Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Acute diverticulitis: surgery timing in elderly patients

Background Diverticular disease is common among the elderly. Its management is complex and offers multiple treatment options. Findings Uncomplicated acute diverticulitis is treated with initial conservative therapy, while cases of recurrence are approached with surgery. Perforated acute diverticulitis (Hinchey I and II) it usually treated with apercutaneous drainage followed by elective colonic resection. Therapeutic failure of percutaneous drainage is an indication for emergency surgery. Acute diverticulitis with peritonitis (Hinchey III and IV) requires emergency surgery. The surgical options are two: one-step or two-step operation. According to the data present in literature one-step operation has a lower mortality and complication rate than the two-step operation approach. Conclusions Acute diverticulitis is a condition that requires surgical management. The timing and the surgical technique depend on the single clinical situation

Diverticular disease hospital cost impact analysis: evaluation of testings and surgical procedures in inpatient and outpatient admissions

Abstract Background Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD’s impact on budget and activity in hospitals. Methods The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals. Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds. Results A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was € 1.656.802 or 0.2% of the total budget of the hospital. € 1.346.218, were attributable to the department of general surgery, 0.9% of the department’s budget . Conclusions The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department.</p

Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

<p>Abstract</p> <p>Background</p> <p>Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.</p> <p>Morphological evaluations performed on serial pre and post – surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ.</p> <p>Methods</p> <p>62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:</p> <p>• dyspeptic symptoms questionnaire,</p> <p>• gastric endoscopy with body, antrum, and fundus random biopsies,</p> <p>• histo-pathological analysis of samples and elaboration of bile reflux index (BRI).</p> <p>The same evaluation was repeated at a 6 months follow-up.</p> <p>Results</p> <p>In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori’s gastric colonization nor on the induction of gastric precancerous lesions.</p> <p>Conclusions</p> <p>Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.</p

Predictive factors of intestinal necrosis in acute mesenteric ischemia

Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory

Predictive factors of intestinal necrosis in acute mesenteric ischemia

Objectives. Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is man- datory. Methods. Registered data of 55 consecutive patients admitted to our center between January 2010 and Decem- ber 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correla- tion to its clinical spectre. Results. Tobacco use was the most statistically signifi- cant (p 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as pre- dictive factors of ITIN in multivariate analysis using logis- tic regression (OR 49.66 and p-value 0.0021). Conclusion. Our univariate and multivariate analysis iden- tified multiple factors (Serum lactate levels ˃ 2mmol/L,Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN

Predictive factors of intestinal necrosis in acute mesenteric ischemia

Objectives. Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is man- datory. Methods. Registered data of 55 consecutive patients admitted to our center between January 2010 and Decem- ber 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correla- tion to its clinical spectre. Results. Tobacco use was the most statistically signifi- cant (p 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as pre- dictive factors of ITIN in multivariate analysis using logis- tic regression (OR 49.66 and p-value 0.0021). Conclusion. Our univariate and multivariate analysis iden- tified multiple factors (Serum lactate levels ˃ 2mmol/L,Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN