advantage of satellite telemetry, and the simultaneous acquisition of a set of various measurements with a unique time reference make GEOSTAR the first fundamental element of a multiparameter ocean network. GEOSTAR's first scientific and technological mission, which took place in the summer of 1998 in the Adriatic Sea, verified the performance and reliability of the system. The mission was a success. providing 440 hours of continuous seismic magnetic and oceanographic data. Thje second phase of the mission, which was funded by the EC for$2 million (US dollars), will carry equipment for chemical, biological and isotopic analyses not used in the first phase, which will broaden the data collection effort.Published45, 48-492.5. Laboratorio per lo sviluppo di sistemi di rilevamento sottomariniN/A or not JCRreserve

Bollettino Sismico Italiano: Analisys of Early Aftershocks of the 2016 MW 6.0 Amatrice, MW 5.9 Visso and MW 6.5 Norcia earthquakes in Central Italy

The Amatrice-Visso-Norcia seismic sequence is the most important of the last 30 years in Italy. The seismic sequence started on 24 August, 2016 and still is ongoing in central Apennines. At the end of February 2017 more than 57,000 events were located, 80,000 events up to the end of September 2017 (Fig. 1). The mainshocks of the sequence occurred on 24 August 2016 (Mw 6.0 and Mw 5.4), 26 October 2016 (Mw 5.4 and Mw 5.9), 30 October 2016 (Mw 6.5), 18 January 2017 (four earthquakes Mw≥ 5.0). In this seismic sequence, all the waveforms recorded by temporary stations deployed by the SISMIKO emergency group (stations T12**; Moretti et al., 2016) where available in real- time at the surveillance room of INGV. Because of the high level of seismicity and the dense seismic network installed in the region, more than 150 events per day were located at the end of February 2017; still 60 events per day were located up to the end of August 2017.The Amatrice-Visso-Norcia is the most important seismic sequence since 2015, the time when the analysis procedures of the BSI group (Bollettino Sismico Italiano) were revised (Nardi et al., 2015). BSI is now available every four months on the web: bulletins contain revised earthquakes (location and magnitude) with ML≥ 1.5, quasi-real time revision of ML≥ 3.5 earthquakes and phase arrivals from waveforms recorded on seismic stations available from the European Integrated Data Archive (EIDA), (Mazza et al., 2012). These last procedures allow the integration of signals from temporary seismic stations (Moretti et al., 2014) installed by the emergency group SISMIKO (Moretti and Sismiko working group, 2016), even when they are not in real time transmission, if they are rapidly archived in EIDA, together with real time signals from the seismic stations of the permanent INGV network. The analysis strategy of the BSI group for the Amatrice -Visso - Norcia seismic sequence (AVN.s.s in the following) was to select the earthquakes located in the box with min/max latitude: 42.2/43.2 - and min/max longitude: 12.4/14.1 to prepare a special volume of BSI on the seismic sequence.PublishedTrieste, Italy1SR. TERREMOTI - Servizi e ricerca per la Societ

ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Background Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications' occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 +/- 98.8 vs 95.9 +/- 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 +/- 22.1 vs 92.2 +/- 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery