How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Residual Tumor After Pancreaticoduodenectomy: The Impact of a Brand New Standardized Technique to Evaluate Resection Margin Status

Context Pancreaticoduodenectomy (PD) is the only potentially curative treatment for patients affected by periampullary cancer. Resection margin involvement (R1) after PD ranges from 14% to 75% and it has been demonstrated to significantly affect survival. It has been recently supposed that the reason of this difference is the lack of consensus on the method used to manage the specimen. The results of recent studies indicate that the use of a new technique to manage the specimen determines a significant increase of R1 resection rate up to 75%. We report the results of a case control study that evaluated the impact of this new technique in a series of 50 patients undergoing PD for cancer. Material and Methods From October 2004 through October 2010 at our institution surgical specimens after PD were analyzed by the pathologist according to international approved guidelines [1]. From November 2010 this method was replaced by a different technique [2] that included: 1) introduction of the concept of “circumferential margins”; 2) multicolor inking of six margins (a. Pancreatic transection margin; b. Biliary transection margin; c. Anterior surface of the pancreatic head; d. Posterior surface of the pancreatic head; e. Bed of the superior mesenteric vein; f. Bed of the superior mesenteric artery); 3) axial slicing of the specimen; 4) the following definition of R0 resection: tumor at a distance of at least 1 mm from the margin. From November 2010 through November 2011 we utilized the new method to manage 50 consecutive specimens after PD. In order to analyze the results of the new method we planned a case control study focusing the following parameters: 1) rate of R1 resections; 2) average number of examined blocks; 3) average number of examined lymph nodes; 4) lymph nodal status. Results Statistical analysis of the two groups of patients showed no significant epidemiological, pathological and clinical difference. 1) The rate of R1 resections was: 68% (new method) and 10% (control group) (P<0.0001); 2) the average number of examined blocks was 48.2 (range: 29-92) (new method) and 10.7 (range: 5-21) (control group) (P<0.005); 3) the mean number of examined lymph nodes was 33.2 (range: 11-60) (new method) and 8.7 (range: 0-26) (control group) (P<0.005); 4) metastatic lymph nodes were found in 90% (new method) and in 46% (control group) (P<0.001). Discussion Our results confirmed that the new method determines a statistically significant increase of R1 resections if compared with the conventional method. This evidence confirms recently published data showing that “conventional technique” underestimate the rate of R1 resections. As a consequence, we can assume that R0 resection for periampullary cancer is performed only in a minority of cases. If confirmed, this evidence will impact clinical management of pancreatic cancer

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies