Spigelian hernia: a case report and review of the literature

Spigelian hernia is a rare abdominal hernia that occurs through Spigelian aponeurosis. The Authors present a case of Spigelian hernia associated with narrowing of sigmoid colon and diverticular pathology.They also described historical background, surgical anatomy and etiopathogenesis of this hernia. By a remarkable revision of literature, they sum up epidemiology and clinical features of Spigelian hernia. Furthermore, they discuss diagnostic and therapeutic principles

Le lesioni polipoidi della colecisti: problemi diagnostici e terapeutici

Le lesioni polipoidi della colecisti costituiscono un’entità eterogenea di difficile definizione diagnostica preoperatoria. L’indicazione chirurgica è discutibile ma in alcuni casi obbligatoria . In questo studio abbiamo analizzato i dati clinici relativi a 25 pazienti sottoposti consecutivamente a colecistectomia laparoscopica per formazioni polipoidi. Ciò al fine di evidenziare la possibile correlazione fra aspetto ecografico e valutazione istopatologica e di definire l’indicazione terapeutica

Le variazioni delle pressioni endoaddominali nella chirurgia dei grandi laparoceli: progressi e prospettive

La misurazione della pressione endo-adddominale è divenuta, solo negli ultimi anni, una pratica comune nella gestione del paziente critico sebbene le prime misurazioni della pressione endoaddominale risalgano agli inizi del ‘900 (1,2) e gli effetti dell’aumento della pressione endoaddominale siano noti già da molto tempo. Il laparocele permagno è una patologia che determina significative variazioni della pressione endo-addominale e la sua riparazione, se non eseguita con tecnica adeguata, può portare all’instaurarsi di una condizione di ipertensione addominale sintomatica. In letteratura, tuttavia, non esistono studi che confrontino le varie tecniche chirurgiche usate per la riparazione protesica dei grandi laparoceli sulla base delle variazioni pressorie endoaddominali. In questa ricerca è nostra intenzione riportare i risultati di uno studio prospettico iniziato nel mese di Gennaio 2008 e rivolto alla valutazione delle variazioni pressorie endoaddominali nei pazienti sottoposti ad intervento chirurgico per laparocele permagno. L’obiettivo è di verificare se esiste una tecnica chirurgica, tra quelle finora proposte per la correzione del laparocele, che più delle altre ristabilisca nel periodo postoperatorio le normali condizioni fisiologiche preesistenti alla comparsa del laparocele

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020).RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (>200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (<20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic