Out of Place: Gallstone Ileus

PRESENTATION Infrequently, a gallstone can travel into the small intestine and lodge there, causing bowel blockage. This was the case for a 70-year-old man who was referred to us with abdominal pain, persistent nausea, and vomiting. He also reported dyspepsia of 3 months\u2019 duration. His medical history included hypertension, chronic ischemic heart disease, and type 2 diabetes mellitu

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience

PURPOSE: Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates. METHODS: This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors. RESULTS: A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI. CONCLUSIONS: There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients

Touch Imprinting Cytology may be useful in the intraoperative evaluation of the sentinel lymph node in melanoma

The aim of the study was to assess whether the reliability of Touch Imprinting Cytology (TIC) of Sentinel lymph node biopsy (SLNB) in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made. Previous experiences have shown that the limit of TIC in extemporaneous diagnosis was represented by the minimal deposits of the tumor. Many current data seem to show that in this situation radical lymphadenectomy is no longer necessary, so we wondered if TIC could regain importance in the intraoperative management of these patients

Patient satisfaction after thyroid RFA versus surgery for benign thyroid nodules: a telephone survey

Introduction: Minimally invasive nonsurgical techniques are gaining ground as alternatives to surgery for the treatment of benign thyroid nodules. Here, we aimed at comparing patient satisfaction after radiofrequency ablation (RFA) to that after surgery. Methods: In this cross-sectional study, we recruited 126 patients treated with RFA and 84 treated with surgery for a single benign thyroid nodule. All patients were contacted by phone call and were asked the following questions: Are you satisfied with the symptom resolution?; Are you satisfied with the cosmetic results?; Are you satisfied overall with the procedure?; Are you taking any medication for your thyroid? Patients\u2019 general characteristics were collected from our database. Results: In the surgery group, there was a higher percentage of patients fully satisfied with the resolution of nodule-related symptoms (p\u2009=\u2009.02). In the RFA group, there was a higher percentage of patients fully satisfied with the cosmetic results (p\u2009=\u2009.001). In terms of overall satisfaction, there were no differences between the groups (p\u2009=\u2009.26). Nevertheless, RFA led to differing results based on thyroid nodule function. In patients with nonfunctioning thyroid nodules, RFA was as effective as surgery in terms of satisfaction with symptom resolution, while it was not in patients with autonomously functioning thyroid nodules (AFTN). Conclusion: Our data on postoperative patient satisfaction support the notion that both RFA and surgery are valid therapeutic options for nonfunctioning thyroid nodules, while surgery should be still preferred for AFTN

Gastric bypass-induced weight loss alters obesity-associated patterns of plasma pentraxin-3 and systemic inflammatory markers

Systemic inflammation contributes to obesity-associated complications. The short pentraxin C-reactive protein (CRP) is a validated inflammatory marker, whereas long pentraxin-3 (PTX3) limits inflammation and is adaptively stimulated by proinflammatory cytokines in vitro. Severely obese (SO) patients (body mass index [BMI]>40] have the highest obesity-associated complications and increasingly undergo surgical treatment. SO-associated changes in plasma PTX3 and their interactions with systemic inflammation are, however, unknown

Colorectal surgery in Italy during the Covid19 outbreak: a survey from the iCral study group

Background The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation. Methods A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regard- ing qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak. Results Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colo- rectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers. Discussion Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers partici- pating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency

Laparoscopic reversal of Hartmann procedure: is it safe and feasible?

Abstract The Hartmann procedure (HP) consists of a sigmoidectomy followed by a terminal colostomy in the left iliac fossa and closure of the rectal stump. Although done as a temporary procedure, up to 74 % of patients will not have stoma reversal with subsequent negative impact on the quality of life. A literature search was performed using MEDLINE (PubMed), The Cochrane Library, and Google Scholar, and the articles from January 2000 until December 2015, edited in English, Italian and French, prospective or retrospective, were analyzed. Outcome variables included number of patients, mean age, sex, etiology of Hartmann's procedure, time interval between initial procedure and reversal procedure (in days), mean operative time (in minutes), number of patients converted to open surgery, causes of conversion, length of hospital stay, mortality, and complication rates. For the purpose of this review, only 21 studies were considered for the final analysis and a total of 681 patients were evaluated. The mean time interval between the initial procedure and the reversal (reported in 18 articles) was 181.6 days (range 95-330 days), while the mean operative time (reported in 20 articles) was 163.2 min (range 62-285). Overall, 80 patients (11.7 %) were converted to open technique. The length of hospitalization was between 3 and 12 days. The mortality rate was reported in 19 articles and was 0.7 % (5 patients). 113 patients (16.6 %) underwent post-operative complications. The HP reversal is a challenging procedure, but it can be safely performed laparoscopically providing various advantages when compared to the open technique and it should be proposed only to a selected group of patients, young and without a severe peritonitis at the first operation

Mini invasive colorectal surgery: an update

Introduction to a dedicated issue of the review to colorectal surger

Duodenal Diverticula: Unusual Case of Upper Gastrointestinal Obstruction

A 78-year-old woman came to our attention with an 18- month history of delayed postprandial nausea and vomiting associated with significant weight loss (about 20 kg in the past year). The patient denied a previous history of abdomi- nal pain or discomfort. She had never undergone an abdom- inal surgical procedure. She was on corticosteroids and tocilizumab for rheumatoid arthritis

Non-operative management of rectal cancer: future perspectives turning into reality?

The management of rectal cancer has considerably changed over the last decades and complete response to neoadjuvant chemoradiotherapy is becoming a common clinical entity. There is still no consensus on the definition of complete response to neoadjuvant treatment prior to surgery. Treatment programs are mostly heterogeneous and non-randomized. In addition, techniques to diagnose complete response are still unclear and there is no uniformity in surveillance modality of those patients managed without operative intervention. We review the most recent evidences reported in literature