\u201cRelaparoscopic\u201d management of surgical complications: The experience of an Emergency Center

Background/aim: Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. Materials and methods: We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. Results: Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixty-three patients (84 %) had no more or further complications and were discharged from hospital between 4 \ub1 3 days after \u201csecond-look\u201d surgery; three patients (4 %) developed postoperative complications requiring a third surgery. Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 \ub1 9.5 days. Mean operative time was 90 \ub1 150 min. Postoperative hospital stay was between 4.5 and 18 days. Discussion and conclusion: Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in \u201crelaparoscopic\u201d management of surgical complications seems to suggest that laparoscopy \u201csecond look\u201d is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems

Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience

Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50\u201390% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes

Tiroidectomia totale con impiego del dissettore ad ultrasuoni: risultati di uno studio prospettico randomizzato

In the last years, the introduction and employment in surgery of the dissectors of last generation (ultrasounds, radiofrequency, etc.) have contributed to a remarkable improvement and simplification of the performances and the surgical techniques. The present study has the aim to verify, on the basis of the experience made in the last two years and through a careful comparisons with operations performed in the usual way, the advantages of employment of ultrasonic dissector in thyroid surgery and if besides such advantages it is possible to obtain real and substantial reductions of the complications. To such aim a randomized perspective study has been lead, confronting two groups of 60 patients, submitted to total thyroidectomy in Chair of General Surgery and Surgical Physiopathology of the University of Palermo - Complex Operating Unit of General Surgery. In all patients have been considered age, sex, histological diagnosis, length of the incision, time (from the incision until suture of skin), entity of the bleeding, hospital stay, post-operative consequences and total costs of thyroidectomy. The elaboration of the obtained data shows the advantages following to the use of the dissectors of last generation: reduction of the times, reduction of the complications, better tolerance of the operation by patients, better rationalization of the resources

Pseudocisti pancreatiche infette: Note di tecnica

Introduction. Starting from the observation of 9 cases of giant infected pancreatic cysts, which occurred from 1994 to 2004 at the Department of Oncological and Surgical Studies, the Authors' aim has been to evaluate whether a more thorough necrosectomy, carried-out under videoendoscopic control, associated with a nose-gastro-cavity tube, which ensures a continuous cleansing of the newly-formed cavity, and an appropriate positioning of the drainages, could reduce the morbility and allow a shorter recovery of the infected psuodocysts. Patients and methods. Of 73 cases of acute pancreatitis, observed from 1994 to 2004, 9 showed severe and acute pancreatitis, which included giant pseudocysts, as revealed by the abdomen angio-TC. Our nine septic patients underwent cysto-gastro-anastomosis, necrosectomy, intraoperative cleansing of the cavity with an antibiotic solution and positioning of multiple drainages. Three of these patients also underwent a thorough and targeted nectrosectomy, assisted by a trans-anastomotic videoendoscopy. A nose-gastro-cavity tube has been placed in all the patients. Results. The disappearance of the septic state in our three patients who underwent a targeted video-assisted necrosectomy occurred after three days of treatment; moreover, the abdomen angio-TC on the 5th postoperative day showed the disappearance of the necrotic areas. The recovery of these three patients was significantly shorter, compared to those undergoing traditional treatment (cysto-gastro-anastomosis, standard necrosectomy and positioning of abdominal drainages). Conclusions. Our surgical video-assisted technique demonstrated that, with a slight increase in the operative time, a better control over sepsis may be accomplished, as well as a reduction of he post-operative morbidity, which leads to shorter hospitalisation of patients with infected pancreatic pseudocysts

Laparoscopic, three-port and SILS cholecystectomy: a retrospective study.

Introduction. The aim of this study was to compare the results of classic laparoscopic, three-port and SILS cholecystectomy. Materials and methods. We conducted a retrospective study of da- ta collected between January 2010 and December 2012 pertaining to 159 selected patients with symptomatic gallstones. 57 underwent lapa- roscopic cholecystectomy, 51 three-port cholecystectomy and 48 SILS cholecystectomy. We then compared the groups with respect to mean ope- rating time, intraoperative complications, postoperative pain, duration of hospitalization and final aesthetic result. Introduction The first laparoscopic cholecystectomy was carried out in 1987 in France by Philippe Mouret (1). The progressive evolution of the technique has led this procedure to be- come the gold standard in the treatment of symptoma- tic gallstones (2). As the technology improved, many sur- geons began to reduce the number and size of the ports with the aim of achieving ever lower invasiveness, con- sequently reducing trauma and postoperative pain and improving the cosmetic results. There was thus a pro- Results. The mean operating time was significantly higher in the SILS cholecystectomy group (93 minutes) than in the other two groups. There were no intraoperative complications. There were no significant differences in the duration of hospitalization among the three groups. Patients in the SILS cholecystectomy group reported significantly less pain 3, 6 and 12 hours after surgery. The aesthetic results at 1 and 6 months’ follow-up were also decidedly better. Conclusions. On the basis of this study, SILS cholecystectomy is a feasible, safe procedure. In any case, it should be used in selected patients only and carried out by a dedicated team with strong experience in laparoscopy. The main advantages of this technique are a reduction in post-operative pain and improved aesthetic result, at the price, howe- ver, of its greater technical difficulty and longer operating times. Future studies are in any case necessary to evaluate any other benefits of this method

Forecasting the duration of volcanic eruptions: an empirical probabilistic model

The ability to forecast future volcanic eruption durations would greatly benefit emergency response planning prior to and during a volcanic crises. This paper introduces a probabilistic model to forecast the duration of future and on-going eruptions. The model fits theoretical distributions to observed duration data and relies on past eruptions being a good indicator of future activity. A dataset of historical Mt. Etna flank eruptions is presented and used to demonstrate the model. The data has been compiled through critical examination of existing literature along with careful consideration of uncertainties on reported eruption start and end dates between the years 1300 AD and 2010 and data following 1600 is considered to be reliable and free of reporting biases. The distribution of eruption durations between the years 1600 and 1670 is found to be statistically different from that following 1670 and represents the culminating phase of a century-scale cycle. The forecasting model is run on two datasets ofMt. Etna flank eruption durations; 1600-2010 and 1670-2010. Each dataset is modelled using a log-logistic distribution with parameter values found by maximum likelihood estimation. Survivor function statistics are applied to the model distributions to forecast (a) the probability of an eruption exceeding a given duration, (b) the probability of an eruption that has already lasted a particular number of days exceeding a given total duration and (c) the duration with a given probability of being exceeded. Results show that excluding the 1600-1670 data has little effect of the forecasting model result, especially where short durations are involved. By assigning the terms ‘likely’ and ‘unlikely’ to probabilities of 66 % and 33 %, respectively the forecasting model is used on the 1600-2010 dataset to indicate that a future flank eruption on Mt. Etna would be likely to exceed 20 days (± 7 days) but unlikely to exceed 68 days (± 29 days). This model can easily be adapted for use on other highly active, well-documented volcanoes or for different duration data such as the duration of explosive episodes or the duration of repose periods between eruptions

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202